Extraction of 3.8 and 2.8 wisdom teeth included, which impacted the sevens.

Wisdom teeth, impacted teeth, and extraction of lower wisdom teeth.

Previous information

Referral

The patient was attended in Sarpsborg (Norway).

Patient Complaint

«The lower part of my jaw hurts a lot when I eat.»

History of presenting complaint:

The patient attends a consultation with Trismus. However, there was inflammation of the face’s left and right sides, extending from the jaw to the eye.
She was prescribed Apocycilin 660 mg and Paralgin forte 40 mg® for five days.

Social history

Age: 27 years old.
Married: 10 years.
Occupation: Student.

Medical history

Actual diseases: Hypercholesterolemia and problems with anxiety.
Allergy: Pollen.
Family conditions: Alcohol intake problems.
Snus: She used snus all day.

Dental history

Oral hygiene technique: Inadequate.
Dental visits: Infrequent.
Oral aperture: The maximum aperture was 35 mm in the anterior zone.

Attitudes towards previous treatment

She had a good attitude, and she was very receptive to listening.

Treatments performed before surgery

1. Cleaning and applying airflow are carried out.
2. Radiological diagnostic method: Periapical radiographs and orthopantomography.

3. Perio chart shows the deep pockets and soft tissue conditions:
A. CAL generalized were <3 Mm in molars and 2 mm in anterior teeth. B. Bleeding and plaque Localized. C. Thin biotype. D. Gingival recessions in the lingual side of anterior mandibular teeth. The recessions were miller type 1 from 1-2 mm. F. CPITN code is 2.

4. The patient was taught the instructions for good brushing and flossing techniques. The use of an electric toothbrush is recommended since, according to Ccahuana-Vasquez et al.3 2019 reduces the level of plaque and gingivitis compared to a regular toothbrush. As there are tablets to detect plaque after brushing, the patient can know if the plaque is being removed well or where she needs to improve her technique.

5. Scaling and root planning were performed; the aims of this treatment are

A. To reduce bleeding and the level of plaque to 25%.

B. To reduce the depth level of the pocket under 5 mm.

C. Keep the horizontal defect less than 2-3 mm in the furcation involved.

D. To prevent pain or bad smell.

E. To evaluate other techniques, such as regenerative or resective surgery, if this treatment is unsuccessful in the periodontal revaluation carried out after four months.

6. The patient was educated on the harmful effects of tobacco and alcohol on health. Visiting pages such as Slutta.no by Helsenorge.no were suggested for more information on how to stop smoking and drinking. Pinto-Filho et al. 2018 conducted a cross-sectional study about alcohol and tooth loss; they found that Alcohol dependence increased 2.5 times the risk of tooth loss.

7. A systematic revaluation was recommended after four months to evaluate the periodontal evolution.

Systematic facial examination

The face:
1. Brachyfacial features. Caucasian woman originally from Sarpsborg.

Diagnosis

1. Impacted wisdom teeth, producing pain and swelling.
2. Initial generalized periodontitis grade C, stadium 1.

Treatment

1. The treatment was the extraction of 3.8 and 2.8.
2. Wisdom teeth: As seen on the X-ray, the wisdom teeth have impacted the sevens, leading to possible cavities and endodontic pathologies.

The treatment of choice was extracting the wisdom teeth to see the natural state of the sevens.
3. Subsequently, the mucoperiosteal flap was displaced apically with the Prichard periosteum, exposing the bone that covers the wisdom tooth.
The bone around the tooth’s crown was removed with a handpiece and a round diamond bur. Later, a division of the crown and the root was performed with a Lindemann Xl turbine bur.
4. The tooth had to be divided into two parts. Subsequently, the alveolus was curetted, considering its proximity to the dental nerve. Finally, two fibrin sponges were placed and sutured with Vycril 4.0.
5. The upper wisdom teeth were extracted.

O.P.G after extraction 3.8, 2.8

Photos of surgery 2.8

Photo of surgery 3.8

Post-operative indications

1. The patient cannot sleep on the left side for two weeks.
2. Have a soft diet for two weeks.
3. Could not touch the cheek firmly or show the stitches to anyone.
4. Use chlorhexidine 0,12% for one week, starting two days after the surgery.
5. Apply ice on the face to decrease the swelling.

Oral medication:

1. Paracetamol 500 mg three times per day for three days.
2. Supplement vitamin D to try to decrease the inflammation and help to heal the bone.
3. The patient was under antibiotic prophylaxis.

Evolution and prognosis

In this case, the extractions were carried out without any complications. Her prognosis was very favourable. The level of plaque bleeding decreased notably after four months of check-up. The patient learned to brush her teeth with an electric toothbrush but did not stop using Snus.