Hi Dr Reznick
I would like some advice on the surgical approach to remove a impacted maxillary mesiodens on a 11yr old boy. Medical History is unremarkable
As always I remember you teaching about ‘only take out a tooth when we KNOW we can do it’. Although I have never removed an impacted mesiodens before but as a general dentist I have removed a lot of impacted wisdom teeth so I feel confident that I do have adequate theoretical knowledge and experience with wisdom teeth that can translate in tackling this case so I am approaching this case with good faith.
My approach is as follows
1. Full thickness muco-periosteal flap with no relieving incision on the palatal
2. Remove bone if required. I normally use a surgical motor + hand piece with a long flat fissure bur for wisdom teeth. Do you recommend a different bur for bone removal on the palatal? Is there a specific way to remove the bone? (E.g for wisdom teeth we always do a ‘buccal gutter’) Or just removal what ever bone that is required to expose the tooth.
3. luxate the tooth
4. Section the tooth if required. I would decoronate the tooth, remove the crown first and the root.
Please see attached an OPG + CBCT.
Thank you for your advice
Joe
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