By:  Victor M. Sternberg, D.M.D.

March 2, 2022

Impacted third molars are a common finding in a great number of our dental patients.  However, in this particular case, we have a gentleman with impacted twin third molars in the maxilla and the mandible.

In the mandible, the key issue was the bone loss on the distal of #18 related the imposition of the crown of #17 proximal to #18.  

The case presented a particular challenge because even if the third molars could be removed safely, you still faced the enormous bone loss in the distal of #18.  In addition, the presence of tooth #18 made the management of the lower third molar challenging, if not impossible.  The removal of the entire root of #17 posed a challenge to the viability of the mandibular nerve.

A choice was made to remove #18 and then the superficial #17.  Regarding the anterior third molar, a coronectomy was performed to avoid injury to the mandibular nerve.  Attached is the immediate post operative panorex.

The patient has avoided paresthesia.

Ultimately he can replace #18 with an implant.  The fate of the roots of the third molar remain to be seen.  Generally, I understand, that these remain viable.

In any event, it is a good example of the value of three dimensional radiographs and the approach to challenging tooth malposition.

As always I appreciate your feedback, and kudos to the oral surgeon who performed the procedure.

Yours truly,

Victor M. Sternberg, D.M.D.

By Westchester Center for Periodontal & Implant Excellence

January 7, 2023