Interesting 3rd molar cases

Case #1

A 57 year old male who has been wearing full dentures for years.  His impacted wisdom tooth in the lower left began bothering him a year ago and he has been unable to wear his denture.


Many patients are hopeful that impacted wisdom teeth can be left alone.  Unfortunately, these impacted teeth tend to cause trouble sooner or later.  Unfortunately for this gentleman, this wisdom tooth had to be extracted before the problem with his denture could be addressed.


Case #2

This 27 year old male has put off having his wisdom teeth extracted for many years.  Now these teeth have become symptomatic.

What makes this situation worse, is that the impaction of the two lower wisdom teeth against the 2nd molars has caused a great deal of bone loss in the area.  There is a significant chance that he will lose these 2nd molars secondary to periodontal disease in the future.


Case #3

This 28 year old presented for consultation regarding the extraction of wisdom teeth.  This case is very similar to Case #2.  The lower left wisdom tooth asymptomatic at this time; leaving this tooth in place, however, puts the lower 2nd molar at risk.  Frequently, we see patients like this who, later in life become symptomatic.  Often times, the 2nd molar will require extraction along with the 3rd molar due to extensive bone loss at it's distal aspect.

Unfortunately, extraction of the 3rd molar at this late date (age 28) may not prevent the eventual loss of the 2nd molar.  This is a lose lose situation in many ways.  This patient would have been better served by the extraction of this tooth in his teenage years, as he would not be facing such a difficult situation at this point in time.


case #4

This 34 year old male presents for evaluation of an impacted 2nd molar.  This area is not causing symptoms at this time.

Clinical exam is significant for periodontal pocketing in the area of the impacted 2nd molar.  At this point in time the extraction of teeth #'s 32 and 31 is indicated; even with this treatment, subsequent loss of the 1rst molar is possible due to distal bone loss.  The prognosis for this tooth would have been better had the impacted tooth been extracted years ago.