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11.05.2024

Removal of a wisdom tooth lying on the mandibular nerve using orthodontic extrusion

Patient Olga
Date 02.2024
Time
Price
Patient Olga contacted us with a request to remove an unerupted lower wisdom tooth on the right in order to finally begin orthodontic treatment. Olga had already had the same wisdom tooth removed on the left side of her lower jaw in another c...
Patient Olga contacted us with a request to remove an unerupted lower wisdom tooth on the right in order to finally begin orthodontic treatment. Olga had already had the same wisdom tooth removed on the left side of her lower jaw in another clinic several years ago, after which Olga permanently lost sensation in her left lower lip and chin.
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Initial situation

On the initial CBCT, we see that the lower right wisdom tooth (tooth 4.8) is tilted and abuts the adjacent seventh tooth, and the root of the tooth is pushing the mandibular nerve towards the lingual wall of the mandible and slightly encircling it (marked by the arrow). It was obvious that classical methods of tooth extraction would most likely lead to injury to this nerve and disruption of the sensitivity of the skin of the lip and chin on the right.

At the initial consultation, Olga reported that the tooth that she had removed on the other side had exactly the same close relationship with the mandibular nerve, and now she is afraid that after a similar removal of the wisdom tooth, she will lose sensitivity in her lip on the right side.

From our side, we offered Olga to remove the tooth using the orthodontic extrusion method, which guarantees that she will retain the sensitivity of her lip, but requires two interventions 1-2 months apart. Olga happily agreed with our plan, and we began the first stage.

Progress of the surgery

Under local anesthesia, access to the tooth was created, its coronal part was exposed, and an orthodontic mini-screw was fixed behind the tooth, acting as a future anchorage for tooth traction.

An orthodontic button was fixed to the crown of the wisdom tooth, and an elastic band was pulled from it to the previously installed mini-screw.

The wound was completely sutured, the stitches were removed after a week, and we took a break of 2 months to wait for the tooth to be pulled out slowly and safely.

Olga conscientiously followed all recommendations for wound care, and healing took place without any complications, and after 3 days, when the swelling subsided, the patient completely returned to her usual lifestyle.

After 2 months, the patient returned to our clinic for the second stage.

In the oral cavity, we immediately saw positive signs – the wisdom tooth was partially erupted in the oral cavity, which already meant that it had been pulled out.

We performed a CT scan and made sure that the tooth was pulled out in such a way that it was no longer pushing back the mandibular nerve.

Therefore, using local anesthesia, in one easy movement, we removed the tooth in a matter of seconds and unscrewed the mini-screw, which successfully completed its task.

The next day, we contacted Olga to find out how she was feeling, and were happy to hear that the sensitivity of her lip was not affected at all!

A week later, we removed the stitches, and Olga happily began orthodontic treatment.

Duration of the first surgery – 25 minutes.

Duration of the second operation – 10 minutes.

Total cost of removal – 3,200 AED.

Doctors who treated

Dr. Aleksandr Siniakov
specialist Oral Surgery, implantologist, periodontist;
languages: English, Russian
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