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Oral Surgery
Surgical Removal of Maxillary first and second molars Abstract
Dr. Parmanand Dhanrajani Oral surgeon Bds, mds, msc, msc, fracds, fdsrcs, ffdrcsi Hcf dental centre, Sydney, Australia dan.dhanrajani@gmail.com
This paper presents technical notes on removal of maxillary upper first and second molars. Maxillary first and second molars are difficult and challenging to remove in best experienced hands. The technique described is easy to learn and implement.
It preserves bone and imply minimal trauma as well as avoids complication such as perforation of maxillary sinus floor. Keywords: Exodontia, Surgical Removal
Maxillary
molar,
Introduction The extraction of maxillary first and second molars is often difficult and challenging especially if they are heavily restored. Teeth with large restorations and/or which are root canal treated are prone to fracture during a forceps removal and a planned surgical technique must be used to start with. These extractions are further complicated by the close proximity of these teeth to the maxillary antrum. Surgical technique requires good planning, meticulous tissue handling and proper use of instruments, especially luxators, so that mishaps such as fracture roots or displacing roots into the sinus are avoided. In the era of implant replacement of the tooth it becomes imperative to maintain as much bone as possible and preserve soft tissue around the extraction site for future replacement 1. This paper describes a systematic approach for removal of maxillary first and second molars which avoids the most common complications such as fractured root tips, sinus perforations and displacing roots into the sinus while simultaneously maintaining bone and soft tissue2.
Technical Notes for removal of maxillary first and second molars 2.1. Pre-operative assessment of the patient’s medical and social history, ensuring that there are no contraindications for surgical procedures. Informed consent is mandatory before the start of the procedure. This must include the warning that prophylactic closure of maxillary sinus may be required. 2.2. Proper clinical and radiographic examination is essential. During examination assess the status of the tooth in regard to decay, restorations and the amount of tooth loss at the gingival and alveolar margins. Assess the soft tissue available if a buccal advancement flap is required.
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Dental News
March 2020