Why Is the Buccal Window Technique Key to Minimizing Post-extraction Complications?
Pericoronitis infections, that is pain, localized swelling, and severe inflammation often accompany the partially erupted or incompletely erupted, or improperly angulated third molar or wisdom tooth is a common dental discrepancy that affects individuals across the world. This is one of the most common causes where the wisdom teeth need to be surgically removed. So, let us explore one such new-age technique that has been proposed by dental researchers and accepted by surgeons, the technique proposed and popularized by referred oral physician Motamedi in the year 1999.
This popularized surgery technique for the extraction of wisdom teeth is to specifically avert post-operative complications in patients having periodontal, or possibly deep bony defects. As bone resorption, as well as infection, would be common in pericoronitis extractions or third molar extractions rather, to prevent possible post-operative complications associated with the infected jaw or alveolar socket in which the wisdom tooth is embedded, the technique proposed in 1999 by Motamedi is commonly implemented by physicians in modern-day oral surgical practice. He coined the term for the technique as ‘buccal window’ which we shall discuss below in detail and also considered the added post-operative stages such as regeneration of soft tissue around the second molar adjacent to the third molars (the soft tissue of second molars commonly affected because of their close proximity to the third molar).
What Are the Surgical Steps in the Buccal Window Technique?
The surgical steps in the procedure of buccal window technique are listed as follows:
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The operator anaesthetizes the segment, under local anesthesia and then performs a full-thickness mucoperiosteal flap reflection in the surgical segment.
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After raising the flap and adequate bone exposure, bone elimination can be done within the region of the lateral cortex by the oral surgeon.
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The surgeon then approaches a further 2 to 3 mm (millimeter) depth below the bony crest, usually by the use of an electric surgical handpiece, typically performed using a round surgical bur.
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The next significant step in the surgical procedure is creating an oval ‘window’ of buccal bone. By this terminology, it basically means that your surgical dentist or operator would be eliminating a part of the buccal bone over the specific area that is, the bone that is removed over the lateral aspect of the third molar or the wisdom tooth (impacted tooth) crown.
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The anterior part (front) of the buccal window should ideally be no closer (in proximity) than around 1 to 2 mm distance from the distal root of the adjacent second molar located next to the wisdom tooth extracted.
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As second molars are functional teeth, it is important for surgeons or the operating dentist to be very tactile sensitive and perform this surgical challenge by adopting extreme care of caution.
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Care should be taken by the dental or maxillofacial surgeon to prevent iatrogenic (operator-induced) root damage of the second molar.
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Post the elimination of the crown and cervical part of the impacted tooth as well, the upper third of the tooth roots would be well exposed at this point the surgeon then tries to effectively section the wisdom tooth vertically at the cementoenamel junction. This procedure can be facilitated usually by the use of a rose or fissure bur.
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Care should be then taken to notice the gap created with the surgical bur post-sectioning of the wisdom tooth, which should be ideally sufficient enough to accommodate the movements within the sectioned crown.
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To avoid any damage to the vital nerve structures such as the lingual or the alveolar nerve, the tooth is usually not sectioned completely at this point of the procedure and the surgeon would depend on using a straight elevator that can be easily placed within the grooves to demarcate the crown clearly from the impacted tooth roots.
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The next step is the horizontal sectioning of the tooth crown, which is then traumatically delivered buccally through the created ‘buccal window’ usually in multiple sections or pieces.
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Bleeding control is established effectively by the oral surgeon using a hemostat, with the impacted wisdom roots sectioned at the point of bifurcation and then effectively removed without any trauma or as minimally invasive way possible.
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Once the dental follicle is eliminated completely, the flap is then sutured back into place usually with interrupted or continuous sutures to ensure that there can be no formation as such of postoperative pockets or defects formation.
How to Avoid Soft Tissue Risks to the Second Molar and Ensure Regeneration of Donor Sites?
When there is a risk of the very close proximity of soft tissue injury common to the second molar, located immediately adjacent to the operating area, that is, the third molar- the surgeon can as per the buccal window technique proposed minimize the impact on the soft tissues. When there is a width of the attached gingiva adequate on the lingual aspect of the second molar, then this flap of keratinized gingiva would be mobilized by the surgeon upon the buccal and distal aspects of the second molar tooth. This is usually facilitated by a submarginal incision post the buccal window surgery, to ensure the regeneration of the attached gingiva, so that the regeneration of the donor site as well can be effectively ensured.
Conclusion
The buccal window technique, is hence, the effective new-age technique in oral and maxillofacial surgery. As bone resorption, localized infections of the jaw or the sinus lining would be involved based on the location and the orientation, the depth of the infected wisdom tooth- the chair time with the patients can be often exhausting and increased. However, with the use of the buccal window technique, there is a scope for reducing both chair time and improving patient compliance. Both dentists and patients need to understand that post-operative complications add common with the elimination of impacted wisdom teeth. Hence to ideally prevent these complications, it is advocated that surgeons conduct a thorough evaluation or preoperative assessment also taking into consideration the patient's medical history, medication history, and dental history.
With an accurate preoperative assessment and with the implementation of the right surgical technique that is aimed to be minimally invasive and more patient compliant, current dental research shows that the risk of nerve injuries, sinus or odontogenic infections of the jaw and even post-operative edema or swelling and pain can all be complications that can be significantly reduced.
