J Korean Assoc Oral Maxillofac Surg.  2022 Feb;48(1):63-67. 10.5125/jkaoms.2022.48.1.63.

A new rationale for preservation of the mandibular third molar in orthognathic patients with missing molars

• Baik UB
• Kim YJ
• Chae HS
• Park JU
• Julian S
• Sugawara J
• Lee UL

• KMID: 2526812
• DOI: http://doi.org/10.5125/jkaoms.2022.48.1.63

Abstract

Controversies exist regarding the need for prophylactic extraction of mandibular third molars in patients who plan to undergo orthognathic surgery. An 18-year-old male patient was diagnosed with mandibular prognathism and maxillary retrognathism with mild facial asymmetry. He had a severely damaged mandibular first molar and a horizontally impacted third molar. After extraction of the first molar, the second molar was protracted into the first molar space, and the third molar erupted into the posterior line of occlusion. The orthognathic surgery involved clockwise rotation of the maxillomandibular complex as well as angle shaving and chin border trimming. Patients who are missing or have damaged mandibular molars should be monitored for eruption of third molars to replace the missing posterior tooth regardless of the timing of orthognathic surgery.

Keyword

Orthodontics; Orthognathic surgery; Sagittal split ramus osteotomy; Temporary anchorage device; Third molar

Figure

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  Fig. 1 Treatment progress. A. Retraction of lower 2nd molar. B. Eruption of impacted third molar.

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  Fig. 2 A. Preoperative lateral cephalogram. B. Preoperative panoramic radiograph.

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  Fig. 3 Initial panoramic radiograph.

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  Fig. 4 A. Final lateral cephalogram. B. Final panoramic radiograph.

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  Fig. 5 Serial radiographs. A. Initial. B, C. During treatment. D. One year after treatment.

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  Fig. 6 Superimposition of the initial and preoperative cephalograms.

Reference

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