:rumu{{las Case Report

nr:nirvlufltno sirutuarutotflun:rufiost

Surgical Removal in Palatal Embedded Premolar Tooth

ovililra, TUot Yt.u.rad

nau{ 11{u :R lril t{nl tltfl ilt{f:silururafxncta-ail0gr:

da v Ifl ? tinu: gu'llR ul?! g'll

Itcll4lu4vvrln 4 qililil I Rl{uluu-t1{?1nil 2560

Chamnan Chaida D.D.S.

Medical Service Department

Phothalae Hospital

Pichit

Sawanpracharak Medical Journal

VoLl Nog SeptemberDecember 2oo?

ctlunnouo :

:rEl.,lrudaBuru6.,:nr:inurmrwTunn::ilInsnr:rirf,ufl.,:qer (embedded tooth) tfrurririrhEJ:rand.,:d,,:r,trurffunuyrnrifiraarnr:ilanfluuirrrud *t+ u.,..:nftilrnirah.tfrty{a1u

rjrnuaytfirrl a1fln1:n:ronruluda.,:il'rnhinuflud +rs uas #2s frrlrshifiil:ihnauf,uu?rrruf,rurriau a1nn1y{rirHi.0f,y{uf[ud *rs uac #25 fl.,:aoati6ruuttnruilrn 6.,:rtruzuuq{

nr :fn urlor u n r : ri l a o n u #.,: or n u'u for fr rh s il r h n rt r ru ru a nr :in tn n u'i r fr r-h E r r s d lil fi nm t{{un:nfrau

Abstract :

This report presents a surgical removal of a palatal embedded premolar tooth.

A chief complain of this patient is a pain at tooth#14 area and referred pain to palate and

periorhital area. On oral examination tooth#14 is found to be normal but tooth #'15 and

tooth#2s are missing. Radiographic examination #15 and #25 tooth are embedded.

Treatment plan is surgical removal.The patient has no complication in a follow up visit.

uvtulf,uqor (impacted tooth) fiilra6.0 flu inurnr.,:riunn::ilfolElaroytutfim'.,:n:dfr

dkjarruT:n.:on{udriarrlT nl6 tn:rsfi frrhufirlatilrlngn:.,:ornf,unorrdu fiornr:i - A e J c x e v dt r 9l -<' - - '-t-1-.:-t-!.1^Y^----q-d{?lept?1{fl1:?rut0{flu d.,:1urlqofuri,,:rflu ilrorrTu ntan:rfidti.,:hifirlrymrtn 6J rnole

flryurdvrutdr.i a stu n { ru {dr ud r{riu nr: nulfiot n n1:n:?a d?Rrnda.:ilr n uaeal n

718 llulq tuold, v 6:

6l?::nu:sm:nut?{61t

f,u n n n aiuyrutfirio s rJl fl (2) da a nf, o.: riu

r-op"" Barnruv(a d.:lddnurdtrmnzua'lu

nr : r.ir f,u q ornr u'jr d1 rfi Ft il1 a't n uoa, "ta-Ae

,J11fi.:AnAntdueJln?161n :Afl Ae 37.5 :O{A\:qe )

tJ1 Ln ltn01 nr:ur og.:hilfi rfi oror n nr:6 n rda

iauav zg.zqJr

r{uAoffirmrufioalimpacteo premolar)(8)tn&

q

ltuLollittLuU vertical mia horizonta d.,rlu

n r : ai r f,u 4 o rir r fi a.0 :c{.,: a-u or:r u ri a I nf e rio r

alveolar nerve u6o mental nerve n1:Bi1v J w A , oe u

v,lu Fr nfl n?1 ilua gm{uu uasal{as [u?1a n fl 1:q

dvlqrtrnfl?nu tFrfll'{unna1{aEa.0uu2ni1n1ilgant

{n1Tfinu1?a{ Tetsch LLas Wagner 'jr'[u

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r c? f, ,e y vH1fl n?1yiU Fr nnaetaluuo n uasF] o{:s?{It{

qvdau n:1 fl n a:1 nfl u?t1{ LFt Ehl

uuotflfirfi3onfi1uuanuirrru sutcus rialfi${a 9 e d, u Al

tfi \:O n nlUty{ Fl'lU n1 LUU}lU nOtIt?lH?A1A

flun:rruuudqofirgtz'sr:ara.:sJ{dtrdfrur{sa rmtanrflo envetop ftap alri?aunntan'lfrum

d.,: gsr,rru(o) tfinunru?:Tilnttilt Lmvf,i.,:fi .,:

