PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

(2) radiographic signs of pathology (e.g. dentigerous cyst formation);
(3) part of an orthodontic treatment plan.


If buried teeth are symptomless, have no associated pathology, and are not causing
orthodontic problems (either by their absence or in preventing the orthodontic
movement of erupted teeth) they should be left alone. Such teeth should be kept under
clinical and radiographic review so that any developing pathology may be detected
and treated. In cases where unerupted teeth are to be removed the first step in
management is to localize the buried tooth by clinical examination and radiographic
techniques. A number of radiographic views may be used:


(1) parallax periapicals;
(2) orthopantomogram;
(3) occlusal views;
(4) true lateral facial bones.


In practice, parallax periapicals and an orthopantomogram are usually sufficient. The
periapical films will help to establish the buccolingual position of the buried tooth in
relation to the erupted dentition. The orthopantomogram will supply information
concerning the overall shape of the tooth, its relationship to neighbouring structures
(such as the antrum, inferior alveolar nerve canal, other unerupted teeth), and the
extent of any associated pathology. Once the tooth has been located and the difficulty
of removal and patient co-operation assessed then the method of anaesthesia should
be determined.


Extraction of buried teeth


When removing buried dental tissue in children it is imperative to have an excellent
view of the operative field. This is especially important when removing unerupted
teeth or supernumeraries closely associated with other unerupted teeth that are to be
retained. In these circumstances the tooth of interest and its unerupted neighbours
must be clearly identified.


FLAP DESIGN
Flaps should:



  • be mucoperiosteal;

  • be cut at 90° to bone;

  • have a good blood supply;

  • avoid damage to important structures;

  • allow atraumatic reflection;

  • provide adequate access and visibility; and

  • permit reapposition of the wound margins over sound bone.


FLAPS FOR BUCCALLY PLACED TEETH
Two designs of flap may be used for the removal of buccally placed teeth. The first of
these includes the gingival margin as the horizontal component and a vertical relief
incision into the depth of the buccal sulcus (1046HFig. 15.23 (a)-(g)). It allows good
exposure, easy orientation, can be readily extended and, for the most part the wound
edge will be replaced over sound bone at the end of the procedure. If this design is

Free download pdf