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Medical Forum / General / Dentistry / May 2008Wisdom tooth extraction and ligaments
I will probably need my upper wisdom teeth extracted soon. I read in a couple of places that the oral surgeon is supposed to use a "burr" to remove the ligaments and the first milimeter or bone in the socket. Is that something that oral surgeons routinely do, or is it something I will need to hunt around for? Thanks. >I will probably need my upper wisdom teeth extracted soon. > >I read in a couple of places that the oral surgeon is supposed to use a >"burr" to remove the ligaments and the first milimeter or bone in the >socket. Is that something that oral surgeons routinely do, or is it >something I will need to hunt around for? Thanks. Who told/sold you that wagon full of excrement ? Routinely remove impacted WTs in my practice. There's nothing to it for an experienced surgeon, and rarely do I ever need to a use a rotary instrument for uppers. Am beginning to think that "Robert" is a troll in the 'classic' sense. We may have been had, gentlemen. > Who told/sold you that wagon full of excrement ? > > Routinely remove impacted WTs in my practice. > There's nothing to it for an experienced surgeon, > and rarely do I ever need to a use a rotary instrument > for uppers. Huh? Obviously I'm hitting on some kind of nerve here, no pun intended. Why exactly is this an unacceptable question? I just started researching tooth extraction since I may need one and I came across it. Please explain. I hate doctors who say don't read up on procedures you are about to undergo. > Routinely remove impacted WTs in my practice. > There's nothing to it for an experienced surgeon, > and rarely do I ever need to a use a rotary instrument > for uppers. Ok, most of the articles I found are on some dentist's website or another, so I am trying to find a "scholarly" article on it. But in the meantime, please explain why this question elicits such a reaction? >> I will probably need my upper wisdom teeth extracted soon. >> [quoted text clipped - 13 lines] > > We may have been had, gentlemen. Don't know your dental school vintage, Newbie. We actually were told to curet the sockets esp. of teeth with molars. The alleged problem was PDL tissue containing epithelial rests, which I suppose were supposedly going to magically transform into cysts. Of course we were also culturing root canals back then. Robert--I think it's time to get off the web--newbie is right. Curetting (much less rotary instrumentation) is hogwash--extra pain, delayed healing and additional trauma for nothing. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Don't know your dental school vintage, Newbie. We actually were told to > curet the sockets esp. of teeth with molars. The alleged problem was PDL [quoted text clipped - 4 lines] > (much less rotary instrumentation) is hogwash--extra pain, delayed healing > and additional trauma for nothing. Thanks - so the ligaments are basically just absorbed into the bone structure or something? >> Don't know your dental school vintage, Newbie. We actually were told to >> curet the sockets esp. of teeth with molars. The alleged problem was PDL [quoted text clipped - 7 lines] > Thanks - so the ligaments are basically just absorbed into the bone > structure or something? Half the time they come out on the root. The rest of the time they degenerate and/or resorb. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>> Don't know your dental school vintage, Newbie. We actually were told to >>> curet the sockets esp. of teeth with molars. The alleged problem was [quoted text clipped - 10 lines] > Half the time they come out on the root. The rest of the time they > degenerate and/or resorb. It seems like it would be an easy thing for the oral surgeon to remove the ligament tissue with the tooth, so I wonder why don't they just don't do it? I'm trying to remember my biology classes from college: does bone reabsorb non-bone tissues? >>>> Don't know your dental school vintage, Newbie. We actually were told to >>>> curet the sockets esp. of teeth with molars. The alleged problem was [quoted text clipped - 15 lines] >I'm trying to remember my biology classes from college: does bone reabsorb >non-bone tissues? You really are a ditz ain't ya ? Look up the size of the periodontal ligament. Though I doubt that information