Dachi unc Howell nr{m'ir arihnr:oin1:rfiFlq

f,urderrnnfiil:srurru SaEJas 0.9 uayfl'r:q

u q X v v dvr{zuurnr:ta.ofl urilHrqcei'rJr{uiiriufl n?o\:fl u

vrolorshin.o vertical incision d.,:n'r:rf,T nhoc

nr:ur cl"r un d.oza.rf,u q n (local ization)u e JJ o J- a o v

Fr Flfl1{f,ilda{ tUfl 6ueil0 n:1n1Ttnn LUylUnfl ilv Yev 3 rriosvrulfiriaH rfralzfi m'.o6dn(u) lfinrhrfi.,:

rirlfi z ifi 6a n1:qr?atuda.:ilrn lortlo 16 q A ,A dv

8e61il1:fl naly\lu Ln [Uy{Unnno gFtu ilanuols

riaaaoiauae 4.6 lun:ridfrrlaElfif,unnad ov#.:rnmalna'nu6u:ma.oflu incisorInsdflnfluq{qqlaa Joo

ol mrn'h: n6fi nfi rirlfr ftJe silrfl uvr-un uvrnd i nciso r al a o nfru n n oiurir'lfr or-r flu fi nr: rnruqq

In fl fi ar rfi rriJ1a1nflu 4 rdr*u r.r'r nlfiuri01n1;il?qflu(') flR1?sillrutandnrau(pericoronitis;(el nr:ufi ofiu 11 uarnr:1fi ot

miaf,u uac6ni6iad.,:6anr:lfintrrir ai,rfid.,r

ntrriraiod uar'lun:ridfludriuftdfltf,tod l:nrjivrTuflur1un:rrudd z dap,riuflunprrflu6ldALUn:unnqsflnL:Un?1 Embedded tooth ii,:g{

voaVaAt*9lU 611m?Un1Ttfl gln\:U1fi :A tUO\:OnAlnY{UnAqq

artmqlunr:tfioflunorutufi z arnanlunitdurri r?illil6{n1:asa1sra.::'rnf,udfrr.:rda.rri'uqqqg

.46l),J6{1 rfi n rail1vll rllu 611 r14 n1t?\ uu a EJyl 6tFt 01 aqaa

^alvclAtVInnfl 1fl uaaErtFt u?fi :afi a1u6l't Lfi FIT?il nu tluq

rdaFl?1tJ14U1ILUUzA.:n:3Anfi:ALU{An n15dil

{ {e

rf, sf,urirururiaudrmua zurorratflunlunarru

u1?? a {m n::lnrhi ei'ilniu ifriu mri ofru{uorA.aJ^ouv

Fl1 Ltl4uil t{ FIU n n nlTtZO 3J n n nuz a\::1 nTlU f]u

n:sornrfitf,u (ankylosis) r{lufru uar 6f1rfi4

Iosii?lil utaarrmmn1.o:slJu lfiud nr, rfi n

(febrile disease) nr:16iui.,rf, (irradiation)

LUUNUv

r'[un?1 iltnfl a.r n1:rn ay{u n n?\u il1 rri'1.:orq 1 6-g0 flt'r Insral'{rcdun:ril6ir.td

I df ll9 \y6lFrm1 Ail tAnldy,lU Lnil1fl UAefl U Lnrilnni1

I A r l|a/ r r uufl 9rzo.::s!u noil LTylaFt'].: I yluqn:Til

te o O e a Aar n r :l{rir'Lr{r fi ot nr :wn a nr :f, u?l a.lf,u

m n::lnruu rina dnr.: dru Ly{ Ftlu tutn n::1n:I u t e : Jo r a

A1\:il nO Eil'hl nIUAU C,.: [U n1:il1l^lU n nUU{q

fr0.,::rt-trrQ maxillary sinus ?6urio ua"'[uI

rfl ui fi u r dr uu il.,:,u a.o f[u n nl da ci,r.] n n fi o.,jqo

uriu au uacrirlfrn ar Eri6 d.:nt r rir EIi.: fi fr fi

4) e) n1:rirfl!;hqndrrrnerutorflun:rur?ouUn 4 AUUtl 3 n.g.-E.R. 2550 Sugical Removal in palatat Embedded premotu Tmth 719

