Plate 01 · Procedures
Third molar removal
Most third molars do not need to come out. The ones that do are usually causing recurrent pericoronitis, distal caries on the second molar, cystic change, or are in the path of planned orthodontics. We would rather review a film with you than remove a tooth that was managing.
For the referring practice
Assessment and removal of impacted and partially erupted third molars, including coronectomy where the root is intimately related to the inferior alveolar canal.
In plain language
Taking out wisdom teeth that are stuck, coming through crooked, or causing repeated infections — and knowing when it is safer to leave part of a root alone.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Recurrent pericoronitis — two or more episodes, or one severe episode with trismus or spread
- Distal cervical caries on the second molar attributable to the third molar
- Non-restorable caries or pulpal pathology in the third molar itself
- Cyst or tumour associated with the follicle, or follicular width beyond 5 mm on film
- External resorption of the third molar or the adjacent second molar
- Tooth in the line of a mandibular fracture, or in the field of planned orthognathic or resective surgery
- Periodontal pocketing distal to the second molar that cannot be maintained
02
How it is done
Flap and access
A buccal envelope or triangular flap raised subperiosteally. Lingual retraction is avoided wherever the case allows, because lingual nerve morbidity tracks closely with retraction technique.
Bone removal and sectioning
Guttering with a copious-irrigation surgical handpiece, then sectioning of crown from root, and roots from each other, so the tooth is delivered in pieces rather than the socket enlarged around it. Less bone removed, less swelling, faster healing.
Coronectomy
Where CBCT shows the canal lingual to or between the roots, and the tooth is vital, non-mobile and free of pulpal or periapical pathology, we discuss deliberate retention of the root fragments. The crown is sectioned 3–4 mm below the crest and the roots are left undisturbed. Roots migrate coronally in a substantial proportion of cases and a small number need later retrieval; that is part of the consent, not a footnote to it.
Closure
Primary or loose closure depending on drainage needs. Resorbable sutures unless there is a reason not to.
| Term | What it records |
|---|---|
| Pell & Gregory — ramus | Class I / II / III — space between the second molar and ramus |
| Pell & Gregory — depth | Position A / B / C — occlusal plane relationship |
| Winter | Mesioangular · distoangular · horizontal · vertical · transverse |
| Root form | Fused, divergent, dilacerated, hooked apex |
| Canal relationship | Separate · contact · grooved · perforated (CBCT) |
- A current panoramic radiograph is the minimum. Under 12 months old, please.
- CBCT if the panoramic shows any of: darkening of the root where it crosses the canal, interruption of the cortical white line of the canal, diversion of the canal, narrowing of the canal, or narrowing/deflection of the root.
- If you have a CBCT, send the DICOM rather than a screenshot — we want to measure it ourselves.
- For maxillary third molars, note tuberosity size and sinus proximity.
A note back to you
Send the panoramic and, if the canal markers are present, the CBCT DICOM. Tell us what the patient has already been through — how many episodes of pericoronitis, whether they have had trismus, and whether they have an opinion about sedation. We will write back with the classification, the canal relationship, and whether we are recommending removal or coronectomy before the patient is seen where the imaging allows it.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Inferior alveolar nerve injury
Altered sensation of the lower lip, chin and gingiva on that side. Usually temporary and recovering over weeks to months. A small proportion do not fully recover, and altered sensation persisting past 6 months is generally considered permanent. Risk is materially higher when the radiographic markers of proximity are present.
Literature: temporary ~0.4–8%; permanent ~0.2–1%
Lingual nerve injury
Altered sensation and taste on that side of the tongue. Technique-dependent — lower where lingual retraction is avoided. Recovery is generally slower and less complete than for the IAN.
Literature: temporary ~0.2–2%; permanent ~0.1–0.5%
Alveolar osteitis (dry socket)
Loss of the clot at days 2–4 with severe deep aching pain and often a bad taste. Not an infection; treated with irrigation and a medicated dressing. More common in mandibular third molars, in smokers, and with oral contraceptive use.
Literature: ~1–5% of extractions overall; substantially higher for mandibular third molars in smokers
Infection
Localised socket infection or, rarely, spread into fascial spaces requiring drainage and admission. Reported more often after removal of deeply impacted mandibular teeth.
Bleeding
Expected ooze for several hours. Significant bleeding is uncommon but is more likely on anticoagulants or antiplatelets — see the medication section below, and tell us before the day.
Trismus and swelling
Peak at 48–72 hours, then settling. Restricted opening for up to a week is normal after a difficult lower tooth.
Mandibular fracture
Rare, and associated with deeply impacted teeth in an atrophic or heavily pneumatised mandible, and with large associated cysts.
Oro-antral communication
For upper third molars, a connection into the maxillary sinus. Small ones close spontaneously with sinus precautions; larger ones need a flap repair.
Damage to the adjacent tooth
Loosening, fracture of a restoration, or exposure of the distal root of the second molar. Sometimes unavoidable when the impaction is directly against it.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
Will I be awake?
That is your choice and we will talk it through. Straightforward teeth are comfortable under local anaesthetic alone. For difficult lower teeth, or if the idea of it is intolerable, IV sedation means you are unaware of the procedure and remember very little.
The nerve, plainly
A nerve that gives feeling to your lower lip and chin runs along the jaw, sometimes right against the roots of a lower wisdom tooth. If it is bruised during removal your lip can feel numb or tingly afterwards. That usually recovers, but occasionally it does not fully. If your scan shows the tooth wrapped around the nerve, we will offer to leave the root tips in place on purpose — that is a coronectomy, and it is a deliberate decision, not a complication.
How long will I be off?
Most people take two to three days for a straightforward case and up to a week for difficult lower teeth. Book it before a couple of quiet days rather than before something that matters.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.