This is the 3730th article of Da Yi Xiao Nursing
Patient: "Doctor, I just wanted to go to maxillofacial surgery to extract wisdom teeth, and the surgeon wanted to do the correction after hearing me, so let me come to the orthodontic department to see if the wisdom teeth need to be removed before orthodontics." Orthodontist: "You've been lucky to meet a very conscientious surgeon. Let's take a closer look at your situation. "It's a conversation that often happens in orthodontic clinics. You will definitely wonder why wisdom teeth need to be seen before orthodontics are removed. In this issue, Xiaobian will talk to you about the two or three things of wisdom teeth and orthodontics.
1. Wisdom teeth can also be a "solid reserve army" of orthodontics
If you are missing molars, don't rush to remove your wisdom teeth. Because in some cases, it is possible to assist orthodontics and move the wisdom teeth forward to replace the missing molars, so that the cost and trouble of dental implants can be avoided. However, the premise is that the wisdom teeth themselves have no obvious lesions, and the size and shape are appropriate.
2. The timing of wisdom tooth extraction is very exquisite
With the popular use of invisible braces and implant nails, some mild to moderate dentition crowding and facial protrusions can be solved by extracting wisdom teeth and pushing the whole dentition to later obtain gaps, solving the problem of crowding and mouth protrusions. The alveolar bones of the first three months of the newly extracted wisdom teeth are in a period of rapid reconstruction, the teeth move fast, and the resistance of the whole dentition is small. This effect cannot be obtained if the wisdom teeth are removed early. Remove wisdom teeth at the right time recommended by an orthodontologist to achieve a multiplier effect with less effort.
3. Orthodontics can reduce the risk of certain wisdom tooth extractions
For example, some patients have lower wisdom teeth that are nearly in the middle and are stuck to the root of the front large tooth, and the root tip of the wisdom tooth is closer to the mandibular nerve tube. Then there is a risk of damage to the mandibular nerve when the wisdom teeth are extracted, resulting in numbness in the lower lip, and the risk of the front large teeth loosening sensitively after the wisdom tooth extraction is also higher. If the patient needs to have anterior molars removed for correction, and the anterior teeth are moved back without the width of anterior molar, then the posterior teeth can be properly moved forward to increase the space for wisdom teeth to erupt. As can be seen in the figure, after orthodontics, the left lower wisdom teeth move near the middle, the long axis of the teeth is upright, the distance between the root tip and the neural tube increases, and the level of the distal middle alveolar bone of the front teeth of the wisdom teeth also increases. At this point, the risk of nerve damage and loose front teeth that may result from the extraction of wisdom teeth after orthodontics can be significantly reduced. The upper right wisdom tooth in the figure needs to be removed before orthodontics, the gums need to be cut, sutured after extraction, and can be directly removed after orthodontics.
4. Some wisdom teeth need to be removed before orthodontics
So is it that these ambushed wisdom teeth can be removed after orthodontics to reduce the risk? The answer is: no. Because some wisdom teeth are partially erupted, obstructed wisdom teeth, there may already be repeated inflammation and pain due to difficulty in cleaning and in place, so it is necessary to remove them as soon as possible. Otherwise, inflammation and pain will occur repeatedly in the 1-3 years of orthodontics, and may also lead to the front molars being absorbed by the top or decaying, or even being extracted, which will also cause local alveolar bone resorption. These are irreversible damages. Preventive early removal of wisdom teeth is always much more time-saving, labor-saving and cost-effective than making amends.
For example, if there is insufficient space for teeth to erupt, wisdom teeth and front teeth are obstructed, you need to first remove wisdom teeth, and then through orthodontics to prevent the large teeth upright.
5. After orthodontics, it is necessary to remove the obstructed wisdom teeth as soon as possible,
Prevents tooth crowding recurrence
Impacted wisdom teeth have the force to erupt all the way along the crown, and the force is transmitted along the back teeth to the front teeth, the back teeth are lumpy, the front teeth are bladed, and the front teeth are more susceptible, which will lead to the crowding and recurrence of the orthodontic teeth, especially the front teeth. Therefore, it is recommended to remove the obstructed wisdom teeth as soon as possible to prevent it.
6. Not all wisdom teeth need to be removed
Not all wisdom teeth need to be removed, such as wisdom teeth that have been fully erupted, are correct in size, position, and have never been inflamed, then they can be retained. In case the molars are missing later, you may be able to perform a tooth transplant and come on as a substitute.
Note: The pictures are all derived from the curved tomography of Dr. Feng Mengqi's correction of patients
Department of Orthodontics, Affiliated Stomatological Hospital of Tongji University
Written by: Feng Mengqi
Reviewer: Liao Chongshan