DCA03TM Third Molar Surgery, 5th Edition _____________________________________________________
Self-Assessment Question 3
The classification of third molar impactions, based on the third molars’ relationship to the second molars and to structures such as the ascending ramus of the mandible, can provide an initial assessment of the degree of surgical difficulty. However, radiographic assessment is also vital when assessing the proxim- ity of the inferior alveolar nerve to the apices of mandibular third molars and the potential for trauma to this nerve upon the extraction. The clinician must be mindful of the potential traumatic involvement of the lingual nerve in the extraction of mandibular third molars and of the risk to the maxillary sinus during the extraction of maxillary third molars. Furthermore, it is imperative that the clinician discusses these potential risks and adverse outcomes with the patient before the surgi- cal procedure begins. The clinician must also choose among the surgical techniques and surgical instruments used for the extraction of third molars, employing the technique and cor- responding surgical armamentarium that is most appropriate for the given procedure. By providing an initial framework with which to evaluate impacted wisdom teeth clinically and radiographically for the degree of surgical difficulty and for the potential for adverse surgical outcomes such as neurosensory changes or sinus com- munications, this course enables general dentists to determine whether extraction of an impacted third molar is within their realm of surgical expertise or is more appropriately referred to an oral surgeon. In all cases, protecting the best interest of the patient is the highest priority for patient care and remains the highest ethical responsibility of the treating clinician. Rehabilitation.
3. Dentigerous cysts: A) Are malignant.
B) Are the most common odontogenic cysts. C) Have the highest frequency of occurrence with impacted mandibular third molars. D) Undergo rapid development. CONCLUSION The extraction of third molars remains a common procedure within the U.S. despite continued controversy over the value of prophylactic extractions. Debate over the procedure weighs the potential for surgical risks of the extraction of an asymp- tomatic impacted third molar without any current pathology against the unknown potential for pathological change of an asymptomatic third molar without current pathology. Basic extraction techniques are generally based on the type of impaction: Soft tissue, partial bone, or full bone. As with any surgery, there are also associated risks. Risks of third molar sur- gery include postoperative infection, bleeding, dry socket, sinus infection, oroantral communication, injury to the adjacent tooth, root fracture and displacement, neurosensory changes (numbness), and fracture of the mandible. The tendency for impaction of the third molars—coupled with limited access; variable root anatomy; and the proximity of third molars to structures such as the inferior alveolar nerve, the lingual nerve, and the maxillary sinus—increase both the difficulty of extract- ing these teeth and the surgical skills required to complete this procedure successfully. Based on the information about third molars presented in this course, the dental clinician must determine whether their surgical skills are commensurate with the level of surgical difficulty that the atraumatic extraction of a third molar presents.
WORKS CITED https://qr2.mobi/third-molar-5ed
THIRD MOLAR SURGERY, 5TH EDITION Answer Keys & Rationales
1. Correct answer is C. There are many causes of dysphagia, some of which are benign. Others, such as a malignancy in the pharynx or esophagus, can have a high degree of morbidity and mortality. When the contiguous soft tissues of impacted mandibular wisdom teeth become infected (pericoronitis), the extent of swelling can compromise the ability to swallow food and liquids . 2. Correct answer is B. Iatrogenic damage to the lingual nerve during the extraction of third molars can cause temporary and occasionally permanent loss of sensation to the anterior two-thirds of the tongue. Unlike the inferior alveolar nerve (IAN), which can be identified in the mandibular canal on a
panoramic radiograph, the lingual nerve cannot be identified on this radiograph. The lingual nerve exhibits a variable course relative to the mandibular third molars and occasionally can traverse the retromolar pad. 3. Correct answer is C. Dentigerous cysts that involve impacted third molars are initially asymptomatic and have a gradual increase in size, which can cause resorption of the mandibular bone. Most are discovered on a routine panoramic radiograph.
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