Impacted Wisdom Tooth Extraction
Impacted Wisdom Tooth Surgery
Impacted wisdom tooth (20) extraction is surgical removal considered when the third molar remains completely or largely under bone and soft tissue. Unlike extraction of an erupted wisdom tooth (20), imaging, surgical technique and complication risks require detailed planning.
Not every impacted or partially erupted wisdom tooth (20) needs to be removed. In asymptomatic cases without signs of infection or harm to a neighbouring tooth, periodic clinical and radiographic monitoring may also be a suitable option. The decision is made by assessing complaints, examination, imaging and patient preference together.
Imaging and Risk Information
A panoramic film may be sufficient for first assessment in most cases. Cone Beam Computed Tomography (CBCT) can be used selectively when there are questions that two-dimensional imaging cannot answer and that may change the treatment plan. Three-dimensional assessment may be useful, for example, when there is proximity to the mandibular canal or sinus floor, relation to the adjacent second molar or complex impaction anatomy.
CBCT is not routinely or automatically recommended for every impacted tooth. Radiation exposure and clinical benefit are discussed together. The risk of temporary or permanent lower-lip numbness is explained before the procedure; in most cases symptoms are temporary.
Surgical Process
Bone removal and tooth sectioning (odontectomy) are often performed. Raising a flap makes the surgical field visible; sutures are usually checked within a week or resorbable material may be used. Procedure duration varies from case to case according to impaction type, bone density, bleeding control and bone-sectioning steps if needed; one fixed minute range cannot be applied to every patient.
Local anaesthesia, conscious sedation or general anaesthesia may be planned according to comfort and procedure complexity. The type of anaesthesia does not change the surgical technique; however, patient comfort, cooperation and total clinical time may differ between protocols. In selected cases, coronectomy may be considered as an alternative when nerve risk is high; long-term follow-up is required.
Healing and Follow-up
The risk of alveolitis may be higher in impacted extractions than in erupted extractions; smoking may negatively affect healing. Gentle salt-water rinsing and avoiding hard foods and straws may be recommended. Antibiotic prophylaxis is considered only for specific indications.
Assessment is recommended if neurological symptoms last longer than expected. In extractions planned for orthodontic reasons, timing may be coordinated with braces treatment. Single-sided or bilateral extraction is planned with comfort and healing in mind.