Impacted Maxillary third molars are very difficult to extract mainly because of the lack of visibility and the presence of a very thin Tuberosity and other factors like the Visibility, Reach and the proximity to Maxillary Sinus all of which make it comparatively difficult.
Maxillary Third Molar Impaction are can also be of many types based on the orientation or the tooth and also the position of the tooth inside the bone, and the Maxillary Third Molar Impaction have been classified by Archer: Maxillary 3rd Molar Classification
Extraction of Impacted Maxillary Third Molar is difficult and based on the classification and the type of impaction in question the Surgical procedure differs and the Dentist has to adapt accordingly. One of the main things in Extraction of an Impacted tooth be it maxillary or mandibular is the ability to retract the covering Gingiva or soft tissue and give proper visibility of the extraction site.
So one of the most important steps in Surgical Extraction of Impacted Maxillary 3rd Molar is giving a Flap and here we are going to discuss about the various types of incisions and flaps which are used in Surgical impaction.
There are 2 types of Flaps which are given for Extraction of Maxillary third molars:
- Triangular Flap
- Horizontal Flap
For a perfect Flap there should be a perfect Incision which should be given and that is what we will be explaining to you in this post here giving you step by step representation of how to give a perfect Triangular Flap and Horizontal Flap. A Sharp and New B.P blade should be used along with a suitable BP Handle.
Triangular Flap for Extraction of Maxillary Third Molar:
the Incision for a Triangular flap should be given keeping in mind 2 main things that there should be proper visibility and the blood supply and the flap should not be torn away while elevating the flap.
Start the Incision from the Maxillary tuberosity and extend it to the distal end of your Second Molar which is in case the 3rd molar is completely impacted, and if the 3rd molar is partially impacted then the incision should start in the same place but extend along the crown of the third molar towards the distal part of the second molar.
Image courtesy: Fragiskos D. Fragiskos textbook of Oral Surgery
The BP Blade tip should be placed at the tuberosity tip and with a slight push the blade is inserted into the soft tissue and the blade tip should should slide through the soft tissue and extend till the distal aspect of the second molar.
After this the incision is continued in an oblique direction towards the Sulcus or the Apical portion of the Second molar extending Anteriorly and it is called the Vertical Incision which extends towards the vestibular Fold.
Image courtesy: Fragiskos D. Fragiskos textbook of Oral Surgery
In cases where the Third molar is impacted deeper and extending towards the roots of the Second molar the vertical incision should be given in the distal aspect of the first molar after the incision is extending from the cervical region of the second molar. This will give you more visibility to remove the tooth in such cases.
Horizontal or Envelope Flap for Extraction of Maxillary Third Molar:
The incision for Horizontal Flap also starts at the Maxillary Tuberosity and should be extended towards the distal aspect of the second molar.
Now the incision is carefully continued following the cervical lines of the Second molar and the first molar extending till the Mesial aspect of the First Molar.
Image courtesy: Fragiskos D. Fragiskos textbook of Oral Surgery
After the incision ends at the mesial aspect of First molar a periosteal elevator is used to carefully elevate the flap towards the vestibule and expose the underlying bone and impacted tooth.
Impacted Third molar extraction is a must as it may lead to infection or periapical pathology and also many types of cysts are associated with impacted teeth like Dentigerous Cysts. And giving a proper flap can make the extraction process atraumatic and help in easy removal of Impacted tooth.
This article was very helpful. Thankyou
the article was easy to understand and helpful.