Dear friends, last time we talked about And today I will tell you in detail and in all details how the removal of "sentenced" teeth takes place directly. With pictures. Therefore, I recommend especially impressionable people and pregnant women to press the key combination "Ctrl +". Joke.
Where does the removal of the 8th, and, in principle, any other tooth begin?
With anesthesia.
So:
Anesthesia (pain relief)
To minimize discomfort during the injection, it is necessary to treat the injection site with a special anesthetic gel. This is the so-called application anesthesia. It is very often used in pediatric dentistry, but we also use it in working with adults. As practice shows, there are fewer unpleasant sensations, and her taste is pleasant ... at least some kind of joy.
When extracting teeth of the upper jaw, as a rule, a simple infiltration of the area of the extracted tooth with an anesthetic is sufficient. It is carried out using a special syringe with specially selected anesthetics and is called infiltration.
When removing teeth in the lower jaw, infiltration anesthesia is usually not enough (with the exception of the frontal group of teeth, from canine to canine). Therefore, the anesthesia technique changes somewhat - the anesthetic is brought directly to the nerve bundle responsible for the innervation of the desired areas with the help of a long, but very thin needle. Such anesthesia allows you to “turn off” the sensitivity not only in the area of the tooth being removed, but also on the lips, chin, part of the tongue, etc.
It should be noted that during and immediately after anesthesia, a number of interesting phenomena can be observed - increased heart rate, trembling of the limbs, an inexplicable feeling of anxiety. Many patients begin to panic about this. And there is no need to panic! These are the side effects of most modern anesthetics, disappear on their own within 10-15 minutes.
Well, the anesthesia is done! Now you need to make sure - was it successful?
Those places that should ideally be numb are listed above. Also, with the help of a special tool and pressure on the gum in the area of the operated tooth, we determine whether there is still pain or not. The only thing that should be felt is the feeling that "something" is touching the gum. That is, tactile sensations are still preserved, but pain is no longer there.
And then our actions differ depending on what type of wisdom tooth we are dealing with.
impacted wisdom tooth
These are usually the hardest eights to remove from all the others.
We have already anesthetized the operating field. What's next?
He's under the gum! So - we take a scalpel in our hands, and we make a delicate incision in the area of \uXNUMXb\uXNUMXbthe tooth being removed. Thus, access to the removed wisdom tooth is created. It is isolated from the surrounding tissues with the help of special tools, and now we can visually assess its position and choose a removal technique.
If the tooth has not erupted, it means that something is interfering with it. This “something” will also interfere with its removal, and this “something” can be a neighboring tooth, a bony protrusion, etc. However, you won’t also remove the seven to get to the wisdom tooth, right?
Therefore, we divide the tooth into parts. With the help of a special tip with a cutter speed of 150 rpm, this is no longer a simple angular, but not yet a turbine one. The latter, by the way, is highly undesirable to use for tooth extraction, because at 000 rpm it is easy to burn everything with a hellish flame, and also inflate emphysema half a face with air from the cooling nozzle. In general, for removal it is necessary to choose the right tools, there are no trifles and compromises here and cannot be. And it’s worth thinking a hundred times before removing such problematic teeth in the dental office for one chair at the rural club on the Half-empty Bins collective farm.
Special surgical handpiece for the removal of wisdom teeth. It rotates at the right speed, provides the right torque, does not burn tissue or inflate emphysema. In surgery, we use only such devices.
So, we divide the tooth into 2-3 parts in order to remove it carefully and less traumatically for the surrounding tissues. And teeth are usually removed with the help of an “elevator” (in the picture on the left). Forceps, which everyone associates with removal, are in fact extremely rarely used.
Well, the tooth has been removed. Next, we clean the tooth socket from “sawdust” and small fragments of the tooth that could remain. With the help of a curette.
When removing wisdom teeth, biomaterials are not used, the hole is filled with a blood clot on its own, this is quite enough for normal healing.
Moreover, "pushing" biomaterials into the hole can complicate the healing process, so let the regeneration process be natural and simple, and not fancy, as some doctors suggest.
Impacted teeth are removed mainly with an elevator, and not with forceps, as many used to think.
Clot in place. Then we bring the edges of the wound together and suture it so that food does not clog into the wound, it does not bleed much, and rather heals. But at the same time, the seams should not be tight, because the wound can bleed significantly for the first day. And if you do not create an outflow, edema often develops.
