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Maxillofacial Surgery: Wisdom Teeth (or ‘Third Molars’)

Among the reasons for the removal of a third molar (or wisdom tooth) as seen on radiographs, is the destruction it can eventually cause to adjacent teeth. Problems associated with third molars include creation of cavities (due to the difficulty of hygiene in the area), impacted food (causing bad breath and pain), infection (pericoronitis), as well as dental crowding resulting in crooked teeth. The presence of problematic wisdom teeth can also cause the development of pathologies, usually benign, but which can become malignant.

Causes leading to the removal of wisdom teeth

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Photo 1: Cavities in the first and second molar caused by the third molar, resulting in loss of the third molar.

Photo 2: Rhizolysis (root reabsorption) of the second molar.

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Third molar in a bad position relative to the second molar, which causes the loss of the second molar.

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Photo 1: Obstruction of the second molar by the third molar

Photo 3: Third molar supra-eruption (extrusion of the tooth from its originally fixed position) causing precancerous white lesions or leukoplakia. The latter shows us another reason why we must remove the superior third molars. Since they do not have to perform the function of biting, they will extrude (downwards) biting the gum and eventually causing white lesions (leukoplakia), which are precancerous lesions.

Another indication for removing a wisdom tooth is to avoid resultant crowding and crooked teeth. The patient shown in the following images had undergone orthodontic treatment three years prior. And even with fixed retainers, as seen in the radiograph, the eruptive force of these third molars caused overcrowding. The removal of third molars is thus recommended before the finalization of orthodontic treatment to avoid this complication.

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Anatomical alteration of the third molars

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Malposition of third molars

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It is rare to find this malposition that is known as gyro. Being another indication of extraction of third molars.