Sutures after removal of wisdom teeth: removal of stitches
Sutures after removal of wisdom teeth is usually imposed in cases where removal has been excessively traumatic for the patient. Removing them is a few days later, when the place of an extracted tooth was delayed so that there can occur spontaneous bleeding. The removal of the eighth teeth is often accompanied by time-consuming surgical procedures and can provoke some complications. Before you delete the eighth teeth, the patient should consult a surgeon — dentist, to determine the need for intervention, there are indications for removal.
Usually for the decision to use radiographs, but CT scan at this point can not only determine the indications, but also to represent the anatomy of the tooth as it is. In the process of the operation information from CT scan, will greatly help the doctor.
Preservation of wisdom teeth
Before you remove the tooth, the doctor needs to assess its functional significance, position, and accessibility for treatment. Now, the eighth tooth should not be removed if:
- The tooth is fully erupted;
- The tooth firmly in the tooth row, having distal, mesial, buccal or lingual tilt;
- Does not extend to the opposite side of the jaw;
- Has a tooth — antagonist, i.e. linked with the opposite tooth by closing the jaws;
- Has no carious lesions, or complications of caries, non-carious lesions;
- Has a lesion that can be treated therapeutically if possible full access to all tooth surfaces.
To estimate the location part in the closing of the dental arches by using visual inspection and radiographic methods.
If the tooth meets the specified criteria, remove it should not be. According to statistics, age of first lost teeth, as they erupt pretty early and experiencing tremendous stress. In the case where the sixth or seventh tooth removed, wisdom tooth may be the only possible support of a fixed prosthesis.
If the tooth is not fully erupted, but absent, for example, seventh—, you can consult the orthodontist to evaluate the possibility of pulling this tooth in a row for a subsequent prosthesis. However, this procedure is not necessary to rely — it also has many disadvantages.
The anomalies of the wisdom teeth
In each generation, the need for eights is lost, the jaws become gradually smaller, and so shortens the teeth. Many people are surprised to find when performing panoramic shots, the rudiments of eights they do not have. More often, however, the beginnings still formed, but the tooth is unable to erupt due to dystopia (wrong location), or retention (delay of eruption through the thickness of bone and mucosa). Often tilted towards the neighbouring sevens, wisdom teeth put pressure on the entire dentition, changing the position, including the front group.
Typically, the lower eighth teeth cause much more inconvenience, as they have larger sizes close to the mandibular canal, when the eruption formed the hood of the gums, which can develop inflammation.
The top eight also tend to dystopia, but under the force of gravity more frequently and more easily erupt in the mouth.
Indications for removal of
- The violation of the shape and position of the tooth;
- Injury to the cheeks, often seen with vestibular inclination;
- The destruction of a neighboring tooth as a result of close contact with the eight;
- Pericoronitis or inflammation of the mucosal hood covering the crown during the eruption;
- Abscess or cellulitis triggered by the inflammation of teething;
- Pain, swelling. Usually accompanied by inflammatory contracture (limited mouth opening), pain when swallowing.
Contraindications to surgery
Usually this operation is carried out as planned, and therefore, possible contraindications, selected methods of correction of somatic status. If there is a suspicion that in the course of the operation will have complications and also in case when the patient is in serious condition due to intoxication, operative intervention is advantageously carried out in a hospital.
If the patient’s condition does not require immediate removal, planned operations are transferred in the case that the patient has identified infectious disease, has significantly increased the pressure, temperature, revealed other vascular reactions. The state of the blood coagulation system also need to be considered to avoid uncontrolled bleeding from the hole tooth.
Anesthesia during the operation is mainly local, namely, conduction anesthesia, which disables the nerve bundle, innervating half of the involved jaw. If the patient does not tolerate local anaesthetics, has expressed fear or neurological disorders that will not let as quickly and efficiently carry out removal, it is advisable to combine anesthesia with sedation, or to remove the tooth under General anesthesia.
The removal of wisdom teeth
Depending on the scope of intervention, that is, the complexity of extracting the problem tooth, is the time of the operation, the skill of the surgeon and, of course, price.
On the day of surgery the patient is advised full to eat, then brush my teeth. In the chair all manipulations begin with the anesthesia. After the required area will lose sensitivity, starts the removal process.
If the tooth is already erupted into the oral cavity, do not rests in the crown and the neighboring tooth has curved roots, it is usually removed entirely by using forceps or Elevator, pre-separating the periodontal ligament. Conduct an audit of wells to ensure that no remaining particles of the root, and no cavitary mass (root cysts or granulomas). Superimposed on the wound gauze, which the patient after some time resting, and the doctor monitors his condition. After confirming the formation of a clot, the doctor may release the patient, giving the necessary recommendations, the standard for removal of any other tooth.
