pericoronitis
DESCRIPTION
Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth. its treatment- operculectomy i.e. removal of the inflammed operculumTRANSCRIPT
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PERICORONITIS Achi joshi
SAIMS, Indore
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PERICORONITIS • Pericoronitis is defined as
inflammation of the oral soft
tissues surrounding the crown of
a partially erupted tooth.
• The major cause is the microbial
flora that develops in the distally
located pseudopocket.
• The term pericoronitis was first
introduced to dental literature by
Bloch in 1921.
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CLINICAL FEATURES • Red, swollen, suppurating lesion that is exquisitely tender with
radiating pain to ear, throat and floor of mouth.
The diagnosis of pericoronitis is mainly clinical with three distinct
diagnostic categories recognised:
1) Acute pericoronitis,
2) Sub‑acute pericoronitis, and
3) Chronic pericoronitis.
These classifications are empirically derived based on how individual
cases arbitrarily fall into the three distinct clinical categories.
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1. Acute Pericoronitis:
Trismus, pain, dysphagia, extraoral swelling, malaise, halitosis,
pus discharge, sore throat, and anorexia. Pain may disturb sleep,
lymphadenitis involving the deep cervical lymph nodes may be
present.
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2. Subacute Pericoronitis:
Pain, dysphagia, intraoral swelling, halitosis, pus discharge,
sore throat. Associated pain is most often described as
continuous, dull, and is occasionally sharp or throbbing. Unlike
acute attacks, radiation of painful symptoms into adjacent
muscles is rare. The individual does not have limited mouth
opening. This is a distinguishing feature from acute
pericoronitis (Nigerian Journal of Clinical Practice, 2014 )
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3. Chronic pericoronitis:
It is diagnosed based on a history of temporary dull aching
low grade pain that typically lasts only 1‑2 days. Signs
include palpable non‑tender submandibular lymph nodes and
macerated buccal tissue consistent with cheek biting.
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COMPLICATIONS
1. Pericoronal abscess
2. It may spreads posteriorly in orophrengeal area.
3. Dysphagia
4. Involvement of lymph nodes- posterior and deep
cervical.
5. Peritonsillar abscess.
6. Ludwigs angina
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TREATMENT
PERICORONITIS
EXTRACTION
OPERCULECTOMY
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INDICATIONS OF OPERCULECTOMY
1. Availability of space for eruption of lll molar
2. Presence and proper alignment of antagonist tooth
3. Proper alignment of impacted lll molar in the arch.
4. Angulation of impacted mandibular lll molar in relation to long
axis of second molar : vertical angulation is favourable.
5. Position/ depth of third molar in mandible.
6. Prosthetic consideration: Requirement of third molar as an
abutment for fixed prosthesis.
7. Socio-economic reasons/ patient not willing for extraction.
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PROCEDURE
Operculectomy
Scalpel
Laser
Electrocautry
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SCALPEL
Operculum covering the occlusal surface of molar- lateral and occlusal view.
Complete removal of the operculum
clearing the occlusal surface
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•Incisions distal to molar
should follow the area with
greatest amount of attached
gingiva.
•It may be directed disto-
lingually or disto-facially
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Advantages
• Cost effective
• Better healing at initial
level is due to primary
healing by suturing.
Disadvantages
• Bleeding at surgical site.
• Post- operative pain.
• Local anesthesia required
• Suturing
• Swelling ,scarring
• Multiple visits of patient
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ELECTROCAUTRY
• Electrosurgery involves the intentional passage of high
frequency waveforms or currents, through the tissues of the
body to achieve a controllable surgical effect.
• The passage of current into tissue cause cellular fluid to turn
into steam, bursting cell wall and disrupting the structure.
• The electro-surgery has significant advantages over steel
scalpel based on incision time, blood loss, early post-operative
pain and analgesia. (Kearns et al, sumit M, k kaur, 2011)
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1. Loop electrode
is used in a
range of 1.5 to
7.5 mHz in a
continuous
brushing
method.
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Advantages
• Blood less field.
• Less post operative
pain.
• sufficient tissue shaping
ability.
Disadvantages
• Unpleasant odor.
• May cause damage to
bone .
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LASER
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Advantages
• Better patient co-operation.
• Bloodless surgical and post-
surgical event;
• Sterilization of the wound
site.
• Minimal swelling
• Less scar formation.
• Less or no postsurgical pain
Disadvantages
• Expensive equipments
required.
• Charring and carbonization
created by laser may
interfere with initial
healing.
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DISTAL MOLAR SURGERY
• Treatment of periodontal pockets on the distal surfac
e of terminal molars is often complicated by the
presence of bulbous fibrous tissue over the maxillary
tuberosity or prominent retromolar pads in the
mandible.
•Operations for this purpose were described by Robins
on in 1966
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• The procedure allows treatment of irregular osseous
defects and access to maxillary distal furcation area.
OBJECTIVES :
• Eliminate periodontal pocket.
• Maintain and preserve attached gingiva.
• Make area accessible for instrumentation.
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Factors that determine the flap design of a wedge
procedure
1. Size and shape.
2. Thickness of soft tissue.
3. Difficulty of access.
4. Band of attached gingiva of the abutment tooth.
5. Depth of periodontal pocket and degree of osseous defect
on the edentulous side of the abutment.
6. Clinical crown length required as an abutment for
restorative/prosthetic treatment.
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FLAP DESIGN OF THE WEDGE PROCEDURE
1. TRIANGULAR DISTAL WEDGE
Requires adequate zone of keratinized tissue and can be
used in a very short or small tuberosity.
Outline of the incision
Cross- sectional
view- removal of the wedge.
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Undermining of incision to thin
the tissue.
Reflection of flaps for osseous correction
Sutures placed to close the flap
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SQUARE , PARALLEL DISTAL WEDGE
• Indicated when tuberosity is longer.
• Allows conservation of keratinized tissue
• Provides greater access to tissues.
Cross- sectional
view- proper blade
angulations.
Outline of the incision
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Flap reflection and tissue is removed
osseous correction
Sutures placed to close the flap
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REFERENCES
1. Carranza. Clinical periodontology. 10th edition.
2. Edward cohen. Atlas of cosmetic and reconstructive periodontal surgery. 87-102.
3. N. Sato. Atlas of periodontal surgery.
4. Sumit Malhotra, Kamaljeet Kaur. Electro-surgery versus Conventional Surgery for Excision of Pericoronal flaps. Indian J Stomatol 2012;3(4):236-40.
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