Assessing wisdom teeth

Below are some of the digital radiography images taken for assessment and consultation prior to surgery removal of wisdom teeth in our clinic
The difficulty of the surgery to removal wisdom teeth are relied on a few factors:

• the position of the wisdom tooth - deep impaction, horizontal impaction would be more difficult than the forward or backward tilt of the wisdom teeth
• the number of roots - the more root a wisdom tooth has, the more difficult it is going to be
• the morphology of wisdom teeth - if the crown is big than surgery will be easier, but if the roots are long, slender and curve then it will be more difficult to be removed as compared to short and fat roots
• near to nearby structure - if the root lies in or very near to the nerve canal in the jaw bone then surgery to remove it has to be very careful not to damage the nerve.
• Other factors: mouth opening, cooperation, the level of anxiety, age

Vertical Impaction of Lower Wisdom Teeth

* "R" side is the patient's right

Left lower wisdom tooth was in vertical position, 2 separated roots. Surgical difficulty - simple.
Right lower wisdom tooth (red arrow) was tilted backward (distally impaction), with 2 separated roots. The distal root curve 90 degree.  Surgical difficulty - moderate to difficult.

* "R" side is the patient's right

Left lower wisdom tooth was in vertical position with 2 separated roots, where one of the root was curved. Surgical difficulty - moderate.
Right lower wisdom tooth was in vertical position, 2 separated roots. Surgical difficulty - simple.

* The "R" side is the patient's right

Left lower wisdom tooth was deeply impacted, with a single root, where the root near to the nerve. Surgical difficulty - difficult.
Right lower wisdom tooth was in tilted backward (distally) with 2 separated roots where one of the root was near to the nerve. Surgical difficulty - moderate.

Horizontal Impaction of Lower Wisdom Teeth

* "R" side is the patient's right

Both lower wisdom teeth were 'sleeping' in the jaw bone (red arrow). Their roots were fused together (single root). Surgical difficulty - moderate.

* The "R" side is the patient's right

Right lower wisdom tooth was tilted (mesially impaction), very near to the nerve (dotted line) and had a single root.  Surgical difficulty - moderate to difficult.
Left lower wisdom tooth was 'sleeping' (horizontal impaction), very near to the nerve (dotted line) and had two separated roots. Surgical difficulty - difficult.

* "R" side is the patient's right

Right lower wisdom tooth was 'sleeping' (horizontal impaction), and had a single root.  Surgical difficulty - moderate.
Left lower wisdom tooth was tilted forward (mesially impaction), and had two separated roots. Surgical difficulty - moderate. However, the neighbour was presented with decay (red arrow) due to the food trap as a result of wisdom tooth impaction!!

* "R" side is the patient's right

Right lower wisdom tooth was 'sleeping' (horizontal impaction), with 2 roots.  Both roots were in the nerve canal (dotted line). Surgical difficulty - difficult.
Left lower wisdom tooth was horizontally  impacted and had two separated roots. The nerve canal seemed penetrate through the roots. Surgical difficulty - very difficult.  Surgery for both teeth was done carefully to avoid damaging the nerve in the canal.

* "R" side is the patient's right

Left lower wisdom tooth was unerupted and in reverse position where the crown face downwards. There was a cyst (thick red arrow) associated with the tooth. Surgical difficulty  - very difficult as the wisdom tooth need to be removed together with the cystic lesion.

Removal of Upper Wisdom Teeth

* "R" side is the patient's right

Upper left wisdom tooth was tilted forward, single rooted tooth. Surgical difficulty - moderate.

* "R" side is the patient's right

Both upper left & right wisdom tooth was tilted forward, single rooted tooth. Surgical difficulty - moderate.
Lower right wisdom tooth was tilted backward (distally), 2 roots fused together. Surgical difficulty - moderate.