What is the guidance for surgical extraction of an impacted third molar (wisdom tooth)?

From the Guidelines

Extraction of impacted third molars (wisdom teeth) should be considered when there are symptoms such as pain, infection, cysts, tumors, damage to adjacent teeth, or periodontal disease, and the procedure should involve a comprehensive clinical and radiographic examination, including orthopantomography as the first diagnostic examination to assess the tooth position and proximity to vital structures, as recommended by 1. The procedure typically involves local anesthesia with options for sedation or general anesthesia in complex cases. Before extraction, patients should receive a comprehensive clinical and radiographic examination, including panoramic X-rays or cone-beam CT scans to assess the tooth position and proximity to vital structures, as supported by 1. Some key points to consider in the extraction process include:

• Prophylactic antibiotics may be given one hour before surgery
• Post-operative care includes pain management with ibuprofen 400-600mg every 6-8 hours and/or acetaminophen 500-1000mg every 6 hours
• Chlorhexidine 0.12% mouthwash twice daily for one week helps prevent infection
• Patients should apply ice packs intermittently for the first 24 hours, maintain a soft diet for several days, and avoid smoking, drinking through straws, and vigorous rinsing for the first 48-72 hours to prevent dry socket
• Follow-up should occur 7-10 days post-extraction to assess healing and remove any sutures, as part of standard post-operative care. This approach minimizes complications such as nerve damage, dry socket, infection, and excessive bleeding while promoting optimal healing, and is in line with the recommendations provided by 1 and 1.

From the Research

Surgical Extraction of Impacted Third Molar

• The surgical extraction of an impacted third molar (wisdom tooth) can be performed using various techniques, including microport extraction 2 and transcervical removal 3.
• The choice of technique depends on the position and angulation of the impacted tooth, as well as the presence of any complications such as infection or nerve involvement 3.
• Local anesthesia is typically used for surgical extraction, with options including infiltration anesthesia with primacaine or lidocaine blocking 2.
• In some cases, orthodontic techniques may be used to facilitate minimally invasive extraction of impacted lower third molars, particularly those close to the inferior alveolar nerve 4.

Indications for Extraction

• The most common indications for extraction of third molars are caries and its sequelae, recurrent pericoronitis, and periodontitis 5.
• Prophylactic extraction of third molars is not a common practice, and is typically only considered in cases where the tooth is impacted or causing other problems 5, 6.
• The decision to extract a third molar should be based on individual patient needs and circumstances, taking into account factors such as age, overall health, and the presence of any complications 6.

Techniques and Outcomes

• Microport extraction has been shown to be a effective and reliable technique for surgical extraction of impacted lower third molars, with advantages including reduced pain and swelling 2.
• Transcervical removal may be necessary in cases where the impacted tooth is positioned at the inferior border of the mandible or is causing other complications 3.
• Orthodontic techniques can be used to facilitate minimally invasive extraction of impacted lower third molars, with benefits including reduced risk of paresthesias and osteoperiodontal advantages 4.