EWJ June 61 2025 web - Flipbook - Page 34
Wisdom Tooth Surgery Trigeminal
Nerve Complications part 1
by Dr R Kumar BDS LDS RCS MSc ImpDent MAGDS RCSEd PGCert Orthodontics
PGCert Facial Aesthetics, Examiner for the Royal College of Surgeons Edinburgh
Part one of a two part article
Impaction generally means that the wisdom tooth is
stuck either horizontally, vertically or at an angle
against the 7 or the body of the mandible behind the
wisdom tooth.
Terminology
M3M terminal mandibular molar
LN Lingual nerve
IAN Inferior Alveolar nerve
IAC Inferior Alveolar canal
Prophylactic removal
Prophylactic removal of 8s is uncommon but can
occur in patients that are planned to undergo:
• Bisphosphonates, antiangiogenic's, chemotherapy
• radiotherapy of the head and neck
• immunosuppressive therapy
• reduction of mandibular fractures
• orthognathic surgery around the angle of the
mandible
• resection of benign and malignant lesions
• military personnel about to be deployed (Pepper)
Introduction
Wisdom teeth are also known as terminal molars, 3rd
molars or 8s. They usually erupt between the ages of
17 and 24 years of age but in about 25% of worldwide
cases the teeth become impacted against the second
molars or the 7s (WHO).
Impacted mandibular molars (M3M) tend to suffer
future problems such as decay, soft tissue infection and
inflammation and commonly cause secondary decay
against the 7s.
Primary dental treatment
On initial presentation with soft tissue inflammation,
the patient may complain of pain, swelling, reduced
opening, halitosis and or food impaction.
The instance of decay on the 7s can range from 24 to
80% depending on the age of the patient (Fisher),
which can lead to gross destruction of the 7s, the need
for root canal treatment or even the removal of the
tooth.
The general term for wisdom tooth soft tissue
infection/inflammation is pericoronitis.
Wisdom tooth impaction occurs as the wisdom tooth
is developing (and the roots are growing) but the
angulation prevents a full eruption.
The dentist may try to clean the periodontal soft tissue
area around the 8 and advise either a saltwater rinse
or antibiotics are prescribed.
Below,Winter’s classification of impaction (Iwanaga)
EXPERT WITNESS JOURNAL
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JUNE 2025
