The extraction of third molars is one of the most frequently performed oral surgical procedures worldwide. Due to their variable position, eruption pattern, and anatomical relationship with vital structures, third molars often require specific surgical techniques rather than simple exodontia.
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✅ Main Surgical Techniques for Third Molar Extraction
1. Simple Surgical Extraction
This technique is indicated for fully erupted third molars with favorable angulation and minimal bone resistance. It involves the use of elevators and forceps without flap elevation or bone removal.
Advantages:
▪️ Short surgical time
▪️ Minimal postoperative morbidity
Characteristics:
▪️ Limited to erupted teeth
▪️ Requires adequate crown exposure
2. Surgical Extraction with Mucoperiosteal Flap
A mucoperiosteal flap is raised to gain adequate access to partially erupted or impacted third molars.
Advantages:
▪️ Improved visibility and access
▪️ Better control of surgical field
Characteristics:
▪️ Requires suturing
▪️ Moderate postoperative discomfort
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Osteotomy involves controlled removal of surrounding alveolar bone using rotary instruments or piezoelectric devices.
Advantages:
▪️ Reduces excessive force during extraction
▪️ Allows safer removal of deeply impacted teeth
Characteristics:
▪️ Increased surgical complexity
▪️ Requires precise anatomical knowledge
4. Odontosection
Odontosection consists of sectioning the crown and/or roots to facilitate removal in segments.
Advantages:
▪️ Minimizes bone removal
▪️ Decreases risk of mandibular fracture
Characteristics:
▪️ Commonly combined with osteotomy
▪️ Particularly useful in mesioangular or horizontal impactions
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This technique uses ultrasonic vibrations to perform selective bone cutting while preserving soft tissues.
Advantages:
▪️ Reduced risk of nerve injury
▪️ Improved postoperative healing
Characteristics:
▪️ Longer operative time
▪️ Requires specialized equipment
6. Coronectomy
Coronectomy involves removal of the crown while intentionally leaving the roots in situ.
Advantages:
▪️ Significantly reduces risk of inferior alveolar nerve injury
Characteristics:
▪️ Strict case selection required
▪️ Requires long-term radiographic follow-up
📊 Comparative Table: Clinical Characteristics of Third Molars
| Clinical Feature | Surgical Relevance | Potential Complications |
|---|---|---|
| Impaction depth | Determines need for osteotomy or flap | Increased surgical difficulty |
| Angulation | Affects choice of odontosection | Risk of adjacent tooth damage |
| Root morphology | Influences extraction strategy | Root fracture |
| Proximity to inferior alveolar nerve | Indication for coronectomy | Nerve injury or paresthesia |
The selection of an appropriate surgical technique for third molar extraction is directly related to anatomical, radiographic, and patient-specific factors. Modern approaches, such as piezoelectric surgery and coronectomy, emphasize tissue preservation and risk reduction, particularly in cases involving neural proximity. However, these techniques require advanced training and careful case selection to ensure predictable outcomes.
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Surgical extraction of third molars is a procedure that demands precise diagnosis and technique selection. Understanding the definitions, advantages, and characteristics of each surgical approach allows clinicians to tailor treatment plans, minimize complications, and enhance postoperative recovery.
🎯 Clinical Recommendations
▪️ Perform thorough radiographic assessment before surgery
▪️ Select the least invasive technique that ensures complete tooth removal
▪️ Consider coronectomy when nerve injury risk is high
▪️ Provide adequate postoperative monitoring and follow-up
📚 References
✔ Renton, T., Hankins, M., Sproate, C., & McGurk, M. (2005). A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve after coronectomy and removal of mandibular third molars. British Journal of Oral and Maxillofacial Surgery, 43(1), 7–12. https://doi.org/10.1016/j.bjoms.2004.09.002
✔ Peterson, L. J., Ellis, E., Hupp, J. R., & Tucker, M. R. (2014). Contemporary Oral and Maxillofacial Surgery (6th ed.). Elsevier Mosby.
✔ Monaco, G., De Santis, G., Gatto, M. R., & Corinaldesi, G. (2014). Coronectomy: A surgical option for impacted third molars in close proximity to the inferior alveolar nerve. Journal of the American Dental Association, 145(5), 463–469. https://doi.org/10.14219/jada.2014.13
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