The preceding discussion of indications and contraindications
for the removal of impacted third molars has
been designed to point out that there are various risks
and benefits for removing impacted teeth in patients.
Patients who have one or more pathologic symptoms or
problems should have their impacted teeth removed.
Most of the symptomatic, pathologic problems that result
from impacted third molars occur because of partially
erupted teeth and occur less comtnonly with a complete
bony impaction. _.
It is less clear what should be done with impacted
teeth before they cause symptoms or problems. In making
a decision as to whether or not an impacted third
molar should be removed, a variety of factors must be
tonsidered. First, the available room in the arch into
which the tooth can erupt must be considered. If adequate
room exists, then the clinician may choose to defer
removal of the tooth until eruption is complete. A second
consideration is the status of the impacted tooth and the
FIG.9-15 lnipacted maxillary right third molar in 63-year-old patient. This molar should not be extracted b(:cJUSC it is deeply embedded and no signs of disease are present
age of the’ patient. It is critical to remember that the average age of complete eruption is 20, but that eruption may continue to occur up to age 25. A tooth that appears to be a mesioangular impaction at age 17 may eventual-ly become more vertical and erupt +nto the mouth. If insufficient
room exists to accommodate the tooth and a soft tissue operculum exists over the posterior aspect, then pathologic sequelae are likely to occur.
Although there have been some attempts at making very early predictions of whether or not a tooth was going to be impacted, these efforts have not yet resulted in a reliable predictive model. However, by the time the
patient reaches age 18, the dentist and surgeon can reasonably predict hether there will be adequate room into hich the tooth can erupt with sufficient clearance of the anterior ramus to prevent soft tissue operculum formation. At this time, if surgical removal is chosen, soft tissue and bone tissue healing will occur at its maximal level. At age 18 or 19, if the diagnosi for inadequate room for functional eruption can be made, then the asymptomatic third molar can be removed and the long-term periodontal health of the second molar will be maximized.