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SURGICAL EXTRACTION OF THIRD LOWER MOLARS IN COMPLEX TREATMENT OF CROWDED TEETH

The success of orthodontic treatment quite often depends on cooperation between the orthodontist and the dental surgeon. An integrated approach, including orthodontic treatment of dento-maxillary anomalies in combination with using the latest surgical techniques can provide quick defect correction of the maxillofacial region and ensure better stability of the results achieved; in most cases of teeth crowding, there is no alternative to the removal of the third lower molars. The purpose of this study was to analyze the surgical interventions performed on for surgical extraction of wisdom teeth for orthodontic reasons and the approach to their choice. Materials and methods. During 2016-2020 years, 158 patients were subjected to 241 surgical interventions for surgical extraction of the third lower molars for orthodontic reasons. We performed on 160 (66.4%) standard operations of atypical tooth extraction, 43 (17.8%) germectomies and 38 (15.8%) coronectomies. The patients' age ranged from 12 to 26 years. All patients were examined by applying the standard technique including orthopantomogram. In cases then it was impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of the superposition of their projections on the obtained pantomograms, we used computed tomography. Based on the data obtained from the examination of the patient, the optimal safest surgical intervention was chosen for removal: the surgical extraction of the wisdom tooth, germectomy, or coronectomy. Conclusions: 1. Operations on surgical extraction of the lower wisdom teeth require mandatory planning and an individual approach to each patient based on a thorough preliminary examination. 2. In cases when it is impossible to clearly assess the ratio between the roots of the wisdom tooth and the mandibular canal as a result of overlapping their projections on the pantomograms, patients are recommended to undergo computed tomography, and then based on the assessment of CT findings to determine the topographic and anatomical relationship of the mandibular canal and roots. 3. The operation of surgical extraction of the lower wisdom tooth can be performed as a standard operation, germectomy can be recommended for patients with underdeveloped roots, coronectomy is a good option when the roots of the wisdom tooth are very close to the mandibular canal.