A 38 year old male patient, was referred to the Department of Dentistry with a complaint of pain in the right mandibular third molar area. There was no relevant medical history or family history of dental abnormalities. Panoramic radiographic examination revealed the presence of horizontally positioned fully impacted mandibular right and left third molars, partially impacted mandibular right distomolar, bilateral vertically positioned fully impacted maxillary third molars and a maxillary vertically positioned fully impacted left distomolar (Figure 1).
Clinical examination disclosed pericoronitis of mandibular right distomolar. The supernumerary tooth was causing food impaction and repeating inflammation of the pericoronary soft tissue. There were occlusal and proximal cavities in the permanent molar teeth. Radiographic findings included proximity of the upper bilateral impacted third molars and upper left distomolar to the maxillary sinuses. Mandibular bilateral horizontally impacted third molars were positioned close to inferior alveolar nerve canal. patient refused further computerized tomographic investigation in order to determine the position of the supernumerary teeth and impacted third molars in relation to the anatomic structures.The patient was given the pros and cons of surgical removal. Intraoral and extraoral antisepsis was performed with 0.12% chlorhexidine gluconate and povidone iodine respectively.
The sterile operating field was placed. 4 ml of local anesthetic was administered in order to get right mandibular anesthesia. Envelope incision was performed with an oblique incision and mucoperiosteal flap was reflected. Bone covering the root of mandibular right impacted distomolar was partially removed with a surgical handpiece under sterile saline cooling. The roots and crown was split using a tungsten fissure bur and carefully removed in two pieces. The flap was placed on its original position and sutured with a non-resorbable 3.0 suture. A week later sutures were removed. Healing was uneventful and no complications were observed. Distomolar supernumerary tooth was in normal tuberculate form, however it was smaller than the regular molars. One year later, the patient visited clinic for follow-up and a panoramic radiograph was taken . At that time, he had no active complaints.
To read more click on the document attached