This document discusses wisdom teeth and whether their extraction is necessary. It defines wisdom teeth as the third molars that commonly become impacted due to insufficient space. Reasons for impaction include heredity factors and decreasing jaw size from modern diets. Surgical removal of impacted wisdom teeth carries risks like infection, pain, and nerve damage. While debate continues on the need to extract wisdom teeth, their impaction can lead to complications if left in place.

1. WISDOM TEETH :
FACT OR MYTH ??
DR. ALI WAQAR
RESIDENT FCPS – II ORTHODONTICS
UCMD UOL LAHORE

2. HAPPY 18 YEARS 

3. INTRODUCTION
 The third molar has been the most
widely discussed tooth in the dental
literature, and the debatable question
“….. to extract or not to extract” seems
set to run into the next century. - Faiez
N. Hattab, JOMS, 57: 389-391 (1999)

4. DEFINITION
 A tooth that has failed to erupt completely or
partially to its correct position in the Dental
Arch and its Eruption Potential has been Lost
 Erupt between 18 – 25 years of age

5. COMMON IMPACTED TEETH
 Mandibular third molars
 Maxillary third molar
 Maxillary canine
 Mandibular premolars
 Maxillary premolar
 Mandibular canine
 Maxillary central incisor
 Maxillary lateral incisor

6. ORTHOPANTOMOGRAM (OPG)

7. TYPES
 ANGULAR
 HORIZONTAL
 VERTICAL
 PARTIAL ERUPTION

9. CLASSIFICATION
 According to Long axis of the impacted tooth in relation to the long axis
of the 2nd molar Winter’s classification (1926)

10. PELL & GREGORY'S CLASSIFICATION
POSITION A
POSITION B
POSITION C

11. THEORIES OF IMPACTION
ORTHODONTIC THEORY
 Jaws develop in downward and forward direction.
 Growth of the jaw and movement of teeth occurs in
forward direction
 Any thing that interfere with such moment will
cause an impaction (small jaw-decreased space)
 Dense bone decreases the movement of the teeth in
forward direction.

12. PHYLOGENIC THEORY
 Nature tries to eliminate the disused organs i.e.,
use makes the organ develop better, disuse
causes slow regression of organ.
 More-functional masticatory force – better the
development of the jaw
 Due to changing nutritional habits of our
civilization, use of large powerful jaws have
been practically eliminated. Thus, over
centuries the mandible and maxilla decreased in
size leaving insufficient room for third molars.

13.  MENDELIAN THEORY
Heredity is most common cause. The hereditary transmission
small jaws and large teeth from parents to siblings. This may
important etiological factor in the occurrence of impaction
 PATHOLOGICAL THEORY
Chronic infections affecting an individual may bring the
condensation of osseous tissue further preventing the growth
and development of the jaws.
 ENDOCRINAL THEORY
Increase or decrease in growth hormone secretion may affect
the size of the jaws

14. RELATIONSHIP OF INFERIOR
ALVEOLAR NERVE TO THE ROOTS OF
THIRD MOLAR

15. SURGICAL MANAGEMENT
 Steps in surgical removal
 Anesthesia
 Incision and mucoperiosteal flap
 Removal of bone
 Tooth removal
 Wound debridement
 Arrest of haemorrhage
 Wound closure
 Postoperative follow-up

17. COMPLICATIONS
INFECTIONS
 Pericoronal infection
 Acute / chronic alveolar abscesses
 Chronic suppurative osteitis
 Necrosis
 Osteomyelitis

18. PAIN
 Slight and restricted
 Severe or excruciating
 Intermittent, constant or periodic
 Referred to ear, the post auricular area, any
of the area supplied by the trigeminal nerve.
(Eg. Temporal pain)

19. FRACTURES
 Impacted tooth proves that weakening of the
mandible occurs due to displacement of bone.
OTHER COMPLICATIONS
 Ringing, singing or buzzing sound in the ear
aurium)
 Otitis
 Dimness of the vision
 Iritis
 Pain simulating that of glaucoma