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