r-ia Elt6'urint^r rir eri.:ffludarilr n ifi u:n 6a

occtusat view roit?t1flTrlnruu a1nn1fl6i1rt rj:sifiilrsfruflnr:uirfi nr nflun a uunmo dm1 0 dlurtnl 6nufo rou frrh s fi ar n1:rh ouirr ruflu n:r ilfi a ss

t o, tgrrarr.,:'lTfluqoroqjdrunrnluilln mrnf,uqnraqj ?l21uu (#14) r?a1rdc'rarfir: kja-lv[udriuOdqgdtuLu uu?fi :o Ltn??a{y{u?1\: tH H{ LL6ln{'i1fl U n Fl

te oaA a uda-eidruuon i6fi aa.r6a ntri.:f,:ou:rnfluru

(periapical radiograph)(u) Ior sifi rdaufl Teuo fl

itfi 1ea shift tube technic) rfluifiuroi,ruuri.:

r a rflu 4 n raiaflu r fi ud o qjtuzr n::1n :lfi q ny-- , , ^aJ r- J enO{UUUAUn?1?fiOU LOEIL:iln1U Pa view Ua?A vdLnaufl:uuan:{6la1nrail}iil:cilrru 1 5-20

A Vy a V a d,fl1:FllJUIToUmTAUItUU tuutJlllt&tJ1fU 1

nud{rjfiflud *r s,zs odludo.:rlrn0,,:FI{uuu?:1u fi1nnu'irf[unorrdoulilmil triarrur:nrua.,:rfiuuiandrnudnuruuuu?ro{

ra'ou {rJrEilrjrnanauf,u rnuanflun:rru9 )- ..-. A _ a,J e ^ttou{ #14 rila e ilfrunr mcLnflflnfruilu

Ja,JyrJ'[ila 1 unua2

nmflr?olilrio.rrJrn

n:Euani.,:e uda{dlf,uqoroqidruruFrlu rmtanddrubuccat uacdru patatat ta.,:flud

tunr.,:n#urYu mnfluqnmdaun:.:firruriunr: #14, 16, 24, 26 unruirerutnfirds.: flud)tnAau?a.: n:cu a ni{fi udo.,:'irf,u n n o Ei

y 3u *aA A o" o

druuan uanornfrEi.rffi66u 1 fiqnrirurtfilfi u ri n r n i.,r f, u a nd0.,: rJ r n rfi or vr rlu:l fi n

(panoramic radiograph)

?1r,.r1il3iihUll

{rJrazreilnu a1q zt fl ruriunr: ilareJ:rnflu trrhlqu6.:u?mrulfrnr 6rn1treJa:fl l*1ytit1ullunfl ::il l:{ilsruralfl msLa d?u rmi a nluria.rrjr nrtrhl fi n1:a-n rdu rf, n ria s

t van 1 r9r 3? o It't{ R lyto'tui{ d

a1 nR1il ri1 ct i.,: etu?ia.:ilr nzfi n:a u

qA Io1n1: U'loufl'rfu1^lu9d # 14 rrarrhurarilr:

:rnflu(periapical radiographl nu'jtf,ud#10, 24, zo rjnfid hifi:osrl triflufinelrB

