Surgical extraction of horizontally impacted left 3rd molar.

Pre-operative view showing erupted mandibular 3rd molar.

X- ray showing horizontally impacted mandibular 3rd molar , Mesial root was in close approximation with IAN.

Molar sectioning ( 2 Parts) was planned for easy removal of impacted molar.

Incision ( with No.15 BP blade) was given till mesial border of 2nd molar and an Envelop flap was raised.

Then bur is used to create a gutter along the buccal side & distal aspect of tooth.

as per planning tooth sectioning was done using carbide bur. elevated crown (more a twist) and root popped out.

smoothening of sharp bony margins by bone file was done.

Thorough irrigation of the socket with betadine solution + saline were given.

Simple interrupted suture were placed to close surgical site.

Post Operative care instructions were given

A 37 year old male patient came to our clinic ( Smile Galleria) with a chief complaint of anterior teeth wear , hypersensitivity in posterior teeth from past few months and requested esthetic enhancement .

Complete medical and dental history of patient was obtained . Patient gave history of accident 20 years back , that time anterior were fractured and under went for root canal treatment in anterior right side of upper one tooth , that time dentist suggested him crown over R.C. treated tooth . but unfortunately that advice was neglected by patient himself. Other then this, patient gave a history of night grinding of teeth which was found to be the cause of wearing away of teeth . and also noted bad habit of smoking and tobacco chewing.

Extra-oral examination revealed no facial asymmetry or muscle tenderness . Intra-oral examination and radiographic investigations revealed generalized severe attrition and cervical abrasion and carious molar .

After complete diagnostic evaluation , treatment plan was designed to establish the occlusal plane at proper level , Full Mouth Rehabilitation of maxillary and mandibular natural dentition with anteriorly full ceramic and posteriorly metal-ceramic restoration after Endodontic therapy and fiber post and core for previously endo treated tooth ( tooth #12) and suggested extraction of wisdom tooth (18, 28, 38, 48).

The patient was explained about the treatment plan . he was agreed for all conservative approach , except patient was not willing for extraction of wisdom tooth (18, 28, 38, 48 ). And adviced to stop smoking and tobacco chewing habits . and wear night guards .
The aim of the treatment was to improve esthetics and restore occlusion so as to achieve optimum oral health for patient .
Photographs were taken for 3D Smile Design .

Study cast were obtained and mounted on a semiadjustable articulator (Bio-Art), using centric relation occlusal record and a Face bow transfer. As revealed from diagnostic mounting , there was insufficient height of several teeth . so planned to increase height approx 1.5 mm .

Full mouth ultrasonic scaling then Endodontic therapy of all natural teeth (except wisdom tooth )and crown lengthening procedure of several teeth was carried out . Putty index of diagnostic wax up was made section-wise which will help in fabricating provisional restorations later. Mockup preparation and diagnostic wax up of anterior teeth was accomplished.

The anterior wax up was checked to see anterior guidance . The anterior guidance was established using anterior plane. Then provisional restorations were fabricated with resin using the putty index and were shaped to achieve ideal contour and cemented with temporary cementation. After anteriors , focus was shifted to reinstate the posterior occlusion . A putty index was fabricated for the wax-up in each quadrant , then fabricated provisional restoration and cemented with temporary cementation.

The plane of occlusion was determined . After gingival displacement was , impression were made with single step putty wash technique. The working cast were articulated using facebow transfer and interocclusal centric record at previously determined Vertical dimension ( that was incleased approx 1 – 1.5mm )

The provisional restorations were fabricated using putty index by indirect technique ( with CAD- CAM technology-PMMA TEMPORARIES) ) and Luted with temporary luting cement .
Patient was analysed for equilibrium, optimum functional harmony , phonetics and satisfactory esthetics. After a detailed assessment , the final restorations were fabricated and cemented with resin luting cement.
Oral hygiene instructions were given to the patient and regular 6 month recall & check-up was advised

Patient is very happy with his new smile.