Periodontal Plastic Surgery: How would you treat this case?

[tx oms]

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This patient is omsres' 28 y/o incarcerated father. His wisdom teeth hurt. How would you treat him?

Picture here.

 

[toofache32]

Endo or extract #20. Maybe take out the lower 3rds to give the 2nds a chance to erupt. The uppers can probably be left alone to give them a chance to erupt a little more, because #1 and 16 are way up there.

Taking out the lower 2nd molars along with the 3rds would be bad because you are setting them up for a mandible fracture assuming you leave them with a lingual cortex and inferior basal bone only. At least taking out the lower 3rds would give the 2nds a chance to move up a little. They may have to eventually come out anyway if they don't erupt.

Are the upper laterals missing? No wonder OMFSRES is so funny looking...it's genetic.

 

[DcS]

Endo or extract #20. Maybe take out the lower 3rds to give the 2nds a chance to erupt. The uppers can probably be left alone to give them a chance to erupt a little more, because #1 and 16 are way up there.

Taking out the lower 2nd molars along with the 3rds would be bad because you are setting them up for a mandible fracture assuming you leave them with a lingual cortex and inferior basal bone only. At least taking out the lower 3rds would give the 2nds a chance to move up a little. They may have to eventually come out anyway if they don't erupt.

Are the upper laterals missing? No wonder OMFSRES is so funny looking...it's genetic.

You are missing quite a few things. First things first.

He's not missing upper laterals because there are 18 teeth in the upper...for those math wizzs out there, that's 2 teeth too many. Looks to me that the primary canines (C and H) were retained because 6 and 11 failed to erupt. Also, taking out lower 2nds and 3rds would not set them up for mandibular fracture IMO good chance it would fill in with bone. If you are that worried about if you could pack some biooss or something to regenerate bone. Also, I highly doubt taking out 17 and 32 will have any effect on the eruption of 18 and 31.

This is how I would treat it:

Extract C and H assuming those are the retained teeth (hard to tell by the pan)

Exract 1, 2, 15, 16, 17, 18, 31, 32. It's fairly obvious you have to extract lower 2nds and 3rds so why keep upper 2nds when they are impacted slightly and even if they did erupt they will oppose nothing (supererupt over time etc).

Orthodontically pull 6 and 11 down into the space vacated by the primary canines (will need to shift 7-10 of course to make room).

Endo on #20 and restore as necessary.

Finally if he's that motivated 4 2nd molar implants.

 

[lnn2]

Exract 1, 2, 15, 16, 17, 18, 31, 32. It's fairly obvious you have to extract lower 2nds and 3rds so why keep upper 2nds when they are impacted slightly and even if they did erupt they will oppose nothing (supererupt over time etc).

Finally if he's that motivated 4 2nd molar implants.

If implant is an option for the lower then I would keep upper 2nds. I second on everything else listed.

 

[DcS]

If implant is an option then I would keep upper 2nds.

agreed.

 

[omfsres]

agreed.

Here's the real answer: Incarcerated = extract #20. Leave the rest of that $hit alone. There's no need to cost the state money required for the OR, the plates and screws and follow up visits. Take a pano once yearly. I don't care if it is my dad.

 

[tx oms]

Here's the real answer: Incarcerated = extract #20. Leave the rest of that $hit alone. There's no need to cost the state money required for the OR, the plates and screws and follow up visits. Take a pano once yearly. I don't care if it is my dad.

Excellent answer.