After removal, resorbable (absorbable) sutures are applied to the hole, most often they do not need to be removed. But everything is individual.
Semi-retinated tooth
In principle, the extraction of such a tooth is no different from the removal of a fully impacted tooth. But, as a rule, it goes a little easier, because the tooth is not so deep. The main stages are essentially the same: anesthesia, creating access to the tooth (and sometimes you can do without incisions), fragmentation (dividing the tooth into parts) and, in fact, removing the teeth in parts.
After removal of the lower semi-impacted tooth, sutures are applied to the hole, in the area of \uXNUMXb\uXNUMXbthe upper wisdom teeth, suturing is not always necessary.
dystopic tooth
The removal of such teeth can be called a simpler case than others, but only if the tooth has one straight root. Then the removal can take place quite quickly. But such clinical cases are extremely rare. And, looking at the picture, we see hooks, not roots, which, with proper pressure, can simply break. There are usually 2 roots, and in this case we just need to separate one root from the other using the same tool - the "increasing" tip. And carefully get each of the roots separately. The beginning and end of the extraction of such teeth is the same as for all the others.
Fully erupted tooth and standing in the dentition
As we found out from , we leave such teeth in place. They just need care and observation, as is the case with ordinary teeth.
And it also happens...
... that wisdom teeth block neighboring sevens and prevent them from erupting normally. In such cases, patients come to the surgeon in the direction of the orthodontist.
Of course, the germ of the eighth tooth must be removed. This is a fairly simple and relatively comfortable operation.
Look at the pictures. Between the top and bottom - a difference of three weeks. It is clearly seen from them that after the removal of the rudiments of eights and “unblocking”, the seventh teeth immediately began to grow.
Wisdom tooth removed. The patient is satisfied. But the most fun is yet to come. Namely, the postoperative period.
After the removal of 8 teeth, strict recommendations must be followed:
- In no case do not rinse or warm the area of the extracted tooth. Forget and do not listen to instructions like "you need to rinse with a tincture of shark fins and mammoth tusks." No! This cannot be done. Why? And all because the very blood clot, which, as we have already found out, should remain in the hole and protect it, can be easily rinsed out. And again we will return to the same inflammation and, accordingly, to a long healing.
- Eliminate physical activity, at least for 2-3 days. For what? And for the fact that, under loads, the pressure somehow rises (yes, yes, yes, even Arnold Schwarzenegger and Rocco Siffredi !!!), and, despite the fact that, again, the clot is not completely formed, the wound may begin to heal, and it’s bad heal up.
- We also exclude the general overheating of the body.. Saunas, baths, hot baths are not allowed. All this also contributes to bleeding.
- Do not eat until the anesthesia is completely gone. Otherwise, the risk that you can bite your lip, tongue or cheek hard enough and not notice it is extremely high. It usually takes about 2-3 hours. And ideally - cold, hunger, rest for the first couple of days.
- But when you got to the food, - chew only on the side opposite to removal to minimize food entering the hole.
- Don't forget to brush your teeth! Teeth must be brushed, preferably with a soft toothbrush, in order not to injure the area of the extracted tooth. And do not forget that the tooth is no longer there, so in this area we work with a brush especially carefully. AND! Necessarily! DO NOT try to clean off the white plaque that can cover the gums in the area of the extracted tooth. This is NOT PURS! This is FIBRIN! A protein whose presence indicates the normal healing of the hole.
- Ice is also dispensed after tooth extraction.. It is recommended to apply it to the cheek in the area of the extracted tooth during the rest of the day. Approximately 15-20 minutes every hour. All the same in order to minimize swelling. But you don’t need to get too carried away, so as not to freeze your throat and lymph nodes (if you keep the ice in the wrong place, or where you need it, but for too long).
In addition to these recommendations, medications are also prescribed., the so-called antibacterial and anti-inflammatory therapy. This is due to the fact that the region of the 8th teeth is extremely easily inflamed, but we would not want this. Along with taking antibiotics, natural yoghurts and other fermented milk products are great - do not forget to support the intestinal microflora.
If the removal was carried out correctly, and the patient followed all the recommendations and followed the doctor's prescriptions, then the risks of postoperative complications are extremely small.
Stay tuned!
Sincerely, Andrey Dashkov.
Source: habr.com