Exodontia Portfolio

The following cases are some of the exodontia cases I have performed during fourth and fifth year

The patient is a 59 year old male, who has well controlled Type II Diabetes, well controlled hypertension. He had thick dense bone. In regard to dental history, he did not report any bruxism.

He presented to the clinic presenting of a dull throbbing ache from the 16 which would last hours, respond to hot and cold, and was also nocturnal. Clinically, the 16 had an occlusal amalgam, and the MP cusp had fractured to a depth of 3mm subgingivally, and the mesial pulp horn was exposed. The tooth was tender to percussion, had normal periodontal probing depths and did not have any mobility.

A diagnosis of irreversible pulpitis and symptomatic apical periodontitis was made. Treatment options were provided including: RCT and surgical crown lengthening (however furcation will be involved, reducing prognosis) and extraction. The patient opted for extraction.

Ideally, the tooth should have been removed surgically due to the patients thick bone, and the proximity of the roots to the RHS sinus. However, due to COVID-19 restrictions on aerosol generating procedures and patient preference, routine exodontia was performed.

A ligated bite block was placed on the LHS. A periosteal elevator was used to visualise the bone, wedging and levering forces were then used to luxate the tooth. Forceps were then applied, the crown, distobuccal and mesiobuccal roots were delivered. Upon clinical inspection, the palatal root was still present in situ. A straight Warwick James was used with wedging forces to dislodge the palatal root with good visualisation.

The sockets were then checked for OAC, which was not found, the patient was then given precautionary sinus precautions on top of the regular post-exodontia instructions.

The patient was a 39 year old male, who was a previous IV drug user, and was currently taking Methadone replacement syrup and Diazepam.

He presented to the clinic complaining of a dull throbbing ache from the upper right hand side, and reported a foul taste emanating from the involved teeth.

Clinically the 15 and 17 had deep composite restorations which were in close proximity to the pulp. Special testing revealed that the 15 and 17 were tender to percussion and mucosal palpation, tested negative to pulp sensibility testing and both had sinus tract stomas visible on the buccal mucosa.

A periapical radiograph which is seen on the left was also taken.

A diagnosis of pulpal necrosis with infection and a chronic periapical abscess were made. As the patient preferred extraction of teeth, extraction was performed for both the 15 and 17.

A ligated bite block was placed on the LHS. A periosteal elevator was used to visualise the bone, wedging and levering forces were then used to luxate the tooth, since the 15 was suspected of having two roots, luxation was performed as apically as possible. Both teeth were delivered through forceps.

Granulation tissue was seen apically to the 15, and curettage was performed for the 15 socket. The 17 socket was not curreted due to the risk of perforation of the Schniderian membrane.

The sockets were then checked for OAC, which was not found, the patient was then given precautionary sinus precautions on top of the regular post-exodontia instructions.