Getting one’s wisdom teeth removed is probably not on anyone’s priority list, but with modern pain control and sedation techniques, the actual procedure is a piece of cake. The sedation will put you in a relaxed, twilight state and your mouth will be fully numb so there will be no pain at all. I have to warn you though this video will show an actual surgery, so if you are squeamish about seeing blood, this may not be the video for you. Otherwise, let’s get started with Dr. Richard Gangwisch.
Hello. I’m Dr. Richard Gangwisch. In this video, I’ll be removing four wisdom teeth. I chose this case because it has the four different varieties of impactions: full and partial bony, soft tissue and simple all in the same patient. Here is an x-ray of our patient that we are going to remove wisdom teeth on. The wisdom teeth are in the back. We’ll start with the lower left one. Notice that one is angled down towards the midline, so certainly they are not going to erupt at all. So we will start with an incision, going down through the cheek to the gum tissue, keeping all that on the cheek side and staying away from the tongue side because there are some nerves there that we’d like to avoid. Now we take a periosteal elevator, that’s the instrument that will peel some of the gum tissue away from the tooth and expose the tooth. Now we’ll make another incision where the periosteum is. Now the periosteum is a membrane that covers the bone. So we’ll need to get that out of the way, since we’ll be removing some bone in this case. Sometimes this can be rather adherent, so it took a little longer in this case. Many times it just peels away fairly easily. There we go; everything’s exposed now so we can see what we’re doing. And we place that instrument on the tongue side called the lingual and that’s there to protect against the tongue nerve, the lingual nerve. Now, if you remember, that tooth was angled towards the midline there so we’re not going to be able to get it out in one piece. So first of all we’ll remove some bone around the crown of the tooth. Alright, now we’re going to go ahead and we’re going to make a split in between the two roots and take each root out separately. Now we’re going to make a cut with the handpiece there. Now we don’t go all the way through the tooth we only go about ¾ of the way. Remember there’s that lingual nerve that’s on the other side of that and we don’t want to mess with that. It’s rather an important nerve to have. All of the pressure is put in an upward direction, not side to side so that way we don’t puncture through to the lingual there. Notice, we have copious irrigation there. That’s sterile saline that comes from an IV bag. That’s to keep the heat down; keeps everything nice and cool. Now we’re going to get an instrument called an elevator in there and we’re going to snap that tooth into two pieces. Now we’re going to pry up underneath that and get one of those roots to come. Now this is only half of the tooth that you are seeing now. And we’ll grab that slippery little devil with a hemostat. There we go. Now we use a little thinner elevator to get down underneath the rest of the piece of that root. It’s pretty tight quarters under there. We apply a little bit more pressure in this case and now it pops on up for us. Notice there is some tissue adhering to the tooth too. There, that’s what that looks like, at least half of the root. Now there is a cyst that forms around the tooth, that’s very natural to be there and we need to get rid of all the remnants of that. We’ll take a hemostat to get ahold of all of those pieces. There we go. We’ve got all those remnants there. Now, we’ll irrigate the socket with a sterile saline solution to get rid of any debris that might be down in the socket. Now it is time to put the patient back together. So we are going to go ahead and suture him up with stitches. We’re going to use black silk sutures for this. I personally like to do this because they’re non-dissolvable. That means the patient is going to have to come back to see so I can see how they’re healing. After-care is very important. Now you’ll notice during this entire procedure that the patient hasn’t been flinching at all. He’s very comfortable. He has good local anesthetic so the area is totally numb, so he doesn’t feel a thing. And he’s very comfortable. He’s hooked up to an IV. We can do IV sedation for him and keep him very comfortable. Believe it or not, he won’t remember a whole lot of what we are doing here today. But the sedation is very pleasant and he’s very comfortable plus it’s very safe. It keeps his protective reflexes available so that if anything were to slip down his throat he would be able to cough it up and he doesn’t have any problem breathing on his own, so the level of safety is extremely high for that. And plus he will feel pretty good afterwards too as opposed to being put out on a general. He’ll go home, he’ll be drowsy and he’ll sleep it off. And we’ll put one last stitch in there. We want to put everything back the way we found it. That way it will heal very well, with minimal scarring. Should get a natural architecture to the area, the way we found it when we got in there. There we go. That’s what everything looks like, all stitched up.
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