Extraction of Impacted Teeth

What are the Surgical Steps for the Removal of Impacted Teeth?

1. Incision and reflection of the Mucoperiosteal flap
2. Removal of bone to expose the impacted tooth
3. Luxation of the tooth
4. Care of the postsurgical socket and suturing of the

Which Types of Flaps are used for Mandibular Impacted 3rd Molars? 

  • The triangular Flap
  • The envelope flap

Triangular flap:

The incision for this type of flap begins at the anterior
border of the ramus (external oblique ridge)
with special care for the lingual nerve and extends
as far as the distal aspect of the second molar, while
the vertical releasing incision is made obliquely
downwards and forward, ending in the vestibular


In certain cases, e.g., when impaction
is deep, to ensure a satisfactory surgical field or
when the impacted tooth conceals the roots of the
second molar, the incision may continue along the cervical line of the last tooth while the vertical incision begins at the distal aspect of the first molar.


Horizontal (envelope) flap:

The incision for the flap also begins at the anterior
border of the ramus and extends as far as the distal
aspect of the second molar, continuing along the
cervical lines of the last two teeth, and ending at the
mesial aspect of the firstmolar. This type
of flap is usually used in cases where impaction is
relatively superficial.


How to Remove Bud of Impacted Mandibular ThirdMolar? 

A triangular incision is made using a scalpel with a no. 15 blade. The mucoperiosteal flap is reflected from the distal aspect of the second molar, continuing along the incision posteriorly as far as the anterior border of the ramus.


Reflection of the flap and use of a surgical handpiece to remove part of the bone over the crown of the impacted tooth.

bone r

Removal of bone from the buccal and distal aspects of the crown of an impacted tooth, to ensure a withdrawal pathway that will facilitate luxation (pathway of removal).


Placement of the straight elevator between the mesial aspect of the impacted tooth and alveolar bone.


Luxation of a tooth with rotational movement distally. Contact between the elevator and the distal surface of the second molar is avoided.


What Should be Done after all above Steps?

When the extraction of the impacted tooth is complete, the follicular sac, which is usually on the distal aspect of the second molar, as well as bone fragments that may be present in the socket are removed.

The bone margins are then examined to ascertain if there are any sharp edges. If so, then a bone file or a special burmay be used to smooth the bone . After this procedure, the area is irrigated with saline solution and the wound is sutured


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