The removal of impacted third molars. Principles and procedures

This article reviews factors relating to the removal of impacted third molars. It covers indications for surgery and how indications and surgical difficulty correspond with the age of the patient. The difficulty of the procedure depends not only on age, but on how the tooth is categorized radiographically (classification, position, angulation) and on the patient's facial characteristics (tapering versus compact facial form). The operator's familiarity with the anatomy of the surgical site is indispensable for uneventful third molar surgery. A signed consent form is necessary to meet medico-legal standards. With a diagnosis, treatment plan, and consent to proceed, these teeth are extricated from their sockets with a modicum of instruments, each one fulfilling a specific purpose. The surgical procedure, whether maxillary or mandibular, can be broken into separate segments for technique elaboration and refinement. These segments are flap development, bone removal, luxation, sectioning, tooth removal, and closure. Specific methods may vary among dental surgeons based on training and experience, but they all should correspond to basic and established principles of surgical technique. Some of these principles and techniques have been outlined in describing the removal of typical mandibular and maxillary third molar impactions.