JB Seigneuric
F Denhez
JF Andreani
D Cantaloube
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R e s u m e. - Completion of dental extractions requires compliance with certain
number of rules inherent in any surgical practice. Conditions of installation,
knowledge of equipment and instruments and their rational use are
elements that determine good operating practice. The techniques presented
allow to address the difficulties gradually corresponding to different cases
FIG. Thus are first exposed simple extractions, then extractions
difficult and extractions of impacted teeth. A final chapter presents complications
related to these extractions and different methods of prevention and treatment.
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introduction
The avulsion of a third molar is an act of common practice and
must meet a precise technique and observe the rules codified.
The indication of this move has been the subject of many discussions and
studies. If the indications for curative avulsions ( infectious , tumor ,
neurological or mechanical ) are clear, the National Agency
Accreditation and Evaluation in Health (ANAES ) attempts to establish criteria
decision in the context of avulsions prophylactically . In all
cases, surgery should be decided with the consent of
patient, informed patterns, techniques and risks of this act. of
Similarly, the choice of the type of anesthesia mode, should be done with caution
and temperance. Risks still present the general anesthesia, will
book extractions , often multiple , particularly difficult or
performed in patients after justifying specific criteria such
anesthesia .
We shall study the techniques for wisdom teeth
lower and upper .
Extraction of lower wisdom tooth
anatomical reminders
Let us first recall some basic facts about this tooth.
Mandibular third molar
· Form
Its volume is usually lower than that of other molar rarely
higher. The crown is roughly rectangular and has little
constant characteristics apart from its globular shape .
Jean- Baptiste Seigneuric : Assistant Hospital of Hosts.
Franck Denhez : Dentist of Hosts.
Jean -François Andreani : Specialist hospitals Armies.
Daniel Cantaloube : Associate Professor of Val -de -Grâce .
Department of Plastic and Maxillofacial Surgery , Teaching Hospital of the Armed Percy , 101,
avenue Henri- Barbusse , BP 406, 92141 Clamart cedex, France .
Any reference in this section shall be marked: Seigneuric JB, Denhez F, Andreani JF
and Cantaloube D. Extraction of impacted teeth . Wisdom teeth. Encycl Med Chir
(Elsevier , Paris ) , Stomatology / Dentistry , 22 to 095 -A-10 , 1999 , 10 p.
The roots are especially considered in their shape and number (Fig. 1).
They can either be grouped ( or conical bulging ) or more frequently
separated ( convergent , divergent or angled ) .
Follicles ( or dental germs ) do not have only one root
draft root . Their round shape characterizes them.
· Location (fig 2)
Most commonly it is found in the retromolar trigone, behind
the second molar ( tooth or 12 years) .
It can be dystopian : in the corner or near the basal edge .
It can be ectopic at the ramus , the condyle or
Corone .
· Position
Compared with the fabric ( over the mandible ) , it can be
set in all three planes of space.
- In the sagittal plane (Fig. 3 ): vertical , oblique mesial or distal or
horizontal .
- In the frontal plane (Fig. 4 ): it may be low and completely enclosed
in the bone . Highest Conversely , it may be partially embedded in the bone
but completely covered by mucosa ( mucous inclusion) . Finally ,
it can flush the mucosa, discovering one or more cusps : tooth
is enclosed .
- In the horizontal plane (Fig. 5) : it can be aligned with the arcade or lopsided
laterally towards the hall or to the lingual side.
· Supernumerary Teeth
The presence of a supernumerary tooth is normal morphology
relatively rare. However , the presence of one or two elements
dysmorphic is more common ( or odontomes odontoïdes ) . these
" Fourth molar " are usually included , affecting the shape of
small molar .
anatomical relationships
The evolution of the lower wisdom tooth is in a small space
where there are many obstacles , hindering the evolution and source
complications .
- Back : the retromolar trigone. Found the ramus . In
this level is frequently found a granuloma or cyst marginal posterior
which carries a small cubicle which can sometimes facilitate the movement of the practitioner.
- Forward : found the tooth 12. Often it completely blocks
Wisdom tooth in its progression. Its roots can be bare or
the seat of carious lesions . The operator will pay special attention to this
tooth weakened and often treated .
- Outside (Fig. 6) : the outer bone table is thick, especially at
the outer oblique line .
- On the inside : the bony table is much thinner , sometimes lysed
up to the neck of the tooth . This fragile partition separates the tooth
lingual nerve. In most cases , the nerve is located in the inner face of the
mandible between the periosteum and gingiva. For some authors ( and Kiesselbach
Chamberlain , 1984) , in 20% of cases , it may follow the alveolar ridge in
then the gum where it is very exposed .
- Top: the retromolar bone segment is triangular in shape and
variable size .
- Bottom (Fig. 7) : the inferior alveolar canal where the packet travels
inferior alveolar neurovascular . His relationship with the roots of the tooth
wisdom are highly variable , with the possibility of direct contact with the
dental apex or exceptionally passage through the tooth. Thus, it
should specify its path before any intervention. technical
Employees will be developed ( see below). Lowest is the basilar edge .
It should also be appreciated bone loss and embrittlement of the angle
when extracting a large and deep tooth .