I

6{n1flila1fl:rn flud #14 flufi otd amatgam

{rJrarjfi raol:nrJ:vqiT rir uavilfr ra

#1G, 24, zo rlnfifi hiyrufi:aflru dauflud

*t+ r,.rufinr:u:rucfirEJ urutg", firuoccluso-distal uit?fu margin fi :aafi urfi nrias

n r : 6 u.,r rir ? a.,: f, u rJ n 6 n 1 : rior d u yrs.,: d o.0 {1.:

tfluuuu Angle Class ll Molar RetationshipA q J yh a F a

HA m1eryiu{ #1 4, 24 f{tl? uila1n1flouusL? fu

&aunvul{ ni{fi ar nr:ilr n EU I u3r? 6u r?t n1u

rlr nirrlr..lou6.,:1fi'nr Ioufi arnr:il1il:csJ'rru

t m'au

lcluts?nnNR't:uflYtu

En1:ufi El1 hi rn elu auvflninur rir'[ul:.,rfl 8l1U1Ail1riOU n',tlriri'Ulafr n 1 1ot7oAArd&,dilaatiln:u:oYr uy{o: 87 n:itnaulYt

filling dru occluso-distal fi marginal leakageIrd

urihinuiinarEanrndalu:1n uinom;u,it:,vJ

ua1Hflfly{ua #14, 16 une #24, 26 nuilflud *ts, zs f,ori'rod InaaEflnf,ila1tr:1n

720 I.lu'rE ruel 6{?:tnu?rt1:nut?t611:

q)

v{ut #14, 16 ttas #24, 26 il',rn Inflf,Ud

#15, 25 uoumr.,:aa"[uttu'] oblique Inurir

flu1crownl aq-lrJnr,ofiru palatal uaffirnflu

flilnr.,:firu buccal'uor:rm'jT.,:flud #14,

16 [tav #24,26xqo r vdf OgaaJLnil'] n''l :Al UR1?I:.1 6t tFl U L{? E'LA AU

n:cuani.,:f,(Pa shift tube technic) d.:rflui6

ur ol"r um ilrz a.:f,u n n n5of,u rfi ud o dtuqsr re v t , aal 1- o'

fl1n5TLn:LAnfl no{uuuaun?1?E8u LFrUL:u

drs Pa ri"* *firrdaun:cuofli.,:f,ornt6ru

ldil:rrrru 1 s-20 o.,:nrluuurflu flu'hfru/ r, va , q

no 16auliln1il nrsuonfnf, rrarr.,:'irr{unno Erqq$

,rlutytFllu

A.l at?fin11?nu]

finEnmlortlnr:rir infraorbital nerve

block drrun-u greater palatine nerve block&

!!as nasopalatine nerve block ornulutflo

ttap lorsi6 envelop ttap Infl?irfiat{r.:i*t

or n firutar riau lor Hninnrilqontfiionalnuir?il second molar 1il6.,: oistat to.,r

centrat i ncisor In EJ tiu uue n ar.:l{rd a fl 4.,: riuavlnlttRnaun:1gaa nasopalatine nerve LLac

artery ornrfu'lfi periosteal elevator tflnoq

palatal flap aanornnreen ttlfilJ?u1n 3-0

i.rfl flap Is.,:ri'ur{ufi1un:.:fi1il rfr ohl'rfiut u u I I rv dY u

u:t?turJlnndntou LnA LilmA{ [d retractor flU& au

flap alnuuLt round carbidebur n:an:3ofl

n:osir uril.,: dhvTulo E dilrird *r s riaulq u nr:'ltnrfl rir ui.:fl il:snou n:aou tfi urr"?flu In a

fi at:rr",: nr:n:fl q n:1 nfluflt r 16 u.: rd a,:

ornaeilnf,:rnflud #14, 1o mn rdauf,ufir{

f,uorvru'iroirfluza.,:d *t s m'ururmr,,:firu

palatal uaffirnflufi'ultlmt.o buccd md.:orn

rfulfi tissrre carbide bur n:amitn"rflul#

uu noofl 01 fl :rn rrfitlfr etevator ior d'rfluaon, &on J

il1nAu Alnuu tt bayonet [ng?{ato'l6l?ufl n

f,ua o n rur mrrda.:'ir.:d d'rfluo d In stfitaun:safl [fl u fulcrum rrf,rriT rriur6srfiu'lu{J A Av q Aq #25 rilonton:rannfi iloaaanilu?1T{u1f

{q{

drY.:a EfluLtut verticat lor sd'rf,ud{uuu LLac

:r nf,uo qj rir.: rurulil rYu nr:nr:rEur d'r)-J

(alignment) fl4.09 #14 uav #16 fia{o1nYl

E1fluaanil1?1ilnufi? tfr curette ?tntm follicle{J v ov v , Jmnnnl{aan lfi ]1ila ua?nTfl url{?ouflTrnnil

tfir{lu fulcrumlfrrisu tfif1rn6o (o.e% NSS)

