The extraction of impacted and semi-impacted third molars is a common procedure in dental practice, yet it demands meticulous analysis to ensure minimal trauma. It is not just about removing a tooth; it is about understanding its relationship with surrounding structures, anticipating difficulties, and selecting the surgical strategy that allows for an efficient resolution without compromising vital anatomy.
Everything begins with preoperative assessment, which is crucial. A third molar should never be approached without first evaluating its exact position, the density of the surrounding bone, and its proximity to key structures such as the inferior alveolar nerve, the maxillary sinus, or the second molar’s root. A panoramic radiograph is often the first step, but in more complex cases, cone beam computed tomography (CBCT) becomes indispensable. These images determine the surgical approach: whether the molar’s angulation will complicate removal in one piece, if bone reduction is necessary, or if the nerve’s proximity necessitates a coronectomy instead of complete extraction.
With a clear plan in place, the surgery should be performed with as little trauma as possible. A flap is designed to provide access without compromising tissue vascularization, preventing tears, and ensuring that suturing will promote proper healing. Here, the balance between osteotomy and odontosection is crucial. In many cases, rather than removing excessive bone, it is more efficient to section the tooth into smaller, manageable fragments, allowing for extraction without excessively enlarging the surgical cavity. Every incision, every cut with the bur, every application of the elevator must be precise, always protecting structures such as the lingual nerve and the second molar’s root.
The extraction itself should be a controlled act, never rushed. It is not about using force but rather taking advantage of points of least resistance. A complete syndesmotomy before attempting any luxation makes the procedure easier and minimizes trauma to the surrounding tissues. When the tooth is finally removed, it is time to assess the cavity, eliminate any bony spicules that could interfere with healing, and ensure proper hemostasis before closing the site.
Postoperative care is just as important as the surgery itself. Well-placed sutures, appropriate anti-inflammatory medication, and strict hygiene control will determine the patient’s recovery. Preventing infections, reducing the risk of dry socket, and managing edema are essential, ensuring that the extraction is not only successful during surgery but also throughout the healing process.
Impacted third molar surgery demands precision, anatomical knowledge, and detailed planning. It is not merely a mechanical extraction but a procedure where every decision impacts the outcome. The ultimate goal is not just to remove a tooth, but to do so in the most conservative and safe manner possible for the patient.