is online, but it may be. Practicing dentists have seen the PDL often enough to recognize it in a gross specimen. And that's 'gross' as in gross anatomy. It ain't the teenage meaning, Boris. Big Huge Frakking Hint: It takes a microscope to even view the periodontal ligament structure. Unless you took Histology in college, and specifically a dental histology monograph, doubt that this was even covered. Hmmm.... This forum is not the place for a complete course in histology. And yet I am willing to recommend that you consider the chapter(s) on "Connective Tissue" in any basic histology text. Learn the difference between a ligament and a tendon. What is periosteum ? Can you identify a chondrocyte ? What is the function of an Osteoclast ? Try not to twist your two neurons connected by a spirochaete into a knot. >>> I will probably need my upper wisdom teeth extracted soon. >>> [quoted text clipped - 24 lines] > >Steve They didn't exactly teach us impaction removal in DS '84 Learned from a couple of good surgeons after graduation. If there is a follicle, I remove it with a curved hemo. really simple, and the PDL comes with the tooth. There really is no need to currette the WT crypt, unless it is filled wth lots of granulation tissue, even then, using a sharp periosteal and a curved mosquito are still the best instruments for the task IMO. > They didn't exactly teach us impaction removal in DS '84 > [quoted text clipped - 7 lines] > a sharp periosteal and a curved mosquito are still the > best instruments for the task IMO. Ok, so it sounds to me like removing the ligament tissue is not a bad thing, and no one really knows what ultimately becomes of it, so why not just remove the stuff routinely? Seems like a no-lose precaution, at least to a non-professional. >> They didn't exactly teach us impaction removal in DS '84 >> [quoted text clipped - 12 lines] > remove the stuff routinely? Seems like a no-lose precaution, at least to a > non-professional. As I said, it is normally attached to the root. If there is extensive granulation or other soft tissue, it usually can be picked out pretty easily as newbie said. Usually these are teeth with long-standing, chronic infections. Often the granulation is adherent to the root as well. Steve >>> They didn't exactly teach us impaction removal in DS '84 >>> [quoted text clipped - 19 lines] > >Steve Yes, and stated so well. Took a #17 out today, pericoronitis, profuse granulation tissue around the crown, and a 1mm thick follicle remnant from buccal groove to lingual groove, distal aspect. The follicle came with the tooth as did the PDL. Removed all remaining granulation tissue by the technic previously described. 3/0 gut X2. SB, you have the patience of a saint. Any way for me to nominate you for that title ? No matter, would really love to share a steak dinner, with fine single malt, lobster on the side, and NY Cheesecake dessert with you and Amatus. Is there any chance we can put this together ? If we all chose the same C-ED course we can meet anywhere in the USA... >>>> They didn't exactly teach us impaction removal in DS '84 >>>> [quoted text clipped - 38 lines] > If we all chose the same C-ED course we can meet > anywhere in the USA... Really should be able to. I've almost never done any real traveling for CE hours, but I'd do it to visit--Marie's always talking about going back to Michigan. Biggest problem is the kid's schedule--a week here, a week there--but still should be able to work something out--I hope. Steve >>>>> They didn't exactly teach us impaction removal in DS '84 >>>>> [quoted text clipped - 45 lines] > >Steve Since you mentioned Michigan, and I want Amatus to fix #'s 19 and 31.. Summer Solstice anyone ? If we are able to agree on a time and place, I will be there and buy us all dinner, drinks, and dessert. > Since you mentioned Michigan, and I want Amatus to fix #'s 19 and 31.. > > Summer Solstice anyone ? > > If we are able to agree on a time and place, I will be there and buy > us all dinner, drinks, and dessert. Everything is a negotiation here--but I'll see what I can do. Steve This will potentially occur near the Amish :-) AC >>>>>> They didn't exactly teach us impaction removal in DS '84 >>>>>> [quoted text clipped - 55 lines] > If we are able to agree on a time and place, I will be there and buy > us all dinner, drinks, and dessert. >This will potentially