6nfir.:urua'[ficvarn'lfiiirnn patatat ftap tfrv)e.vd

rfi rfi rruurTun:vrrfl tvrFrluriouma.,:orntEu-tlo

tfirirnr:td clear acrylic base plate (palatal

pate; drirrnisillildtfi{rJra lorarynarorfiorv q J q e - oynul^lutTloila.:nun1:rn0 hematoma LFrflap

A rd, drT{0 flap Qe[n Lilu?tJllacfi1utT?

rna-.: rirn'or {rhslfifu Elr I buprofen 200vv,taae

ilaan:il :ulj:sil1un:{as 2 LrJn 3 L?41 ila{orur:r[ufi Serratiopeptidase s fiafiniru

&cven:{Au 1 tilA ?UAs 3 L'lA1 }14\:O1t11: [[Ag

special mouth wash aufituilrn 1il16'hi

uT rJfr fi rururi {rJ'l u rd o.,:or n1r,[6fi nr:fi or rf,a

mtanr:nsalrfamiadomu n or nu&u6 n g i'u9tuaillnan clear acrylic base plate aofl ltlu?'lJ ud ,d v en dYtttr.lafl{iln1:u?ilagtafluafl zuil?uil41n11{{

d a tv rrl rdtauu:[?6uttzuao gulit ttrl |,ilil41n1:to{n1:

Ua^X-&a

ant6lufi:0flntf,0 fin{a1nuuon 7 ?u uoril1

n-nlfi runu'ir fi nr:fi r s?o.i ur.r ail n A rirh uki

uYt 4ouuyt 3n.u.-E.nnr:rirf,uil{qn Crurrnrutarfun:rurlouRemoval in Palatal Embedded premolil Toorh

fiarnr:rJantn jad?oltot

fi .,r ufr nr:rfi orflu n ntuflu n:1 ilfl o EJ

ovfiIanranuhiur nrin fi n'rru uoifi,i'nrfl u

rlrgnrd.ttilu fr a.: ufilr uudo.:or n ner il sitfl uOeLurnum:tfr orngr6anltitdl.,t g niu n1:tfi n

gq.,:urlcyst formation) neoplasm un#,rlfr:rndt e d Xvaflu{r.:ffi g.:rfr nn1:acms uanalniiei,,:fi rualu

,dooruo n'',:auflud fi oil n fi or n nr:aru 16lu

arch length [asn?1il6t?uit1il 6{n?:fior:ruri6nr:tn 1 fi orr rud atrr:nri,r'lr{fludu rurtu

da.: rJr ntrl'tdrur n n,ir n r :o a ufludriu a, n g:rJt

4.-- .- -r- aaa a I e adf,irl'ru?1rJ?E',n1finMri1{ I nufi a1uT6 uoiac^dil

OtT6fr ar ffi na1 il 6t1rJ1:n :cetsnal uarrirlfrqir El

un n sir.: n-u aiodddqndruiu {dr a 6ooqU

nr:rir nr:ufih n-t uoi r3rlt,rur}y nr fi r n ah.Je fle qi dr

-A {lu u )a1 qua g y,luil t0 n1 6lnac{u [6] t0\1n1 ufi a.:fr--- 9 a a q Y ah.6l ouy{u rnum:0 0 0uyiuu.ruufr lil u oilila Ft

a o n n1 til n fi a a nhjln slri,l"r rfl u fr a.:rir nr :rvaau

airrrlor uncil5a{nfludufirs a1nn1:6nmr?u??il{ailard sa riu rda.,rdnu.ir dauln qj rfl u

uil nfl ilfl rJ,,nu {d? u nr:fi ntntu fnurusfla.:-.-..-.-e_-q J 3ua tdy.:ru1oEflur5a.:iieirfiaqjihiaailrn uacrfl unr:6nur fro un #.:a1 nrj:crh frdr u dor..'o

rirtfitd{o ry

a ntl a ru q :oi d,o 0". n,ft u n:nidvru16'hi il a s rin uasfr o,,:t{rr artu nr:fi rr rn n

zuau1u

tu {rJe u:r sd tffiu nr:inurln rr.vqAr,

n1:ahd'atorr{uAnaanriiarornlilalsJtntfr-y-! 1v y-tt- 4 e A11U?Ur0{ [a tilT1rBlil?EJilar EIE\] ta EJ t?a1fr

f [uddnrn'nr r rn{u uorlfi unstri ar rur:nlinr:

