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- Pre-Dental
3rd molar ext incison
- Thread starter lalago
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A traditional distal hockeystick incision does not involve incising the buccinator. The other popular incision, the "comma" or "triangular" flap, is even more conservative.
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No. Do you?
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- Dentist
No please stay away from the lingual. Standard anatomy drawings where lingual nerve is depicted doesn't apply to everyone. In some people the lingual nerves comes almost to to the distal-lingual cusp of the third molar. Don't flap, don't elevate there, don't drill bone there, don't even drill near there to section.
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- Attending Physician
I don't typically but I know a couple private practice guys that do. I'm a senior resident, maybe take out 2-3 sets of wisdom teeth per week and still trying to get my routine down. A few changes I've made throughout the year though include starting with the lowers before uppers and suturing as I go along vs suturing at the end.
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- Resident [Any Field]
I'm also a senior resident doing about 10 sets of thirds a week. I've started refining my methods a little bit from when I started. I do my lower 3rds incision first (more important to have a fresh blade for a clean flap) then going up and doing the entire upper third first. Then i go back down and reflect my lower flap and take out the lower 3rd. Then switch and do the same on the other side with a fresh blade.
I like doing uppers first because I don't have to worry about debris falling into my lower flap/socket that I already irrigated out as I take out the upper third. Also my local sets in faster in the maxilla so the patient is numb faster and don't have to wait. I also suture everything at the end in order to get all of the most stimulating portions of the procedure done while my patient is most sedated and then things such as suturing I can do as the patient is waking up. In patients I'm doing with only local, I suture each side as I go.
In terms of a lingual flap, I reflect the occlusal/lingual tissue of full bony impactions just enough that I can see the crown of the tooth. I try to avoid touching that area as much as possible because even if you are subperiosteal and avoid the lingual nerve, you still subject it to stretch injuries which I've seen on more than a couple occasions by other residents.
I like doing uppers first because I don't have to worry about debris falling into my lower flap/socket that I already irrigated out as I take out the upper third. Also my local sets in faster in the maxilla so the patient is numb faster and don't have to wait. I also suture everything at the end in order to get all of the most stimulating portions of the procedure done while my patient is most sedated and then things such as suturing I can do as the patient is waking up. In patients I'm doing with only local, I suture each side as I go.
In terms of a lingual flap, I reflect the occlusal/lingual tissue of full bony impactions just enough that I can see the crown of the tooth. I try to avoid touching that area as much as possible because even if you are subperiosteal and avoid the lingual nerve, you still subject it to stretch injuries which I've seen on more than a couple occasions by other residents.
D
