Les troisièmes molaires dans la décision thérapeutique en orthodontie

Abstract

Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans. The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management. The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration. In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars. Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.