Pacific Coast Society of Orthodontists Bulletin Summer 2014 - (Page 15)

PRACTICE MANAGEMENT DIARY THIRD MOLAR PROTOCOLS By Dr. Gerald Nelson I got a call from a patient's mom. She wanted to know whether her son's third molars should be removed. The patient, Brian, is 13 years old. That sounds early, but I took a look at the panoramic radiograph in order to confirm my suspicion. This looks early to me. There is bone over the second molars, and no roots are present on the third molars. The following are factors that one should consider in order to decide both if and when third molars are candidates for removal: * Significant mandibular growth anticipated - wait. * Bone ceiling over the third molars - probably too early to make a decision. * Ascending ramus position - will it clearly block the eruption? * Amount of root formation - extract as soon as possible before the roots engage the alveolar nerve. * Disturbance of the second molar position - a good indicator for extraction. * Good timing for extraction. The ramus over #17 will never resorb. Bone or root wall resorption - also a good indicator for extraction. This may be slightly late, as second molars are affected. The ideal timing parameters for extration are: * There is no bone ceiling. * There may be ascending ramus in the way. * The root is less than 50% formed. * The second molar position is intact. This one could wait until the ceiling of bone resorbs. Some examples: The third molars are in good position, and the ramus is clear, but some displacement of the second molars has already occurred. Brian's panoramic radiograph. I think it is a bit early, as quite a bit of bone will need to be removed. S SUMMER 2014 * PCSO BULLETIN 15

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2014

The Big Easy: Not Always So Easy
About the PCSO Mission Statement
AAO Trustee Report
PCSO Business
AAO Council on Scientific Affairs (COSA) Report
Component Reports
PCSO at a Glance
AAOF Report
Decrease Stress and Increase Volume
Resident Spotlight: Loma Linda School of Dentistry Postgraduate Orthodontic Program
Younger Member Spotlight: Dr. Melissa Bailey
Third Molar Protocols
Editorial: Special Section
PCSO Program Talk: Orthodontic Residency Programs and the Use of TADs
Case Report: Pre-Treatment
Faculty Files: TADs in Orthodontics: A Review
Seasoned Practitioner's Corner: Dr. Terry McDonald Interviews Dr. Michael Chaffee on TADs
Case Report: Post-Treatment
Pearls of the Pacific: Instant Edentulous Anchorage
Portrait of a Professional: Dr. Earl S. Johnson
Sweet Farewell: Retainers and Retention
In Memory: Dr. Burton Littleton Fletcher

Pacific Coast Society of Orthodontists Bulletin Summer 2014