occur near the Amish :-) > >AC As long as you and a fine bottle of single malt are there... include me in. Of course SB gotta be there too. Forget that tractor comment, you are going to need a draft horse and a barn. I'll be at the airport to pick up the two of you no matter what. Signature/ Amatus / > >>This will potentially occur near the Amish :-) [quoted text clipped - 8 lines] > Forget that tractor comment, you are going to need > a draft horse and a barn. > SB, you have the patience of a saint. > Any way for me to nominate you for that title ? I agree. SB is Da Man! >> SB, you have the patience of a saint. >> Any way for me to nominate you for that title ? > >I agree. SB is Da Man! OK Roberto, youse a guy in Cuntneticut, eh ? Gall dern Yankees. Have a bit of history in the NE quad. Gonna give you a break, sonny boy. Don't be a w.nker, and I'll be nice and answer your questions to the best of my ability. Amatus and me have sat down face to face more than once. He may tell you that my ng persona is much different than IRL. He would be speaking truth. Capisci ? >>> SB, you have the patience of a saint. >>> Any way for me to nominate you for that title ? >> I agree. SB is Da Man! > > OK Roberto, youse a guy in Cuntneticut, eh ? > Gall dern Yankees. You're not a Boston fan, are ya? Not many New Englanders here. Whatever happened to Charle Ruff? Don't know much about NE CT. In a prior life I had a GF in New Haven. My old bike club had weekends occasionally in Litchfield County, which was pretty brutal when I wasn't in shape. Steve > Have a bit of history in the NE quad. > [quoted text clipped - 8 lines] > > Capisci ? "Steven Bornfeld" <dentaltwinmung@earthlink.net> wrote in message > You're not a Boston fan, are ya? Not many New Englanders here. Na - more a Yankees fan. Of course, in South-West Connecticut a lotta Mets fans too because of the now teamless Bobby Valentine. Me, I'll take a good NFL game over BB anyday. >> Gall dern Yankees. > > You're not a Boston fan, are ya? When do they play the Cowboys ? Looking forward to that game ! How 'bout them Mets ? They still suck right ? Actually lived in Boston for a season. Paul Revere, dentist, silversmith, dinnerware supplier ? Heard something about laterns and a horse. One, Two.. Land, Sea.. Hike ! Old North Church... And just where is "Old Iron Sides" moored ? Is it any where near Plymouth Rock ? Wasn't there a cracked bell in there somewhere ? Mebbe that was Philly... Durgin Park, a fine place to eat lobster. And there was Cape Cod and all that huey... Would have to look that other stuff up. > On Fri, 02 May 2008 13:46:19 -0400, Steven Bornfeld > Durgin Park, a fine place to eat lobster. Correction: Durgin Park WAS a fine place to eat lobster. It is now a factory-style tourist trap relying on its past reputation. Saying that the food is mediocre would be generous. >> On Fri, 02 May 2008 13:46:19 -0400, Steven Bornfeld >> Durgin Park, a fine place to eat lobster. > >Correction: Durgin Park WAS a fine place to eat lobster. It is now a >factory-style tourist trap relying on its past reputation. Saying that the >food is mediocre would be generous. Good to know, I was about 8 or 9 at the time. >> SB, you have the patience of a saint. >> Any way for me to nominate you for that title ? > > I agree. SB is Da Man! Amatus, can they do that? My people don't name saints, they just have big funerals with motorcades... Steve >>> SB, you have the patience of a saint. >>> Any way for me to nominate you for that title ? [quoted text clipped - 5 lines] > >Steve Those as you described are only for high level whacked mafiosi. Or not. <hehe> You related to G. B. Hinckley? SignatureChristopher A. Young Learn more about Jesus www.lds.org . On Fri, 02 May 2008 13:40:58 -0400, Steven Bornfeld <dentaltwinmung@earthlink.net> wrote: >Amatus, can they do that? My people don't name saints, they just have >big funerals with motorcades... > >Steve They would have to declare that were converted at the moment of death. AC Ugh, back to 4th position studies >>> SB, you have the patience of a saint. >>> Any way for me to nominate you for that title ? [quoted text clipped - 5 lines] > > Steve > They didn't exactly teach us impaction removal in DS '84 > [quoted text clipped - 7 lines] > a sharp periosteal and a curved mosquito are still the > best instruments for the task IMO. I agree 100%. Steve I bet