Distal Defect of Lower Third Molar

A 20-year-old woman requests extraction of #17 with distal bony defect (Fig.1 *).   Since #17 and 18 are close to each other (as compared to the other case), small elevator is not initially inserted between them without incision.  The elevator slides distal  (Fig.2 (occlusal view)).  Incision has to be made for better vision.  In spite of block anesthesia, pain is severe.  When local anesthetic is being injected into the lingual gingiva, the patient is shivering.  As the tooth is removed, a large piece of granulation tissue is attached to the tooth (Fig.3 D (green circle)), while a small piece of granulation tissue remains to the lingual wall of the socket (L (green oval)).  After debridement and irrigation, a piece of Osteogen Plug is placed, followed by 5-0 Chromic gut suture.

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Xin Wei, DDS, PhD, MS 1st edition 03/19/2021, last revision 03/20/2021