Maxillofacial surgery or not? Here is the question... Part II

Hello dear friends!

Before you start reading this article, I recommend that you familiarize yourself with the “first part”, which I wrote almost 5 years ago.

The debate about where to remove wisdom teeth has not subsided so far. So hospital or not?

I constantly say that even the most difficult wisdom teeth are removed within 40 (do not expect complications Part I, Part II) minutes, but every second patient, coming for a consultation, says that he was frightened in another clinic with words about a three-hour removal under anesthesia and a week in the hospital.

After I say that often the removal of an impacted (that has not erupted) tooth takes 20-30 minutes, of which more time is spent on suturing, bewilderment is read in the patient’s eyes, and the facial expression is as if he wants to convict me in ~~3.14here~~ some cunning.

They can be understood. Even 5 years ago, I opened a CT scan of a patient with a slight trembling and fear of seeing an incredible hell there. And now the words “CHLH” and “three-hour removal” just make me smile. True, under this smile lies disappointment in some colleagues. Because not bone grafting, and even more so not implantation, is not a standard measure of his skills and abilities for a dental surgeon. If the doctor does not know how or does not know how to correctly and quickly remove teeth, which is the most common manipulation at a surgical appointment, then … I have bad news.

Of course, cases are different, I can not disagree. But these are extremely rare exceptions, not the rule.

So, about a year ago, a man came to see me with about the same concerns. Like, he will have teeth removed in a hospital, followed by an exciting journey from the ward to the dressing room and back (for about five days). It can be understood, because no one wants to experience all the joys of snoring and gurgling neighbors, injections in the ass and a nosocomial infection as a bonus.

“What nonsense,” I thought, and sent the patient to do a CT scan …

The beginning of spring that year was unusually frosty and nasty, although it usually happens that way. I, waiting for the picture, looked out the window and dreamed “of the sea and the sunset; how damn cool to watch a huge fireball as it melts in the waves. But that’s not all. Slush, wind, light rain in the face, dog feces at every step as an apotheosis.

Suddenly I hear a light “knock-knock”. This meant that it was time to “return to earth.”

“Ready!” the patient said, and we sat down at the computer together.

It has long been difficult to surprise me with the location of the teeth, but this time I broke into a smile – “finally something interesting.”

The patient already had discomfort and problems with chewing, so there was no point in delaying the removal.

After studying the picture and additional consultation with the therapist, almost all chewing teeth were sentenced, except for the left lower six. (pictured right)

After I warned about ALL the possible risks and consequences, plus the chance that the conditions for implantation in the upper jaw may not present themselves in the future, the patient agreed. I started by removing the teeth in the upper jaw on the right. (pictured left)

How long do you think it took me to remove these three teeth?

Important clarification!

I must note right away that I NEVER belittled the abilities of doctors in the CSF hospital. On the contrary, he always said that they had a job quite different and an order of magnitude more difficult than a conventional outpatient appointment. And spray on some kind of removal when they collect whole heads, like Lego without instructions, oh well. I can’t do it like this. So honor and praise, seriously. I think that an adequate reader understood all this without this remark. I trust in you. But I do not cancel the srach in the comments of those who read between the lines, trying to see what is not here.

Were distracted.

So, the removal took about an hour (more precisely, 70 minutes). And so that you understand: this is not work for speed, not a competition. The health of the patient always comes first. I am never in a hurry, even taking into account the fact that our clinic has a rule: if the extraction of one tooth takes more than 45 minutes, then the patient does not pay for it. Perhaps the point is that first you need to have experience in such deletions, and only then do it en masse. But, asserting yourself, you don’t need to puff and sweat over the patient for 3 hours.

Three teeth – 70 minutes (from anesthesia to the last stitch).

Hemostatic sponges were placed in the wells, the wound was tightly sutured.

About a month later, we started extracting three teeth in the lower jaw, which took a little less than an hour – about 50 minutes.

How do you like that, Ilov Max?

Next was the healing period. I note right away: from below, healing did not go as we would like.

3 months later, this is what it looked like.

Everything seems to be fine, but taking into account the fact that the mucous membrane recovers much faster than the bone tissue, it turned inside and half filled the holes of the extracted teeth.

I had to partially clean everything and smooth out the protruding edges. New blood clots formed in the wells.

A follow-up shot was scheduled in 3-4 months.

By the way, after the removal of an ordinary tooth, two months are enough before an implant can be installed. Of course, if there were no conditions for simultaneous implantation, which happens much more often.

Wow, and four months behind.

Well, this time everything was perfectly delayed and restored. The volume of bone tissue in the lower jaw is sufficient to install an implant in the area of the missing sixth tooth.