The principles andsteps for removing impacted teeth are the same as for other surgical extractions. Five basic steps make up the technique: The first’ step is to have adequate exposure of the area of the impacted tooth. This means that the reflected soft tissue flap must be of an adequate dimension to allow the surgeon to retract the soft tissue and perform the necessary surgery. The second step is to assess the need for bone removal and to remove a sufficient amount of bone to expose the tooth for sectioning
and delivery.  The third step is to divide the tooth with abur or chisel to allow the tooth to be extracted without removing excessive amounts of bone. In the fourth step the sectioned tooth is delivered from the alveolar process  with the appropriate elevators. Finally, in the fifth step the.wound is thoroughly cleansed with irrigation and mechanical debridement with a curette and is closed with simple   interrupted sutures. The following discussion elaborates onthese steps for the removal of impacted third molars. Although the surgical approach to. the removal of impacted teeth is similar to other surgical tooth extrac tions, it is important to keep in mind several distinct differences. For instance, the typical surgical extraction of a
tooth or tooth root requires  the removal of a relativelysmall amount of bone. However, when an impacted tooth (especially a mandibular third molar) is extracted,  the amount of bone that must be removed to deliver the  tooth is substantially greater. .This bone is also much’denser than it is’ for typical surgical extractions, and its  removal requires better  nstrumentation and a higherdegree of surgical skill Impacted teeth also frequently require sectioning, whereas other types of tooth, extractions do not. Although ‘erupted maxillary and mandibular molars are  occasionally divided for removal, it is not a routine stepin the extraction of these teeth. However, with impacted mandibular third molars, tile surgeon is required to divide the tooth in a substantial majority of patients. The  surgeon must therefore have the necessary equipment for – ‘such sectioning and the necessary skills and experience for dividing the tooth along the proper planes.  Unlike most other types of surgical tooth extractions,for an impacted tooth removal the surgeon must be able to balance the degree of bone removal and sectioning. Essen

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