good decisions come from experience and experience comes from bad decisions
third molar extractions is one of the most frequent procedures in the oral
surgery 10 million teeth are extracted from approximately 5 million individuals
every year in the United States the reported reason for third molar removal
iinclude the risk of impaction associated with caries, pericoronitis,
periodontal defects in the distal surface of second molars, odontogenic cysts and
dental crowding a prospective study showed that general dentists recommend
extraction for a third molar in 59 percent of patients mainly to prevent
future problems or because a third molar had an unfavorable orientation or was
unlikely to erupt. However, the power to predict third molar eruption is
low, and impacted third molars that remain static, with no changes in
position or angulation over time are rare the ideal moment to determine
whether or not to remove a third molars is also under debt since impaction
production has not been scientifically proven moreover it is a daunting task to
predict this biological condition with any degree of reliability systemic
reviews report that there is no evidence to support or refute prophylactic
removal of asymptomatic impacted third molars even in adults however in
comparing the opinion of orthodontists and oral and maxillofacial surgeons it's
become clear that later indicate prophylactic removal of third molars to
prevent crowding more often than a former however indicating extraction
of third molars dentist should have adjustable reason one that takes into
account future treatment planning from an
orthodontic, surgical, periodontal and/or prosthetic point of view. At the same
time a cost-benefit analysis should be carried out to justify the prophylactic
removal of third molars which should only be indicated with a purpose of
preventing cases that involve pathological processes such as root
resorption or caries in the second molars, cysts and pericoronitis
furthermore dentist and patients must take into account that surgical
complications after third molar removal are common the prevalence of seeking
post surgical emergency appointments is around 10% the reason are severe pain
swelling, bleeding, alveolar osteitis, abscesses
dehiscences, sequestra paresthesia, hematoma, and trismus. Although
uncommon there were hundreds of reports on jaw fracture after third molars
surgeries published in literature these fractures predominantly occur in a
patient who are older than 25 years thus it seems reasonable to believe that
postponing the extraction of third molars increase the risk of mandibular fracture
on the other hand third molars can be used to replace a first or second molars
previously extracted also because stem cells can be delivered from healthy
human third molars they represent an easily accessible source which opens a
range of new possibilities for regenerative medicine for orthodontic
patients the decision whether or not to remove the third one earth could be
postponed until the end of orthodontic treatment except for situations in which
the removal of third molar is mandatory since that the beginning of treatment a
follow-up evaluation of third molar position during treatment can be
contributed to be a more realistic the decision for prognosis of these teeth
if orthodontic treatment is complete before the final positioning of these
teeth is achieved the patient should be be reassessed by a clinical examination
and periodic radiographic in general not deciding is the best decision for such cases