The wisdom tooth in orthodontic treatment

The wisdom tooth, also known as the ‘third molar’, is part of the last set of teeth to erupt in the mouth, usually between the ages of 17 and 25. In many cases, these teeth do not have enough space to erupt properly, which can lead to problems such as pain, inflammation, crowding of other teeth or even infections.

In the context of orthodontic treatment – whether we are talking about fixed braces or clear aligners – the presence of wisdom teeth can influence both the stability of the results and the general health of the teeth.

From an evolutionary perspective, the trend is towards a reduction in the number of teeth. It is estimated that, in the future, certain groups of teeth – particularly the last ones in each row – will disappear completely. Thus, we frequently encounter patients who are missing one or even all of their wisdom teeth, not due to extraction, but because the tooth buds were absent from the developmental stage. 

However, when wisdom teeth are present, their eruption can proceed normally, with correct alignment in the dental arch, contributing to efficient chewing. In other cases, however, the eruption of these teeth can be difficult and may cause discomfort or complications requiring medical intervention.

From an orthodontic perspective, the eruption of wisdom teeth can significantly influence the long-term effectiveness and stability of treatment. In patients with narrow or underdeveloped jaws, the pressure exerted by wisdom teeth on neighbouring teeth can lead to crowding. To prevent relapse after treatment, the orthodontist may recommend the prophylactic extraction of these teeth before fitting braces.

A lack of space for the teeth to erupt can cause pain, inflammation of the gum tissue or even infections – problems that can be exacerbated when the patient is wearing braces and oral hygiene is difficult. Furthermore, the posterior position of wisdom teeth makes them difficult to clean, increasing the risk of tooth decay and thus affecting the health and stability of the aligned teeth.

However, there are also situations where the extraction of wisdom teeth is not necessary. In these cases, the orthodontist will monitor them periodically to observe their development. Furthermore, the presence of wisdom teeth can sometimes be beneficial: for example, when the patient has lost their six-year molars, these teeth can migrate and help close the gap left behind, thus avoiding the need for a dental implant.

Therefore, it is essential for the orthodontist to carry out a comprehensive assessment at the start of treatment, determining both the necessity and the optimal timing of any extraction. Proper planning plays a decisive role in the success of orthodontic treatment and in maintaining long-term results.

From a surgical perspective, there are several important aspects to consider. One of these is the patient’s age. In adolescents, the bone is more elastic and the roots of the wisdom teeth are not fully formed, making extraction easier and healing faster, with minimal risk of complications. In contrast, in adults, bone density increases, the roots are fully developed, and the procedure becomes more complex, with a higher likelihood of complications.

Wisdom teeth that remain impacted after the normal eruption period may also develop conditions such as cysts or tumours, which is why radiological assessment and the correct decision regarding the timing of extraction are essential.

Another key consideration is the relationship of the wisdom tooth to neighbouring anatomical structures and its degree of eruption. A fully erupted wisdom tooth is visible in the dental arch and can usually be extracted through a simple procedure. As the tooth becomes less visible in the oral cavity, the difficulty of the procedure increases. Thus, a partially or fully impacted wisdom tooth requires a more complex surgical procedure, often involving the removal of a portion of bone to allow access and extraction.

Wisdom teeth are not ordinary teeth. Their roots may be very close to the inferior alveolar nerve or the maxillary sinus, and this anatomical relationship varies from patient to patient. For this reason, extraction requires a precise three-dimensional assessment – most often carried out via a CBCT scan. This allows the surgeon to accurately observe the tooth’s position and plan the procedure safely, using techniques such as controlled sectioning of the tooth, minimal bone removal and protection of sensitive anatomical structures.

The specialist in dento-alveolar surgery undergoes additional training compared to a general dentist, acquiring advanced skills in bone surgery techniques, complication management, complex suturing, haemorrhage control and nerve protection. These specialists work with three-dimensional imaging (CBCT), which provides detailed information on the position of the wisdom teeth relative to the alveolar nerve and the maxillary sinus. Based on this data, the surgeon can tailor the surgical technique to each case: complete extraction, coronectomy, a minimally invasive approach, or the use of specific instruments – such as the piezotome, physiodispenser or surgical microscope.

An experienced specialist knows how to prevent and promptly manage any complications, such as damage to the inferior alveolar or lingual nerve, mandibular fracture in cases of deep impaction, post-operative infections, haemorrhages or oedema. Proper planning and the use of a minimally invasive technique significantly reduce these risks, shortening the duration of the procedure and minimising bone trauma. Furthermore, the surgeon is experienced in performing aesthetic sutures and in post-operative management, which contributes to rapid and comfortable healing for the patient.

“Wisdom tooth extraction is not a routine procedure, but a complex surgical intervention involving important anatomical structures. Therefore, the safest choice for the patient is to consult a specialist in dento-alveolar surgery, with experience and access to modern 3D planning technologies. Such an approach ensures a smoother, safer procedure and rapid healing without complications.” – Dr Doris Turcu, Specialist in Dento-Alveolar Surgery.

“The success of orthodontic treatment depends not only on the braces, but also on the health and stability of the entire dental arch. Close collaboration between the orthodontist and the surgeon is essential to achieve predictable, aesthetic and long-lasting results.” – Dr Delia Ciocan, Specialist in Orthodontics and Dentofacial Orthopaedics.

Through a joint assessment and careful planning, the two specialists can provide the patient with comprehensive, safe and personalised treatment.

For patients, the key message is one of reassurance: wisdom tooth extraction is a safe procedure when performed by a specialist at the right time. Furthermore, removing these problematic teeth prevents future complications, helping to maintain oral health and achieve a balanced, beautiful and long-lasting smile. 

1. American Association of Oral and Maxillofacial Surgeons (AAOMS). White Paper on Third Molar Data. Rosemont, 2022. Available at: https://www.aaoms.org
2. American Association of Orthodontists (AAO) – Third Molars and Orthodontic Treatment: Clinical Considerations, 2021. Available at: https://www.aaoinfo.org
3. Ventä I, Ylipaavalniemi P, Turtola L. Clinical outcome of third molar extraction in relation to orthodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998
4. Capelli J Jr. Mandibular growth and third molar impaction in orthodontically treated patients. Angle Orthod, 1991
5. Kim TW, Artun J, Behbehani F, Artese F. Prevalence of third molar impaction in orthodontic patients treated without extraction versus with premolar extractions. Am J Orthod Dentofacial Orthop, 2003