In the case when the crown of the tooth is obscured by gum or bone, access to the summit is difficult, the doctor has after the anesthesia spend incision, and then to saw the bone carbide cutters the portion of the jaw, which is impacted tooth. The tooth is sawn into pieces diamond Bur in order to remove the parts, causing minimum damage to the surrounding bone. All these manipulations are carried out with water cooling and constant irrigation with antiseptic solutions. At times such removal may last about an hour. Extracted the tooth match the outside of the mouth, in advance assuming the number and twists of the roots, focusing on the. When the doctor was convinced, finally extracted the tooth, it is possible to complete the operation.
The hole is usually placed in biodegradable material (eg. Alfoil) having essentially krovoostanavlivajushchim or turundas with antiseptic preparations (e.g., Iodoform). In some cases, for the speedy recovery of the space where the extracted tooth lay the material, stimulating bone formation, usually on the basis of collagen. Then the wound is sutured at the incision, wound edges are matched. The patient a few minutes after the operation, sitting in pre-op, biting gauze and hold the cold on the side of the face. These measures help to expedite the cessation of bleeding, and to avoid extensive postoperative swelling.
The imposition of suture material
Suture the doctor uses with a large amount of interference and deep hole left after extraction of the tooth. Purpose: to prevent infection, including the neurovascular bundle of the mandibular canal to avoid bleeding, keep pledged to the hole the material or turundas. In the case of significant inflammation of the tissues around the tooth before removal, suturing sometimes not made, but placed in the wound drainage tube, sometimes the locked thread.
The types of needles and threads
Variety of threads for suturing — at the discretion of the doctor, his experience and preferences. Disposable atraumatic needle at the moment — the gold standard of surgical dentistry. Absorbable sutures be used or not, the doctor decides, but must notify its decision to the patient. In any case, it is necessary to observe the patient, make the appointment the day after surgery or one.
The classic version of the threads for suturing — Sutures. Thread resolved themselves within 2 weeks, but in some cases can provoke the inflammatory reaction. In modern dentistry widely distributed thread Vicryl is a synthetic material which does not provoke inflammation. During his sucking — up to 30 days, but this period do not need to withstand, it removed much earlier.
Recommendations after removal
In the first days it is advisable to apply cold 2-3 times no more than 15 minutes. You can use any item from the freezer, wrapped in cloth. It is important not to hold ice for too long, as this can cause frostbite skin and neuritis of the facial nerve. The first three days are the most difficult because of swelling and inflammation until the third day only increase, then gradually decrease. During this period, you must:
- To refrain from bad habits, annoying solid food (this may damage the units and will have an irritating effect on the wound).
- After the operation it is not desirable to eat for two to three hours. It is primarily associated with the continuation of the anesthesia. While the tissue around numb pretty easy to bite cheeks, lips during mastication.
- In any case it is impossible to visit the baths and saunas, use any heating both local and General character.
- Contraindicated rinse your mouth until the removal of the threads. Apply oral bath with antiseptic solutions and rinses based on herbs with anti-inflammatory effect.
- After the third day should be carefully clean the threads with a toothbrush to prevent plaque.
It is possible that the doctor will prescribe remedies to relieve inflammation and prevent the infection in the form of tablets. Typically, such therapy is used only when the deterioration of the patient after removal onset of symptoms.
On average, the removal of the stitches the surgeon a week after surgery, that is, before the threads have time to dissolve. If there are signs of inflammation in the wound, suppuration, thread removed early conduct sanitation and, together with new stitches establish drainage.
The process is not too painful, but when that increased pain sensitivity can hold application anesthesia using gel or spray Lidocaine. In the process of removing used tweezers to separate knots and scissors for cutting threads. Assistant usually pulls the soft tissue of the cheeks to ensure the review the doctor.
If the doctor thinks the wound is healing slower than expected, the wear time threads can be extended. For faster healing, epithelialization growing gums you can use the ointment Methyluracil or solcoseryl dental. These funds help to accelerate tissue regeneration locally at the site of application.
After the removal of suture material repeated visits are not supposed, final healing takes place and all individually but as a rule, not cause discomfort. If suture material independently dispersed until the time of withdrawal, you should contact the surgeon for inspection. In any anxiety and anxiety symptoms after removal should inform the surgeon, not to self-medicate.