_____________________________________________________ DCA03TM Third Molar Surgery, 5th Edition
• Elevators: Available in various shapes. These are used by placing the tip of the instrument between the root to be extracted and its socket wall. The instrument tip is then rotated into the root and braced against the bone. The adjacent tooth should never be employed as the leverage point because such usage could fracture or luxate this tooth unintentionally. • Scalpel blades and handle: A #15 (straight) blade is typically the blade of choice. Occasionally, a #12 (curved) blade may be used to make an incision if access to the impacted wisdom tooth is limited by the patient’s intraoral anatomy. • Periosteal elevator: Used to reflect the flap and retract tissue during the surgery. A Pritchard periosteal elevator, a double-ended instrument, will allow reflection with the smaller end and retraction with the wider paddle end. • Needle holder : Used to grasp the cutting needle of the suture assembly. • Scissors : Used to cut the suture. • Tissue retractor: Used to retract the tissue flap and allow visualization and access to the tooth being extracted. • Surgical-length carbide burs : Used to remove bone and / or section and separate roots of multi-rooted teeth. • Rongeur: Useful when removing bone to expose the tooth or for grabbing a root or tooth fragment. • Forceps: Maxillary: 150, mandibular: 151. • Suture material: 3-0 chromic gut and polyglycolic acid (PGA) and 4-0 PGA on a ½ circle reverse cutting needle; 3-0 chromic gut suture and PGA is used when muscle pull may be exerted on the suture line and resistance is needed for more than 10 days; 4-0 suture is suited for closure of releasing incisions for full thickness mucoperiosteal flaps and in areas in which the tension exerted by muscles or frenal attachments is minimal.
CLASSIFICATION OF NEUROSENSORY CHANGES (NERVE INJURIES) The Seddon classification of three types and degrees of nerve injuries is often used to describe the severity of nerve injury and/or probability of nerve recovery (Biso, G.M.N., 2025). • Neurapraxia: Transient nerve injury and conduction delay of a compression type with a high probability of full recovery within two to three months • Axonotmesis: Stretch-crush nerve injury with axonal involvement without continuity defect and a likely spontaneous resolution within three to six months • Neurotmesis: Laceration of the nerve with a
partial or complete discontinuity defect, high possibility of neuroma formation, and partial or full sensation loss that can be permanent
If numbness has occurred, an operating doctor should promptly investigate postoperative complaints of sensory changes of the lip/chin or tongue. An early referral to an oral and maxillofacial surgeon for neurosensory testing is indicated in these cases. TREATMENT MODALITIES Commonly described treatment strategies include observation (i.e., no surgery or pharmacological or nonpharmacological therapy), operculectomy (removal of inflamed pericoronal tissue), and extraction. In the U.S., the preferred treatment modality for impacted wisdom teeth is extraction. Observation and operculectomy are uncommon because of the frequent regrowth of the trimmed tissue and recurrence of the symp- toms later in life. Each clinician will have their preferred surgical instruments for use when extracting impacted wisdom teeth. The following list is a sampling of some of the instruments most commonly used. The list, however, is not exhaustive. Clinician preference and experience, the degree of impaction, and surgical access are among the variables that will dictate the selection of the surgical instrument armamentarium for the extraction of impacted wisdom teeth. • Periotomes: Thin-bladed instruments used to
SPECIFICS OF THE SURGICAL EXTRACTION OF WISDOM TEETH
An extraction of third molars can be done under local anes- thesia or intravenous sedation. The extraction technique can vary depending on the preference of the operator and the type of impaction. The nature of the impaction, thickness of bone, length and anatomy of the roots, and skill of the clinician are all factors that will influence the chosen modality of surgical treatment.
detach the periodontal ligament between the tooth and socket wall. These should not be used like elevators because the tips may break when employed to locate a tooth or root. The motion used is light pressure in an apical direction within the periodontal ligament space.
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