PMC3654636_01
Preoperative panoramic radiograph. The direction of the initial cuts is marked.
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fig1
A new panoramic radiograph was taken (Figure 1) which confirmed bilateral complete bony, horizontally impacted MTMs, Pell and Gregory's class 2C on the lower right and 3C on the lower left with the roots in intimate radiographic proximity to the IAN bundle.
Lower right MTM: (a) after amputation of the crown, rotary instruments were used to reduce the distoocclusal section of the remaining stump; (b) after an additional cut and sectioning of the mesial portion of the tooth; (c) sufficient clearance to the second molar confirmed.
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fig2
Next, a #10 round carbide HP bur, 2.7 mm diameter was used to grind away the distoocclusal section of the remaining stump above the IAN, well below the bone crest level (Figure 2(a)). Due to insufficient clearance between the third molar stump and the second molar root, an additional cut was performed on the mesial portion of the remaining tooth, at 3/4 of the diameter and it was fractured off with a Schmeckebier #81 straight elevator (Figure 2(b)). A sufficient clearance to the second molar was confirmed with a radiograph (Figure 2(c)).
Lower left MTM: (a) after amputation of the crown; (b) after reducing the distoocclusal section of the remaining stump; (c) after an additional cut and removal of the mesial portion of the tooth, to create sufficient clearance to the second molar.
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fig3
This side was somewhat more difficult due to less available space mesiodistally and significant resorption of the distal root of left second molar. (Figures 3(b) and 3(c)).
Six days postoperatively. Please note that the bone graft is radiolucent at this stage.
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fig4
A follow-up panoramic radiograph was obtained (Figure 4). 