Creating a Distal Limited Defect by Surgical Exposure of an Impacted Third Molar. Prognosis and Treatment

Restoration of occlusion, speech and aesthetics are the 3 basic problems in prosthetic dentistry. A various number of materials and different treatment methods are used for its perfect implementation, depending on the pathological alterations (7). In most of the clinical cases, when a distal unlimited defect is present, the treatment is limited to elaboration of some kind of a non-fixed denture (4, 13). However, non-fixed partial dentures and model-casted ones are preferred neither from dentists, because of their pathological transmission of the occlusal pressure and loss of bone, nor from patients, because of their mobility. The great successes of dental implantology, practically allows the transformation of most distal unlimited defects in limited ones and their easier restoration. However, in a lot of the clinical cases this kind of treatment is impossible, because of severe bone loss and need of further bone grafting, close proximity to anatomical features such as the inferior alveolar nerve or the maxillary sinus; or just because of its unaffordable price for most of the patients (6). Fortunately, in some of the clinical cases the lower third molars are with well-formed crowns and radices, despite of the fact that they are impacted (semi-retained). That gives a possibility for including them in restorations, if a favorable ratio between the clinical crown and radix is developed by a surgical intervention (3, 10). The retained (impacted) teeth are most common for the permanent dentition (highest % - 3rd molar). Sometimes there are no symptoms, and the impacted tooth is found by chance, when a X-ray is done. Clinically the impacted tooth could be placed entirely in the jaw (bone), could be covered with mucosa and periosteum, or a little part of it has erupted (5). In case of an impacted tooth, there are several well-known approaches of treatment: ? Observation- divided in 2 periods: before and after the exposure. During this period of time no act is undertaken, but observing the germination of the tooth. ? Intervention includes an orthodontic treatment for a short period of time or a surgical excision of the “holder/retainer”, which the tooth cannot erupt. ? Transposition of the tooth can be achieved by orthodontic methods or surgical ones, as well: re-implantation of the tooth. ? Extraction ? if there is no option for the tooth to be placed in a proper position in the dental arc (1, 2, 14).