Atlas of Minor Oral Surgery: Principles and Practice by David A. McGowan

By David A. McGowan

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The inferior dental canal is not clearly demarcated, but it seems to run a safe distance beneath the root apices. The distal bone l evel is at the neck of the tooth, but there is a faint radiopacity which suggests a broad, bony dish around the crown. This impression is strengthened when the other side is examined, as it shows a similar feature more clearly. 31 removed, in case the impacted tooth might be producing pressure on the inferior dental nerve i n an attempt to erupt. Grossly carious lower first molars had been removed four years before, but this had not avoided third molar i mpaction.

However, yesterday, he came to see me again complaining that the tooth was causing trouble and wanting it cut out. As there is considerable bony covering with just the cusps showing above bone level, and the roots appear radiographically to be close to the The patient complained of a shooting pain on the left side when eating, leading to earache. This symptom is more likely to originate from the temporomandibular joint, but since the provision of dentures would be delayed until the third molar was removed, it was probably the indirect cause of pain.

Reflection The flap is reflected with a Howarth's periosteal elevator and the external oblique ridge can be seen clearly. Third molar removal The flap must be reflected cleanly over the internal oblique ridge, distally and lingually, since blind cutting in this area can endanger the lingual nerve. Bone removal Using a small rosehead bur, bone is removed to form a deep, narrow gutter around the buccal and mesial sides of the crown. The entire circumference of the crown has been cleared. 47 48 An atlas of minor oral surgery The crucial distal bony gutter is made, with a Howarth's inserted to guard the lingual soft tissues.

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