Precise Minimally Invasive Extraction of Impacted Teeth: Standardized Techniques and Management Practices

Summary

A standardized protocol enables precise, minimally invasive extraction of impacted third molars, optimizing surgical accuracy, minimizing complications, and enhancing healing outcomes across varying impaction classes.

Abstract

Impacted mandibular third molars frequently pose surgical challenges due to their complex anatomical positioning, particularly when classified as Pell and Gregory Class II or III. Traditional extraction methods often result in significant soft tissue trauma, prolonged operative times, and increased postoperative morbidity. This study presents a standardized, minimally invasive surgical protocol for the extraction of impacted mandibular third molars, designed to enhance precision, reduce trauma, and improve patient outcomes. The technique includes a controlled 1 cm mesial vertical incision, atraumatic flap elevation, conservative bone contouring, and segmental tooth sectioning. Thirty patients were treated using this protocol, with mean operative times of 16.8, 18.9, and 22.7 min for Class I, II, and III impactions, respectively. Postoperative pain scores significantly declined from 3.1 ± 1.1 at 24 h to 1.7 ± 0.9 at 48 h (p < 0.0001), with no major complications observed. The results support the reproducibility, efficiency, and safety of this protocol for diverse impaction types.

Introduction

Impacted mandibular third molars, commonly referred to as impacted wisdom teeth, are teeth that fail to erupt into the dental arch within the expected developmental window, often due to lack of space, obstruction by adjacent teeth, or unfavourable angulation. These impactions are highly prevalent worldwide, with estimates suggesting that up to 72% of individuals experience some form of mandibular third molar impaction during their lifetime^1,2,3. The Pell and Gregory classification system is a widely adopted framework for evaluating the difficulty of impacted mandibular third ....

Protocol

This study was approved by the Ethics Committee of The Second Affiliated Hospital of Zhejiang University (Approval No. 2025-1114). All participants provided written informed consent before their inclusion in the study, following the Declaration of Helsinki.

1. Patient preparation

NOTE: This study enrolled systemically healthy adults aged between 18-40 years with radiographically confirmed mandibular third molar impactions classified as Pell and Gregory Class I, II, or III. Inclusion required the absence of associated pathology and the availability of preoperative imaging. Exclusion criteria comprised any systemic c....

Results

A standardized minimally invasive protocol was applied in a clinical cohort of 30 patients undergoing extraction of impacted mandibular third molars. Patients ranged in age from 19 to 34 years (mean age 26.2 ± 4.3 years), as age may affect surgical difficulty and healing. The cohort included 17 males and 13 females. According to the Pell and Gregory classification, 10 cases were Class I, 12 were Class II, and 8 were Class III impactions, as determined from the radiological images and intr.......

Discussion

The presented protocol for minimally invasive extraction of impacted mandibular third molars marks a significant advancement in oral surgical practice, prioritizing surgical precision, procedural safety, and the preservation of critical anatomical structures. A key determinant of its success is the carefully designed incision combined with precise and controlled flap elevation. The mesially positioned vertical incision, limited to approximately 1 cm, reduces soft tissue trauma and allows targeted access to the impacted t.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
2% Lidocaine	China Otsuka Pharmaceutical Co., Ltd	DB09-3.1004
4% Articaine	Jiangsu Hengrui Pharmaceuticals	H20066184
4-0 or 5-0 Absorbable sutures	Tianjin Jinyao Group Co., Ltd.	TJJY-AS405
Amoxicillin	Shenzhen Gaozhuo Pharmaceutical Co., Ltd.	H44021345
Bone chisel	Tianjin Zhengtian Medical Instrument Co., Ltd.	TJZT-OC080
Fissure bur	Beijing Leiton Medical Device Co., Ltd.	BLT-DT006
Ibuprofen	Teyi Pharmaceutical Group Co., Ltd.	H44021099
Periosteal elevator	Shandong Shinva Medical Instrument Co., Ltd.	SHIN-PS012
Saline	CSPC Pharmaceutical Group Limited	CSPC-SS500
Sterile cotton pad	Zhende Medical Company Co., Ltd.	ZD-SW150
Straight elevator	Shanghai Medical Instruments (Group) Ltd., Corp.	SIM-RH300
Triangular elevator	Shanghai Medical Instruments (Group) Ltd., Corp.	SIM-EL450
Turbine handpiece	Foshan Anke Medical Technology Co., Ltd.	ANKE-TH200