Robert foudn a Homeopathic site that was trying to justify excesive fees for extracting perfectly good teeth with RCT's Amatus Working on H.E. Kayser, Op 20 right now >>>> I will probably need my upper wisdom teeth extracted soon. >>>> [quoted text clipped - 36 lines] > a sharp periosteal and a curved mosquito are still the > best instruments for the task IMO. > I bet Robert foudn a Homeopathic site that was trying to justify excesive > fees for extracting perfectly good teeth with RCT's > > Amatus > > Working on H.E. Kayser, Op 20 right now Can't says I knows 'im. At least you play an instrument that was written for by composers people have heard of. Was Kayser a pedagogue, or did he write concert music? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 pedagogue Signature/ Amatus / >> I bet Robert foudn a Homeopathic site that was trying to justify excesive >> fees for extracting perfectly good teeth with RCT's [quoted text clipped - 8 lines] > > Steve >I bet Robert foudn a Homeopathic site that was trying to justify excesive >fees for extracting perfectly good teeth with RCT's Nope. Just was asking about normal wisdom tooth extraction. Don't think there is any point in doing an RCT on a wisdom tooth. >>I bet Robert foudn a Homeopathic site that was trying to justify excesive >>fees for extracting perfectly good teeth with RCT's > >Nope. Just was asking about normal wisdom tooth extraction. Don't think >there is any point in doing an RCT on a wisdom tooth. Depends on the case. If 1st and 2nd molars are missing, a second or first bicuspid or both are missing the WT especially on the lower becomes very important. The problem is that you, Robert, are not a dentist, *AND* you "don't think". Frakking moron. > On Sat, 3 May 2008 14:58:39 -0400, "Robert" > > The problem is that you, Robert, are not a dentist, > *AND* you "don't think". > > Frakking moron. Thank goodness I am not your patient. The factory dentist used to become petulant if I asked too many questions or did research on the internet. That should have been a big red flag. Unfortunately I "bowed to his better judgement" and look where that got me. No offense Robert, but you are researching things that you cannot get a "grasp" on in less than a few years of study. Your small tid-bits of knowledge gained this way are messing you up more than helping. Any patient coming into my office trying to micro-manage his care, gets referred down the street. I love teaching my patients about what I do and why, but they don't need to know the histiologic basis of basic healing processes. Find a dental office you trust and settle back and enjoy the ride. You will be much better off. Signature/ Amatus / >> On Sat, 3 May 2008 14:58:39 -0400, "Robert" >> [quoted text clipped - 7 lines] > That should have been a big red flag. Unfortunately I "bowed to his better > judgement" and look where that got me. We have all had patients that use up an hour of chair time for a 15 minute procedure. If I happen to have a cancellation, and the convesation is interesting, it's no big deal. On a regular day, I just don't have time to break down every minute detail of every treatment. Otherwise, the patient needs to pay for an hour appointment even though the treatment should be much less. Like AC says, you can't get a real understanding of dental disease or treatment in an hour. When I had eye surgery following an auto accident in 1994, I didn't pick apart the ophthamologist. She told me basically what she was going to do, and I let her do her thing. Understanding more does not make the outcome any better. You just have to find a good professional in the first place. D > Thank goodness I am not your patient. The factory dentist used to become > petulant if I asked too many questions or did research on the internet. > That should have been a big red flag. Unfortunately I "bowed to his better > judgement" and look where that got me. When seeing all of the ridiculous crap about dentistry on the internet, it sure makes me look at any other 'research' on the web with a 50 lb. block of salt. D > I bet Robert foudn a Homeopathic site that was trying to justify excesive > fees for extracting perfectly good teeth with RCT's [quoted text clipped - 43 lines] >>a sharp periosteal and a curved mosquito are still the >>best instruments for the task IMO. |
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