wisdom teeth removal – surgery,extraction – 15,24 http://www.sdcdentist.com wisdom teeth, 14,25 credit to Clinic & Surgery: Johannes Bartsch, Kassel, Germany Camera & Editing: Norbert Piekorz Impaction of premolars is much rarer than impaction of the wisdom teeth or canines. In this thirteen-year-old patient premolar #15 is impacted and displaced palatally This can already be identified from the slight bulge under the palatal mucosa. The OPG and open-mouth maxilla view show the position of the impacted tooth clearly. To remove the impacted premolar vestibular and palatal infiltration with local anesthetic is required to expose the impacted tooth crowned a trapezoidal incision is made the palatine artery must be spared by further relieving vertical incisions. Usually however the operative approach to the displays tooth can be exposed without any problem by stretching the mucoperiosteal flap without the palatine artery tearing the nearby roots must also be born in mind. The remainder of the circumference of the impacted crown dissected out linearly with the fine lindemann burr. Last prepared the tooth can then be elevated out with the fine elevator after removal of tooth #15 enhance follicle with the forceps the palatal flap is replaced then sutured. The wound is covered it for about a week with the shape retaining acrylic plate. Surgical removal of the mandibular pre molars is much more difficult because of the vicinity of the inferior alveolar nerve and the mental foramen. Before the operation the position must be determined accurately by appropriate x-rays the mental foramen can be seen clearly on the OPG with the impacted tooth #45 mesial to it. In this twelve-year-old patient the operative procedure is performed from the vestibular side vestibular and lingual terminal infiltration of local anesthetic is quite adequate. If the gap over the impacted tooth has not yet closed the trapezoid mucoperiosteal flap is dissected on the alveolar ridge and vestibule when elevating it the mental foramen should be exposed carefully only there is the tooth crown exposed in its greatest circumference with the surgical burr. After adequate exposure impacted tooth#45 is now dislocated out with a fine elevator. After curetting the tooth bedded the mucoperiosteal flap is replaced and fixed with sutures.
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