J Korean Assoc Oral Maxillofac Surg.  2023 Aug;49(4):184-191. 10.5125/jkaoms.2023.49.4.184.

Surgical removal of third molars in a young adult: review of indications and surgical techniques

• Themkumkwun S
• Sawatdeenarunat S
• Manosuthi P

• KMID: 2545583
• DOI: http://doi.org/10.5125/jkaoms.2023.49.4.184

Abstract

Germectomy is a surgical method most typically performed in young adults. The indications for treatment are controversial. The purpose of this review was to determine the correct indications for germectomy and to discuss the advantages and disadvantages of the procedure. We reviewed the surgical techniques (anesthetic methods, patient preparation, and flap designs) and complications. Germectomy for orthodontic purposes is a common indication for surgical removal of tooth germ among young patients. Several studies have supported removal at an earlier age to produce fewer surgical complications. Several surgical techniques have been described in the literature.

Keyword

Impacted tooth; Wisdom tooth; Orthodontics; Tooth germ; Adolescent

Figure

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  Fig. 1 Demirjian’s classification which is used for assessing the third molar development. A. Mineralized cusp tips. B. Mineralized cusps united. C. The crown approximately half formed. D. Crown formation is complete to dento-enamel junction. E. Root formation has begun. F. Root length at least as great as crown length. G. Parallel root walls with open apices. H. Apices are completely closed. Adapted from the article of Melo et al.16 (Sci Rep 2022;12:2838) under the terms of the Creative Commons Attribution (CC BY 4.0) license.

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  Fig. 2 Flap designs in germectomy. A. Vestibular incision. B. Envelope flap. C. Triangular flap with vertical releasing at mesiobuccal line angle. D. Triangular flap with vertical releasing at distobuccal line angle.

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  Fig. 3 Surgical techniques for germectomy. A. Part of panoramic film shows #38 tooth germ. B. Tooth #37 linguoversion and clinical absence of tooth #38. C. Triangular flap with vertical releasing at mesiobuccal line angle. D. Mucoperiosteal flap was reflected. E. Buccal bone was removed. F. Longitudinal odontectomy. G. Cross-sectional odontectomy. H. Bone window after tooth germ removal. I. Flap closure.

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  Fig. 4 Calculation of Ganss ratio (A/B). A: Space form distal surface of second mandibular molar to anterior border of ramus. B: Mesiodistal width of third mandibular molar.

Reference

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