"Children's dental health"

Diseases of teething. The concept of retention and dystopia. Retention of the

third molar. Methods of surgical intervention.

Retention of the teeth most often occurs asymptomatically and is found by chance
during X-ray examination or the appearance of "swelling" of the jaw bone. The
retention is indicated by the absence of one or more permanent teeth on the
alveolar arch.
There are partial and full retention.
The position of the retained tooth can be vertical, this position is often observed in
the lower and upper wisdom teeth.
If the axis of the retained tooth and the vertical axis form an angle of less than 90 °,
then the term "angular position" is used.
The definition of "horizontal position" is used in the case when the axis of the
tooth and the vertical axis form a right angle

Fig. 1. Location of the third molar in the lower jaw.

Operative intervention.
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 - dissection of soft tissues;
- formation of a mucous-periosteal flap;
-extraction of the retained tooth;
- suturing the wound.

Fig. 2. Scheme of access to the retained tooth from the side of the atrium of mouth
cavity on the upper jaw.

Extraction of the retained tooth from the side of the palate.

When the tooth is been removing from the palate, a L-shaped incision is made,
which provides good access.
A drill is used to remove the compact plate of the jaw bone. Fissure drill is used to
make furrows along the tooth, and then a retained tooth is extracted using forceps
or an elevator.

After the extraction of the tooth, fragments are removed from the wound, the sharp
edges are peeled or cut, washed with solutions of antiseptics, filled with a
hemostatic sponge, then the mucoperiosteal flap is put back and stitched.

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During operation on the upper jaw, the roots of adjacent teeth can be damaged with
a violation of their vascular nutrition. With this complication, resection of the root
tips should be performed according to generally accepted rules. When the
maxillary sinus is opened, the wound is sutured tightly.

Fig. 3. Scheme of removal / opening of the detained tooth from the side of the
palate.

Removal of the retained third molar.

Produce an L-shaped section.
Form a muco-periosteal flap.
Expose the alveolar part of the bone in the area of the projection of the retained
tooth, use a milling cutter or a drill to remove a compact plate, exposing the crown
of the tooth, and produce a dislocation of the tooth.
If the retained teeth are located in the body of the lower jaw (or its branch), they
are removed by extraoral access in a hospital.

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Fig. 4. Schema of the incision and suturing of the wound during the extraction of
the retained wisdom tooth on the lower jaw