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Introduction to Third Molar Surgery: Part-2 Indications and Contraindication

Mandibular Third Molars  

According to George Dimitroulis, there are common and uncommon reasons for the removal of the mandibular third molar.   

The common reasons are   

  1. Pericoronitis  
  2. Periodontal disease  
  3. Severe caries  
  4. Prophylactic; e.g., orthodontic needs  
  5. To improve access for the restoration of mandibular second molar  
  6. Difficult to clean  
  7. Mandibular sagittal split osteotomies  

The uncommon reasons for the extraction of mandibular third molars are  

  1. Earlier failed attempted extraction somewhere else  
  2. The tooth is associated with a pathology; e. g. cysts or rare tumours  
  3. The tooth is exposed under denture or to facilitate the construction of a prosthesis, for example, lone standing third molar in otherwise fair edentulous jaw.  
  4. When the tooth in in line with jaw fracture  
  5. Prophylactic reasons; for example, if the patient is to go under radiotherapy of heart valve replacement of kidney transplant  
  6. Obscure facial pain  
  7. When there is resorption of adjacent second molar  

  

 Maxillary Third Molars  

These teeth, when present, are often removed at the same appointment along with the mandibular third molars because they are of no functional use in absence of opposing teeth. The common indications of maxillary third molar extraction are as follows:  

For Erupted Teeth  

  1. When the tooth is non-functional  
  2. When the tooth is supra-erupted or buccally displaced and causes trauma to the operculum of partially erupted opposing third molar.  
  3. When it becomes difficult to clean the area due to limited access to the area for a tooth brush  
  4. Caries  
  5. periodontal diseases  

For Unerupted Teeth  

Unerupted maxillary third molars do not show any symptom. The indications for their extraction are as follows:  

  1. When there is space deficiency for their normal eruption  
  2. When a patient feels convenient to get it removed at the same appointment along with the removal of mandibular third molar extraction.  
  3. When there is resorption of adjacent maxillary molars.  
  4. When there is an associated pericoronal pathology; e.g., odontogenic tumour or dentigerous cyst  

  

CONTRA-INDICATION FOR THIRD MOLAR SURGERY

There is no absolute contraindication for the third molar surgery. All the contraindications are relative and with proper degree of precautions the third molar extractions can be performed safely. We can divide the factors of contraindications in local and systemic.  

Local Factors  

  1. Previously radiotherapy of the area where the tooth is to be removed.  
  2. Tooth is in close proximity to a tumour and there are chances of seeding and spreading.  
  3. Acute gingivitis with gross plaque and calculus because it may delay healing and infect the extraction site.  

Systemic Factors  

Cautions should be taken when following systemic conditions are present.  

  1. Uncontrolled diabetes  
  2. Pregnancy  
  3. Underlying bleeding disorder  
  4. Acute blood dyscrasias  
  5. Cardiac conditions where there is risk of getting infective endocarditis 
  6. When a patient is on anticoagulants, steroids, immunosuppressants, or chemotherapy 

 Difficult Cases

Inferior dental nerve passing below the third molar tooth causing indentation in the tooth structure in first two teeth. The Same nerve is passing through the tooth in third tooth.


  

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