TIUEI #14, 16 uas #24, 26 rutn frdraffi orornrnjrprflu{ror6s.,: unnllahrliloufi .:

u?nrulfrnr rntalunrir unsororfl u6t1rfi mo\:

nr ale n fi:uetfid.r ao n n fi a.: riu nr::r EJor uz a.:

Lopes uarnruc(l df, nur6.,:rfi ailatunl:airfiu q a rrrrYo 6rt, u n a-r nr:q na. u o, nu..,,

rfl u ilcr5,,: tu rdaoza.,: nr:aurTu aiile fl fi nr:auf,u uacnl:riEr.,:flud 6 un,s a ru iutfiil:sn au ffu {rJr arJfr raonr:fnr*r?11\: n1?uvu

ilunn:tilJeoy'lu

Aqu:r Er.truiitu nt:rfi nflu f,o n or aof,u

n:rl.rrio a'[u {rJr udra d firuryr aru uartfiiunr:airflu f,o q rdu u n ar a nr:nir rinyrud.rar rur:ndrr{u fl.,: 4 n a o n rurlfi uarhi fi nmcuvr:n{au'ln 1 d.,ri6 nr:oi.,: n rim ar m:n rjr}ltfr rfl u uur mr stu nr :i fi o fs ua vn1 :;n u1

lfrriahl

u q Xs o

oaf,ulffn r:r; oir umri.:tra.:flunn afllnfr:rnqg

722 llillq runld, v 6'

611::nu:cu1:nuL?{d't:

lonm:ol.loil1. Obiechina AE, Arotiba JT, Fasola AO.Third molar impaction:evaluation of the

symtomps and pattern of impaction of mandibular third molar teeth in Nigeria.

Odontostomatol Trop 2001; 24: 22-5.

2. Chu FC,L| TK,Lui VK,Newsome PR, Chow RL, Cheung LK.Prevalence of impaction

teeth and associate pathologies:a radiographic study of the Hong Kong Chinese

population. Hong Kong Med J 2003; 9: 158-63.

3. Quek CKT,Tay KH,Toh SL,Lim KC.Pattern of third molar impaction in a Singapore

Chinese population:a retrospective radiographic survey.lnt J Oral Maxillofac Surg

2OO3;32: 548-52.

4. Bishara SE. lmpacted maxillary canines: a review. Am J orthod and dento orthopedic

1992; 101: 159-71.Jto v - a < &A d 6o v5. tzaltn il{ddn.Oral and maxillofac surg. lltJv1n:{?l 1. nfltYlv{tJfi1unl: lEufl]nflU--laf,{.,1; 2536.

6. Punwutikorn JWA, Ochareon P. Symtomps of unerupted mandibular third molar.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 301-10.

7. Lopes V, Mumenya R,Feinmann C, Harris M.Third molar surgery:an audit of the

indication for surgery,post-operative complaints and patient satisfaction. Br J Oral

Maxillofac Surg 1995; 33: 33-5.

8, ou-ud' r,.rrd'aariunn.flunn.ranrtlrilTenaunl:6tou n:eu?ue{lrTaHaranirio.*:il1n2

[online] zooo trz f.u.ruio:, 1 (1): (28 screen). Available from : http//www.dent

cmu. ac.th./mis/ dis/UserFiles/File/ surg.

n.l:ilrfl uf, ,rnn drurrnutorfl un:tulauRemoval in Palatal Embedded premolu Tmth

n r u dru 5{a*fiisruriiuurio u u avfi ff{Eirv1uflr qo z frrJo r #

grlfi r #nurusrTufl.,:d *rs uns #2s uirrrurrnrorru

,igrJfi z uBrrru*ryorunrar#rnr:airf,ufl.,:d #1s, #zs z ffi)n-tvi