Monday 3 April 2017

Blood and Pain and Suffering

As you all know, I enjoy inflicting pain and suffering on helpless victims, which include the pain and suffering I inflict on you all by forcing you to look at my handiwork.

Yes, I am a cruel sadist. Why on earth do you imagine I’m called Bill the Butcher? Huh?

All right, this 35 year old lady arrived with tooth pain in the lower right jaw. As you can see in this photo, there was an almost completely submerged wisdom tooth buried in the gum, with only the tip of one cusp showing.

I took an X Ray, which revealed a vertical impaction, in which the tooth is vertically embedded in the bone and gum. It’s quite a rare form of impaction, actually, and vertically impacted teeth are surprisingly hard to extract because they’re very difficult to loosen in the socket.

So I anesthetised her and started the job. Here you can see a periosteal elevator being used to detach the gum from around the tooth.

Then, with a Number 15 Bard Parker Knife, I cut a flap in the gum to expose the bone and as much of the crown of the tooth as possible. Here you can see the flap, somewhat obscured by already coagulating blood.

The tooth was mostly deeply embedded in the bone, with no way to grasp it with a pair of extraction forceps, so I cut a gutter in the bone around the crown, with a tungsten carbide bur mounted in a straight airotor handpiece.

Here you can see the gutter clearly, between the tooth and the jawbone.

This permitted me to introduce an Apexolever elevator between the tooth and the bone, and lever it  out of the jaw.

However, it did leave a gaping open socket...

...which I closed with a single black silk suture.

Any questions? Apartfrom asking me why the hell I inflict these on you, I mean?


  1. It's interesting to see the dentist's view.

  2. I was there once, but I was sound asleep at the time (not sure what he used, a shot of something plus gas of some kind).


  3. You said you had to cut a gutter in the bone to leverage the tooth out. Will the bone grow back?


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