NAG’s Method - A NEW METHOD OF IMPACTED THIRD MOLAR REMOVAL?!?!?!.

NAG’s Method - A NEW METHOD OF IMPACTED THIRD MOLAR REMOVAL?!?!?!.

Hello  all,

We all know that the impacted teeth are those are failed to erupt. Impacted teeth will give many problems and often requires  surgical removal. Due to their abnormal angulations, obstruction in the path of removal, to spare the bone and uselessness of extracted tooth  (tooth is dentist’s, bone is patient’s concept) impacted teeth  are usually  sectioned (split in to pieces) for their easy removal. Conventional split methods are totally depends upon using  rotary straight hand piece. In our NAG’s method ,we suggest a different design of  hand piece or modification in conventional contra angled hand piece so one can split the tooth in a favorable  way  and  the main  portion of the tooth  in the  path of removal which obstructs movement of the tooth  is  eliminated . Because of this method the  removal of  impacted teeth becomes easy.

Impacted wisdom teeth are those are failed to erupt through the gum line. among all  wisdom teeth the  third molars are the teeth which are frequently impacted.  Incidence of the type of impaction is Mesio angular impactions ( more common  44%) > vertical (38%)>disto angular(6%)> horizontal(3%).mandibular is more common than maxillary.

Normally straight hand piece is used to split the tooth as shown in the FIG1.

 But the method has the following disadvantages.

1.limited accessibility with the inherent design .

2. Visibility is greatly compromised while performing the procedure.

3. Surgical trauma to the surrounding tissues will be more because  oral and perioral tissues should be stretched to the maximum extent to perform the procedure.

4.Thermal injury to the perioral tissues.  

5.It is our feeling that straight handpiece is ideal in distoangular impactions where the main obstructing portion can be cut favorably and  removed easily with straight handpiece as shown in the FIG: 4

Fig1: shows the conventional method of splitting the tooth. with straight hand piece 5 . Horizontal impaction is depicted as 4 and mesioangular as 6 tooth cuts are shown as 1,2 3

Fig 2: in NAG’s method  hand piece is modified like  7  and create  a cut in  a new direction, the cut is favorable and  which eliminates  the main obstructive part in the path of removal in mesio angular impactions. The angulations 8 between the handle and the head just opposite  to the conventional contra angled hand piece. angulation can vary from zero degrees to 75 degree where zero degree means the head is in line with handle and 75 degrees either side.

Fig3: modified handpiece in the treatment of horizontal impaction.

FIG 4:: removal of DISTOANGULAR mandibular molar with straight handpiece.

FIG 5.MODIFICATION WITH DIFFERENT ANGULATIONS

   

 

In one method we can modify the regular contrangled handpiece in the way shown in the diagram and can be used to spilt the tooth. Regular NSK contra angle  hand piece can be readily modified and be used. The angulations can be varied depending upon the operators preference and type, position, class etc of the impaction. The angulations can be any thing as shown in the FIG 5.  The modification is different for the   right and left sides. Modify the contra angle hand piece in such a way that the handle of the drill is away from the tongue and not interferes with the procedure. FIG 6.

In another method we suggest to use thicker bur to make the cut so after the cut the fractured mesial portion can be moved distally and removed easily

in some situations(partially erupted teeth, fused roots, a little or no bone covering, absence of root locking etc)the distal portion of the tooth is grasped with UPPER MOLAR or any suitable forceps and extraction force is applied in the path of removal direction (similar to normal tooth extraction ) . In the above mentioned situations the impacted tooth can be extracted non surgically. In some situations minimum surgical intervention is required.(fig 7,8, and 9)

The advantages of our technique are

·        with this method we can create a favorable cut   and  remove the main obstructed  portion of the tooth in the path of removal.(2 portion)

·        most often  patients will have limited mouth opening (trismus) so this design works well in limited mouth opening cases.

·        This is the best method  for mesio angular and horizontal impacted tooth removal which comprises nearly 50% of the impacted mandibular molars

·        Extensive retraction of cheek is not necessary.

·        Less invasive regular  buccal approach is followed.

·        Readily available contra angle hand piece can be modified and  can be used.

In some situations (mentioned!!)  the tooth is removed non surgically  so the  surgical morbidity is nil.

Disadvantage::

·        Some what blind procedure.

·        Some discomfort in holding the hand piece

    The non surgical method is not useful in deeply impacted molars which are covered by bone.

Thanks and regards

P.S::   NAG’s method is a patent pending method .if you come across any similar patent kindly inform us.