Estimating the difficulty of wisdom tooth extractions. -

How hard will your wisdom tooth extraction be?

It's important for your dentist to have an idea.

Long before the day of your procedure, your dentist will have made an estimation about the level of difficulty they expect when they remove your teeth.

• Their determination will influence factors about your case such as how many of your wisdom teeth should be removed per visit, the length of your appointment(s) and whether or not a recommendation for some type of sedation is made.

• Their pre-treatment evaluation will also help with planning your procedure, so it's performed in a manner that helps to minimize the chances for complications both during your extraction(s) and the healing process that follows.

A) Factors that influence extraction difficulty.

A panoramic x-ray is frequently used to evaluate 3rd molar positioning.

If more detail is needed, an individual "intraoral" x-ray of each tooth may be taken too.

1) The tooth's position in the jaw.

Much of the difficulty associated with removing a wisdom tooth will be due to the way it's situated in the jawbone.

In general, the more normal the alignment of the tooth, and the further through the gum line it has pierced, the less involved its extraction and the healing process that follows are likely to be.

Rules of thumb.

• You can expect that erupted wisdom teeth (those that have penetrated through the gums fully) will be easier to extract than impacted ones (those still significantly buried in the gum tissue or jawbone).
• Soft-tissue impactions are typically less difficult than bony ones (teeth still substantially or completely encased in the jawbone). (Graphic: Soft-tissue vs. bony impactions.)
• The tilt of the tooth will affect the ease with which it's removed. Vertical (upright) and mesio-angular (leaning forward) impactions are typically easier to remove than disto-angular (tilted backward) or horizontal (sideways) ones. (Graphic: Impaction orientations.)
  

  Evidence of this comparative surgical ease lies in complication rates associated with the various types of impactions, with disto-angular and horizontal surgeries associated with a higher degree of swelling and reduced mouth opening postoperatively than vertical ones. (Bello 2011) [page references]

2) Tooth depth.

Another method that's used to estimate extraction difficulty is to make a comparison between the impacted wisdom tooth and its neighboring 2nd molar.

The wisdom tooth's depth is compared to the neighboring 2nd molar.

Removing this wisdom tooth can be expected to be of "moderate" difficulty.

When making this calculation:

• The 2nd molar's root is marked in thirds on an x-ray.
• A point is then identified on the 3rd molar where the forces of the dentist's extraction instrument (an elevator) will be applied.
  

  This point is frequently that part of the tooth where its crown (enamel-covered portion) ends and root begins. (The white dot and arrow in our diagram.)

• The level at which this point resides in comparison to the 2nd molar's root gives an idea of how hard the extraction will be.

3) Root anatomy.

Wisdom teeth have multiple roots (lower ones typically have two whereas uppers usually have three). And there can be quite a bit of variation in the way they are shaped.

In some cases, each root will be separate and distinct. In others, they may be fused together (fully or partially) or have an irregular shape or curvature.

These anatomical variations will affect the relative ease with which the tooth can be removed.

Extraction difficulty is influenced by the tooth's root form.

Rules of thumb.

If the "average" wisdom tooth is one where its roots are relatively straight, distinct and separate (see animation), in comparison:

• Teeth with fused roots (partially or fully) are often easier to extract (this is especially true for upper third molars).
• Teeth that have roots that are curved or irregularly shaped can be more difficult to remove. Although, in some instances the curvature may be such that it actually facilitates the extraction.
• Teeth whose roots are just 1/3 to 2/3rd formed typically make for an easier extraction that those whose roots are fully formed.
  

  This factor is dependent upon the age of the patient. We discuss this and other age-related issues here: What's the ideal age to have your wisdom teeth extracted?

B) How anticipated extraction difficulty affects treatment planning.

More so than with any other type of tooth, removing wisdom teeth routinely poses an assortment of challenges (ranging from just minor to significant). And this level of difficulty must be factored into the way your dentist plans your case.

1) Some wisdom teeth are quite easy to remove.

You don't have to expect the worst. In the case of fully erupted 3rd molars (those that have come all of the way into place), the extraction process may be no more difficult than with any other molar, and possibly less.

Examples.

• When compared with the molars in front of them, there's a tendency for wisdom teeth to be slightly smaller and more likely to have fused roots. Either of these factors can help to make their removal comparatively less difficult.
• Upper wisdom teeth that have fused roots can be astonishingly quick and easy to extract.

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2) Some wisdom teeth will require "surgical" intervention.

With impacted third molars, the dentist will of course need to gain access to the tooth they're removing. So in these cases, the dentist will need to perform a "surgical" extraction.

This is the type of process where gum tissue is flapped back and, if needed, bone tissue cut away, so the dentist can visualize and manipulate the tooth. Use the link above for more details.

Less bone removal is needed when a tooth is "sectioned" into parts.

3) Sectioning wisdom teeth.

A dentist may be able to minimize the amount of bone that must be removed during the extraction process by cutting the tooth into pieces.

Since each individual part is smaller than the tooth as a whole, they can be removed through a smaller access opening. This procedure is termed "sectioning" a tooth.

C) How extraction difficulty can affect patient aftercare and the post-extraction healing process.

In general, the quicker and easier it's been for the dentist to access and remove a wisdom tooth, the less tissue trauma that's created and the more uneventful the extraction site's healing process should be.

As examples:

• The post-operative inconvenience and aftercare needs associated with the routine extraction of an easily accessed, fully-erupted third molar may be surprisingly minimal, to almost non-existent.
  
• At the other extreme, the swelling and pain resulting from a difficult impaction may require several days of recuperation.

Which scenario applies to you will simply depend on how difficult your extraction process has been. And thanks to the type of indicators discussed on this page, your dentist should be able to give you an idea of what to expect even before your procedure is performed.

Aftercare guidelines and instructions.

For the most part, extraction aftercare is broken into two general time frames:

• The first 24 hours after your surgery.
• The time period 24 hours after and beyond.

When it comes to preventing or minimizing post-operative complications, nothing is more important than following your dentist's instructions, period. (Use the links above for more information.)

Topic Menu ▶  Wisdom Teeth (third molars).

• Wisdom teeth basics -
  
  • Which teeth are they? | Classifications of impaction types.
  • FYI facts about getting your wisdom teeth out.
• Overview of valid reasons to have third molars extracted.
  
  • Pain | Tissue trauma | Cysts, tumors, resorption.
  • Pericoronitis - Persistent / recurring infections.
  • Complications associated with: tooth decay or gum disease.
• Reasons not to extract third molars.
  
  • The fallacy of "tooth crowding" theory.
• The extraction procedure -
  
  • Estimating surgical difficulty.
  • At what age should you have your surgery performed?
  • Conscious Sedation.
  • Wisdom tooth extraction costs - by impaction type.
• Common post-extraction complications.
  
  • Dry Sockets / Paresthesia (nerve damage)
• Related pages -
  
  • Topic: Tooth Extractions