PDF: General technique of third molar removal

The most commonly performed surgical procedure in most oral and maxillofacial surgery practices is the removal of impacted third molars.

Extensive training, skill, and experience allow this procedure to be performed in an atraumatic fashion with local anesthesia, sedation, or general anesthesia.

The decision to remove symptomatic third molars is not usually difficult, but the decision to remove asymptomatic third molars is sometimes less clear and requires clinical experience.

A wide body of literature (discussed else-where in this issue) attempts to establish clinical practice guidelines for dealing with impacted teeth.

Once the decision is made to remove impacted third molars, a classification system based on clinical and radiographic findings becomes a tool for predicting the difficulty of removal. Accessibility significantly influences the degree of difficulty of removal of a third molar.

The ease with which the tooth can be removed is also influenced by the degree of surgical exposure, the ability to create a pathway for tooth delivery, and the ability to gain purchase (natural or surgically prepared) on the tooth. 

A classification system is a useful tool to categorize the degree of impaction and plan a surgical approach that facilitates removal and minimizes morbidity.