Sunday, February 4, 2024

Most difficult to extract.. Mand. 3rd molar with distoangular with divergent curve root

Most difficult to extract?

  • A. Mand. 3rd molar with mesioangular with fused roots.
  • B. Mand. 3rd molar with distoangular with divergent curve root.

Determining the most difficult extraction between these two scenarios requires considering several factors:

Mesioangular mandibular third molar with fused roots:

- Challenges:

  • Fused roots make separation and removal more challenging.
  • Requires careful technique to avoid root fracture.
  • May necessitate sectioning the tooth for removal.
  • Increased risk of damage to adjacent teeth or nerves.

- Advantages:

  • The mesioangular position generally offers better access compared to distoangular impaction.
  • Crown may be more visible, facilitating initial access.

Distoangular mandibular third molar with divergent curved root:

- Challenges:

  • The distoangular position offers limited access and visibility.
  • Divergent curved root makes instrument placement and leverage more difficult.
  • Increased risk of bone removal and potential damage to the mandibular canal.
  • May necessitate extensive bone dissection and flap manipulation.

- Advantages:

  • Individual root anatomy may sometimes allow for easier separation if the curvature is not severe.
  • Root may be less likely to be fused compared to mesioangular impaction.


While both scenarios present significant challenges, the distoangular mandibular third molar with a divergent curved root is generally considered more difficult to extract due to:

- Limited access and visibility:

The distoangular position significantly hinders the surgeon's ability to visualize and manipulate the tooth.

- Complex root anatomy:

The divergent curved root poses a significant challenge for instrument placement and leverage, increasing the risk of complications.

- Increased risk of bone removal and nerve damage:

Extracting a distoangular tooth often requires more extensive bone removal, which increases the risk of injuring the mandibular canal and associated nerves.

Various Factors:

However, it's important to remember that every case is unique. The difficulty of extraction depends on various factors beyond the angulation and root morphology, such as:

- Patient's anatomy:

Jaw size, bone density, and proximity of vital structures can significantly impact difficulty.

- Surgeon's experience and skill:

A skilled and experienced surgeon can navigate challenging extractions with greater ease.

- Availability of specialized instruments and techniques:

Advanced equipment and techniques can aid in overcoming extraction difficulties.

Therefore, while the distoangular scenario presents greater inherent challenges, the specific difficulty of each case requires a comprehensive evaluation by a qualified dental professional.