Mandibular 3rd Molar Extraction

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Preoperative Considerations

Consent:

  • IAN and lingual nerve damage
  • Jaw fracture
  • Damage to adjacent teeth/restorations

Anesthesia/Positioning:

  • Reclined (clinci)
  • Supine (OR)

Other:

  • None

Armamentarium:

  • Dental syringe and local anesthetic for numbing the area
  • #15 blade
  • Elevators (e.g., straight and curved) for tooth elevation from the socket
  • Extraction forceps (e.g., #150 or #151) for grasping and removing the tooth
  • 3-0 chromic
  • Gauze for cleaning and packing the extraction site
  • Surgical handpiece and burs (#703)
  • Irrigation syringe for rinsing debris from the extraction site
  • Hemostatic agents (e.g., gauze soaked in a vasoconstrictor solution) to control bleeding
  • Surgical aspirator for suctioning blood and saliva during the procedure

Technique

Postoperative Considerations

Immediate:

  • Gauze pressure

Follow Up:

  • None

Operative Note

Clinic Note

Local anesthesia was administered using [Name and dosage of local anesthetic agent] with vasoconstrictor at the surgical sites to provide profound anesthesia and hemostasis. Incision: Anesthetic infiltration was followed by a crevicular incision and mucoperiosteal flap reflection to expose the impacted third molars and surrounding bone. Bone Removal: Utilizing a surgical handpiece and appropriate burs, bone removal was performed to gain access to the impacted teeth and facilitate their extraction. Tooth Extraction: With the aid of elevators and extraction forceps, the impacted third molars were carefully luxated and extracted from their respective sockets. Socket Inspection: Following tooth removal, thorough irrigation with sterile saline was performed to clean the extraction sockets, and the sites were inspected for any remaining bony irregularities or fragments. Hemostasis and Closure: Hemostasis was achieved using gentle pressure and the application of hemostatic agents as necessary. The mucoperiosteal flaps were repositioned and approximated using resorbable sutures.

OR Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None

Specimen:***

Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Local anesthesia was administered using [Name and dosage of local anesthetic agent] with vasoconstrictor at the surgical sites to provide profound anesthesia and hemostasis. Incision: Anesthetic infiltration was followed by a crevicular incision and mucoperiosteal flap reflection to expose the impacted third molars and surrounding bone. Bone Removal: Utilizing a surgical handpiece and appropriate burs, bone removal was performed to gain access to the impacted teeth and facilitate their extraction. The tooth was sectioned using a high speed handpiece and with the aid of elevators and extraction forceps, the impacted third molars were carefully luxated and extracted from their respective sockets. Socket Inspection: Following tooth removal, thorough irrigation with sterile saline was performed to clean the extraction sockets, and the sites were inspected for any remaining bony irregularities or fragments. Hemostasis and Closure: Hemostasis was achieved using gentle pressure and the application of hemostatic agents as necessary. The mucoperiosteal flaps were repositioned and approximated using resorbable sutures.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

Coding

  • D7210 surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth Includes cutting of gingiva and bone, removal of tooth structure, minor smoothing of socket bone and closure.
  • D7220 removal of impacted tooth - soft tissue Occlusal surface of tooth covered by soft tissue; requires mucoperiosteal flap elevation.
  • D7230 removal of impacted tooth - partially bony Part of crown covered by bone; requires mucoperiosteal flap elevation and bone removal.
  • D7240 removal of impacted tooth - completely bony Most or all of crown covered by bone; requires mucoperiosteal flap elevation and bone removal.
  • D7241 removal of impacted tooth - completely bony, with unusual surgical complications Most or all of crown covered by bone; unusually difficult or complicated due to factors such as nerve dissection required, separate closure of maxillary sinus required or aberrant tooth position.
  • D7250 surgical removal of residual tooth roots (cutting procedure) Includes cutting of soft tissue and bone, removal of tooth structure, and closure.