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PERICORONITIS Achi joshi

SAIMS, Indore

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PERICORONITIS • Pericoronitis is defined as

inflammation of the oral soft

tissues surrounding the crown of

a partially erupted tooth.

• The major cause is the microbial

flora that develops in the distally

located pseudopocket.

• The term pericoronitis was first

introduced to dental literature by

Bloch in 1921.

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CLINICAL FEATURES • Red, swollen, suppurating lesion that is exquisitely tender with

radiating pain to ear, throat and floor of mouth.

The diagnosis of pericoronitis is mainly clinical with three distinct

diagnostic categories recognised:

1) Acute pericoronitis,

2) Sub‑acute pericoronitis, and

3) Chronic pericoronitis.

These classifications are empirically derived based on how individual

cases arbitrarily fall into the three distinct clinical categories.

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1. Acute Pericoronitis:

Trismus, pain, dysphagia, extraoral swelling, malaise, halitosis,

pus discharge, sore throat, and anorexia. Pain may disturb sleep,

lymphadenitis involving the deep cervical lymph nodes may be

present.

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2. Subacute Pericoronitis:

Pain, dysphagia, intraoral swelling, halitosis, pus discharge,

sore throat. Associated pain is most often described as

continuous, dull, and is occasionally sharp or throbbing. Unlike

acute attacks, radiation of painful symptoms into adjacent

muscles is rare. The individual does not have limited mouth

opening. This is a distinguishing feature from acute

pericoronitis (Nigerian Journal of Clinical Practice, 2014 )

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3. Chronic pericoronitis:

It is diagnosed based on a history of temporary dull aching

low grade pain that typically lasts only 1‑2 days. Signs

include palpable non‑tender submandibular lymph nodes and

macerated buccal tissue consistent with cheek biting.

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COMPLICATIONS

1. Pericoronal abscess

2. It may spreads posteriorly in orophrengeal area.

3. Dysphagia

4. Involvement of lymph nodes- posterior and deep

cervical.

5. Peritonsillar abscess.

6. Ludwigs angina

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TREATMENT

PERICORONITIS

EXTRACTION

OPERCULECTOMY

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INDICATIONS OF OPERCULECTOMY

1. Availability of space for eruption of lll molar

2. Presence and proper alignment of antagonist tooth

3. Proper alignment of impacted lll molar in the arch.

4. Angulation of impacted mandibular lll molar in relation to long

axis of second molar : vertical angulation is favourable.

5. Position/ depth of third molar in mandible.

6. Prosthetic consideration: Requirement of third molar as an

abutment for fixed prosthesis.

7. Socio-economic reasons/ patient not willing for extraction.

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PROCEDURE

Operculectomy

Scalpel

Laser

Electrocautry

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SCALPEL

Operculum covering the occlusal surface of molar- lateral and occlusal view.

Complete removal of the operculum

clearing the occlusal surface

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•Incisions distal to molar

should follow the area with

greatest amount of attached

gingiva.

•It may be directed disto-

lingually or disto-facially

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Advantages

• Cost effective

• Better healing at initial

level is due to primary

healing by suturing.

Disadvantages

• Bleeding at surgical site.

• Post- operative pain.

• Local anesthesia required

• Suturing

• Swelling ,scarring

• Multiple visits of patient

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ELECTROCAUTRY

• Electrosurgery involves the intentional passage of high

frequency waveforms or currents, through the tissues of the

body to achieve a controllable surgical effect.

• The passage of current into tissue cause cellular fluid to turn

into steam, bursting cell wall and disrupting the structure.

• The electro-surgery has significant advantages over steel

scalpel based on incision time, blood loss, early post-operative

pain and analgesia. (Kearns et al, sumit M, k kaur, 2011)

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1. Loop electrode

is used in a

range of 1.5 to

7.5 mHz in a

continuous

brushing

method.

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Advantages

• Blood less field.

• Less post operative

pain.

• sufficient tissue shaping

ability.

Disadvantages

• Unpleasant odor.

• May cause damage to

bone .

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LASER

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Advantages

• Better patient co-operation.

• Bloodless surgical and post-

surgical event;

• Sterilization of the wound

site.

• Minimal swelling

• Less scar formation.

• Less or no postsurgical pain

Disadvantages

• Expensive equipments

required.

• Charring and carbonization

created by laser may

interfere with initial

healing.

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DISTAL MOLAR SURGERY

• Treatment of periodontal pockets on the distal surfac

e of terminal molars is often  complicated by the

presence of bulbous fibrous tissue over the maxillary 

tuberosity  or  prominent retromolar pads in the 

mandible. 

•Operations for this purpose were described by Robins

on in 1966

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• The procedure allows treatment of irregular osseous

defects and access to maxillary distal furcation area.

OBJECTIVES :

• Eliminate periodontal pocket.

• Maintain and preserve attached gingiva.

• Make area accessible for instrumentation.

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Factors that determine the flap design of a wedge

procedure

1. Size and shape.

2. Thickness of soft tissue.

3. Difficulty of access.

4. Band of attached gingiva of the abutment tooth.

5. Depth of periodontal pocket and degree of osseous defect

on the edentulous side of the abutment.

6. Clinical crown length required as an abutment for

restorative/prosthetic treatment.

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FLAP DESIGN OF THE WEDGE PROCEDURE

1. TRIANGULAR DISTAL WEDGE

Requires adequate zone of keratinized tissue and can be

used in a very short or small tuberosity.

Outline of the incision

Cross- sectional

view- removal of the wedge.

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Undermining of incision to thin

the tissue.

Reflection of flaps for osseous correction

Sutures placed to close the flap

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SQUARE , PARALLEL DISTAL WEDGE

• Indicated when tuberosity is longer.

• Allows conservation of keratinized tissue

• Provides greater access to tissues.

Cross- sectional

view- proper blade

angulations.

Outline of the incision

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Flap reflection and tissue is removed

osseous correction

Sutures placed to close the flap

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REFERENCES

1. Carranza. Clinical periodontology. 10th edition.

2. Edward cohen. Atlas of cosmetic and reconstructive periodontal surgery. 87-102.

3. N. Sato. Atlas of periodontal surgery.

4. Sumit Malhotra, Kamaljeet Kaur. Electro-surgery versus Conventional Surgery for Excision of Pericoronal flaps. Indian J Stomatol 2012;3(4):236-40.

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