Description

Surgical extraction of impacted third molars (wisdom teeth) involves a detailed, multi-step procedure designed to safely remove teeth that are partially or fully embedded in the jawbone or gum tissue, often requiring more extensive intervention compared to simple extractions. Procedure Overview Assessment & Imaging: Comprehensive evaluation using panoramic X-rays or CBCT scans to determine tooth position, root anatomy, and proximity to nerves (especially the inferior alveolar nerve).​ Anesthesia: Local anesthesia administered, often including an inferior alveolar nerve block, lingual, and buccal nerve blocks for full numbness.​ Flap Creation: A mucoperiosteal flap is incised and reflected, commonly using incisions like Ward’s or triangular flaps to expose the tooth and surrounding bone while protecting soft tissues.​ Bone Removal (Guttering): Using rotary surgical burs, a buccal trough or window is created by removing bone around the tooth to facilitate mobilization.​ Tooth Sectioning: The impacted tooth may be sectioned by cutting the crown and roots into smaller parts to ease extraction without excessive force or bone removal.​ Elevating & Removing Tooth Segments: After sectioning, each piece is gently elevated and removed with specialized instruments, ensuring minimal trauma.​ Hemostasis & Suturing: The surgical site is cleaned, bone edges smoothed if necessary, and the flap repositioned and sutured to promote healing.​ Post-operative Care: Includes instructions for pain and swelling management, oral hygiene, diet, and activity restrictions. Key Points The surgical approach ensures preservation of vital structures like nerves and adjacent teeth while effectively removing difficult impactions.​ The use of advanced imaging and precise techniques minimizes complications such as nerve injury or excessive bone loss.​ Healing time may be longer than simple extractions, and patients often experience swelling, bruising, and discomfort post-surgery.​ This methodical surgical technique is the standard of care for managing impacted third molars, optimizing patient safety and surgical success