Third molars extraction, also known as wisdom teeth is one of the most common surgical procedures in maxillofacial surgery. The main indications for their removal are:
Pericoronaritis: is an infection of the soft tissue around a tooth. It is the most common cause of indication of extraction of wisdom teeth and usually occurs in lower third molars and especially when they are partially erupted. Clinical manifestations include pain and swelling of the gum around a third molar, halitosis and in some cases may be associated to trismus. These symptoms usually reduce in about 3 or 4 days and can be repeated periodically, but in some cases can worsen and cause an abscess and progress to cervical abscess or to the masticatory spaces.
Caries: The third molars are more prone to the formation of dental caries due to its posterior location that difficults oral hygiene. The mesioversion and impaction to the second molar can induce the formation of distal caries in the second molar due to the difficulty of access to clean the area.
Infection: The progression of dental infection to the soft tissues or bone adjacent can have serious complications. In mild cases the infection can be controlled with antibiotics but when it has formed an abscess it is necessary to drain the purulent material and remove the primary site of infection which is the third molar in order to solve the problem and prevent further complications.
Cyst: Wisdom teeth can have a small follicular cyst associated but in some cases it can increase in size with a consequent loss of bone mass and possible involvement of adjacent teeth.
Orthodontics: One of the reasons for extraction of third molars is in the context of an orthodontic treatment. It may be before the start of it to generate space and distalize second molars, during a presurgical orthodontics in an orthognathic surgery or after the treatment to prevent possible recurrence with crowding in the lower incisors.
When wisdom teeth are included in the gum it is necessary to perform a surgical extraction to open the gingiva, remove the bone and divide the crown and roots to remove the tooth.
One of the main risks of the removal is the involvement of the inferior alveolar nerve which gives the sensibility of half inferior lip. To reduce the probability of its occurrence it is necessary to perform a CT-scan to study the relationship of the roots of the third molar to the nerve and carefully plan the extraction.