Successful surgical treatment of a case of bilateral impacted fourth molars

Background: lower third molar impaction is an uncom- mon condition to observe in daily dental practice. it is commonly characterized by pain, swelling and functional limita- tion of the mouth. aim of the study was to share the clinical experience of the oral Surgery Unit of the Dental School, University of Messina on a case of bilateral impacted fourth molars. the report encourage discussion on an extremely rare condition to convey important best practice knowledge. MethoDS: a 48-year-old female came to clinical obser- vation at the oral Surgery Unit of the Dental School, University of Messina for swelling in the left buccal region with slight tenderness, that persisted from several days before. Past clinical history of the patient was not contributory neither family history. clinically limitation in mouth opening and swelling in the left cheek region were the main extraoral findings. at intraoral examination a slight swell- ing was reported extending from the left buccal mucosa to the anterior side of the mandibular branch. overlying mucosa was normal, there was no pus discharge from this region. regional lymphnodes were not palpable. Panoramic radiographs highlighted an impacted supernumerary tooth in the left mandibular branch with pericoronal resorption of the bone in the distal area. Furthermore the presence of a controlateral impacted supernumerary fourth molar was reported on the right side. teeth extraction was performed in conjunction with administration of standardized periop- erative antibiotic therapy with amoxicillin plus clavulanic acid 1 gr/die for 6 days, Surgery was performed with an intraoral approach. alveolar nerve block was performed followed by the incision and reflection of a full-thickness muco-periosteal flap. the fourth and the third molar of each side were extracted. the extractions were performed with odontotomy followed by separation and removal of the teeth. Following the extraction, curettage of the post- extractive socket was performed and primary wound closure was obtained. the use of mouth rinses with an antimicrobio- logic solution (chlorhexidine 0.20%) three times a day was recommended. clinical outome were evaluated at evaluated at 12 weeks follow-up together with Quality of life (Qol) related parameters by means of a visual analogic scale on perceived patient’s related outcome with numerical values ranging from 0 to 100. Results: the patient did not experience any postopera- tive discomfort as reported through patient’s related Qol assessment. a weak numbness persisted for approximately two months in the left mental region and then disappeared. Conclusions: the strength of the study is certainly hav- ing reported an uncommon anatomical position of impacted fourth molars treated by surgery. Surgery is the treatment of choice although the extraction of disto-angular impacted mandibular molars is complex and often followed by a complicated post-operative course that has an impact on the patient related outcome and quality of life.