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By David A. McGowan

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Follow-up The tissues healed well, but the symptoms recurred. A repeat procedure, performed a few months later, resolved the problem. 60 An atlas of minor oral surgery Radiographic assessment A panoramic radiograph (see page 59) taken at the beginning of orthodontic treatment, a year before referral, showed a high caries rate with active lesions in at least two molars and a retained root in the upper right molar region. The anterior occlusal film confirms that there was no evidence of a mid-line supernumerary tooth, and the upper central incisors were of a normal shape and structure.

Third molar removal 29 Operation Operation site The partially-erupted third molar is surrounded by a gingival cuff of variable thickness, free of inflammation. The mesial part of the crown is directly in contact with the distal surface of the second molar crown. I ncision The first incision is made to bisect the gingival margin distally, and the second started with the blade against the distal surface of the second molar, cutting across the attached gingivae and turning forward for a short distance into the sulcus, to end level with the mesial surface of the second molar.

Despite having one congenitally-absent kidney, she was i n good health and agreed to have the teeth removed, one side at a time, under local anaesthesia. Third molar removal Operation The first three and penultimate photographs have been taken using a mirror and are printed inverted, so as to relate more easily to the other photographs in the sequence. Operation site The second molar has an intact distal surface and there is no sign of eruption of the third molar. I ncision The incision runs in a straight line from the palatal side of the tuberosity, obliquely forward at a tangent to the disto-buccal corner of the second molar, and up across the buccal attached gingivae towards the sulcus.

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