How and why to remove wisdom teeth

What are wisdom teeth?

Wisdom teeth, also known as eights or third molars, are the last eight teeth in the dental row. They do not always erupt, because many people do not even have wisdom tooth buds. It also happens that these teeth are formed, but remain retained (do not erupt). If eights do try to grow, they often push other teeth forward to take up space in the dentition, and in this way form problems with the bite. Wisdom teeth, as a rule, erupt between the ages of 18 and 27, but cases where the figure eight formed, erupted and did not disturb the tooth row are actually quite rare. This is explained by the fact that modern people have a smaller jaw compared to our ancestors, and there is no longer enough space for eights.

What problems can arise with wisdom teeth?

In addition to the already mentioned crowding in the frontal area, which is created by eights, trying to fit into the tooth row, they also have problems with mineralization. Therefore, wisdom teeth are often affected by caries even during eruption. If the degree of destruction of the tooth is insignificant and the nerve is not damaged, a filling can be installed, but in the presence of more serious problems, doctors definitely advise removal, because endodontic treatment (manipulation of the root and root canal of the tooth) of the figure eight makes no sense.

Another problem arises from this: the atypical position of wisdom teeth creates difficulties for removal. It is already the most distant tooth in the row, which is difficult to reach, and if it is in the wrong position, it can also be directed towards the cheek, tongue, or support the neighboring tooth from below or behind so that it interferes with removal. In addition, on the upper jaw, the figure eight often grows roots into the maxillary sinus cavity, so during removal there is a risk of pushing a tooth fragment into the maxillary sinus or perforating it so that after the operation it will remain connected to the oral cavity.

The removal of figure-eights on the lower jaw also has features: a vascular-nerve bundle consisting of an artery, a vein and a nerve trunk passes through the body of the lower jaw, which innervates the chin part of the lower lip and the lower teeth. And the roots of the wisdom teeth lie very close to this bundle or grow around it. In our practice, there was a case when the vascular-nerve bundle passed through the ring formed by the root of the figure of eight, so when removing it, we had to saw the tooth and carefully remove each fragment so as not to damage the nerve.

Why are wisdom teeth almost always removed?

Considering all the listed problems and the fact that the eights actually do not participate in the bite and are not needed by a modern person, their removal is fully justified. Wisdom teeth are not treated endodontically anywhere in the world. Facial asymmetry after removal of wisdom teeth is a myth, because their absence does not affect the oval of the face. Accordingly, it will not be possible to immediately get a beautiful thin face after removing eights.

However, it is not necessary to throw the extracted tooth in the trash. At Sirius-Dent, we offer a replantation service where an eight is transplanted into the place of a missing six. Although an implant can be placed anywhere at any time, there is still a difference between a natural tooth and a titanium structure. At the same time, the figure eight is replanted as it is, without a crown, only before that the depulpation (removal) of the nerve is performed.

Moreover, we replant not only wisdom teeth that have formed, but also their embryos. In particular, such operations are indicated for children after early removal of the six. We transplant the embryo of the figure of eight and wait for it to erupt and be positioned in the tooth row, so that the child develops a correct bite from a young age.

Do you need to remove healthy wisdom teeth?

If the wisdom tooth has completely erupted, has a relatively normal anatomical shape, has taken the correct position and has not displaced the tooth row, and is also fully mineralized (covered with enamel), then there is really no need for its immediate removal. But such cases are the exception rather than the rule.

Is it necessary to remove wisdom teeth or can they be treated?

If we are talking about the perfect eight from the previous paragraph, on which minor caries appeared, which affected the enamel and a little dentin, but not the nerve, then it is quite possible to install a filling so that this tooth will still serve. But in cases where we are talking about pulpitis or periodontitis, it is easier to immediately remove the wisdom tooth than to spend money and time on meaningless treatment.

Is it possible to transplant an eight to the place of a six?

Few people engage in tooth replantation, but this issue can be resolved in our clinic. In order for everything to go well, two conditions must be met: first, the figure eight must be healthy, not affected by caries, periodontitis, pulpitis, etc. Secondly, the six must be completely absent, and enough time has passed since the removal. Or the six – in such a state that it needs to be removed, but at the same time there is no inflammatory process in the bone. These conditions correspond to trauma, chronic inflammatory process of the tooth, gradual destruction of the brush with sealed channels and indications for removal. It is important that there is no acute inflammatory process of the bone tissue near the sixth tooth.

Therefore, the six is removed (or absent altogether). Using computer tomography, we can print a model of a figure of eight on a 3D printer and use it to cut bone tissue and form a bed for a tooth that will soon be transplanted. After that, we remove the figure eight and install it in the prepared place. Before implantation, the figure eight must be depulped and the root canals sealed – for this, a dentist-therapist is present in the operating room.

Stabilization must now take place so that the tooth becomes immobile, and this will take approximately 3 months.

Why is it necessary to remove wisdom teeth before implantation?

In fact, there is no need to remove wisdom teeth before implantation, because adontia (absence of a tooth) has nothing to do with the presence or absence of eights. However, if there are indications for the removal of wisdom teeth, this should really be done before implantation, because the operation is traumatic. If the installation of the implant is planned in the projection of 6-7 teeth, it makes sense to carry out both the removal of the figure of eight and dental implantation in one surgical intervention under sedation anesthesia. Then in the future there will be no need to return to the removal of the figure eight with the risk of damaging the implant.

Can wisdom teeth be removed while wearing braces?

As a rule, before orthodontic treatment, which is the wearing of braces or aligners, wisdom teeth are removed in advance. However, there are individual cases (about 10%) when the figure-eights are left to stimulate and develop the jaw, and are removed during or after treatment.

How are wisdom teeth removed?

Removal of wisdom teeth requires a highly qualified dentist. It often happens that this is a full-fledged operation on the jaw bone, so it is appropriate to carry it out under sedation. We recommend removing four eights at once, so that the patient has only one operation, one anesthesia and one recovery period and never returns to the issue of wisdom teeth. In simpler cases, the removal can be done under local anesthesia.

Swelling and itching at the site of wisdom tooth removal are normal consequences of the operation and pass in a few days. The pain is well managed with medication. But a clicking jaw after the removal of a wisdom tooth or pain when trying to open the mouth can indicate damage to a nerve or soft tissues. This can happen when removing a figure of eight, which is located incorrectly and presses on the root of the adjacent tooth (therefore, after the removal of the wisdom tooth, the adjacent tooth may hurt and wobble for a while).

Is it possible to remove a wisdom tooth without anesthesia?

A wisdom tooth can be removed without anesthesia except in theory. We do not recommend doing this in reality due to the painfulness of the procedure. In addition, the dentist-surgeon needs high-quality operative access and enough time to carry out manipulations, and the constant struggle with the patient’s jaws, which instinctively clench, will greatly hinder him.

What can not be done after the removal of wisdom teeth?

If the hole from the removal of the figure of eight is not sewn with suture material, then a blood clot should form there, which closes the bone wound. Hence the ban on rinsing the mouth: the liquid washes away the blood, and instead of a closed wound, the patient gets an open one. And this leads to the appearance of pain and, in the future, alveolitis (inflammation of the bony cavity of the tooth after extraction), which will hurt from several weeks to several months.