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Small mouth – can I keep impacted wisdom teeth, or is removal prior to MSE a necessity?

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Snaggle
(@snaggle)
Posts: 1
Topic starter
 

Hello all, 

 

This is my first post so please bear with me.

As the title suggests, I’m curious to find out if anyone has been able to keep their impacted (or erupted at awkward angles) wisdom teeth rather than having them removed.

 

I had a consultation earlier in the week for MSE and was advised that I should have them removed prior. Having already had 4 extractions as a child, I am worried that more removal of teeth will have adverse effects as I grow older. 

Ideally, I’d like MSE (or expansion of any sort) to allow me to keep my wisdom teeth, rather than their removal being a prerequisite. 

If anyone has any advice, personal experience, or knows of any specialists who may be able to help, I ask that you help guide my research. 

 

Thanks in advance for your help.

 

*additionally, please message me if X-rays would be useful

 
Posted : 16/09/2021 6:07 am
Apollo
(@apollo)
Posts: 1732
 
Posted by: @snaggle

Ideally, I’d like MSE (or expansion of any sort) to allow me to keep my wisdom teeth, rather than their removal being a prerequisite. 

If anyone has any advice, personal experience, or knows of any specialists who may be able to help, I ask that you help guide my research. 

My wisdom teeth were extracted as an adolescent. So I can’t say what effect my MSE expansion would have had on them, but it does feel like there is now ample space to accommodate another molar back there. DOME might require extraction of the wisdom teeth to allow for the pterygomaxillary cut, but MSE without surgical assist or even MSE with only cuts to the midpalatal suture and the zygomatic buttress without the pterygomaxillary release, shouldn’t require the third molars to be removed. Of course, the MSE only expands the maxilla. You’d have to have a plan for the mandible, and the non-surgical expansion options for the lower arch aren’t going to create as much skeletal change to give the wisdom teeth room to come in. However, if yours are already starting to erupt, you might not need much more space.

 
Posted : 16/09/2021 12:10 pm
FunctionalCranium
(@functionalcranium)
Posts: 3
 

@apollo Can you please point me to some distinction/or explain to me the difference between MSE, MSE + surgical assist, DOME etc? Why are some cuts done and some not? Do the different cuts have an impact on nasal expansion? 

Also, what about mandibular transverse distraction (MSDO?) Do you think that would provide enough room for the lower wisdom teeth?

 
Posted : 25/11/2022 9:33 am
Apollo
(@apollo)
Posts: 1732
 

Posted by: @functionalcranium

@apollo Can you please point me to some distinction/or explain to me the difference between MSE, MSE + surgical assist, DOME etc? Why are some cuts done and some not? Do the different cuts have an impact on nasal expansion? 

Also, what about mandibular transverse distraction (MSDO?) Do you think that would provide enough room for the lower wisdom teeth?

MSE alone doesn’t involve any osteotomies, but can be facilitated by cortipuncture along the midpalatal suture. DOME involves cuts along the midpalatal suture, zygomatic buttress and pterygomaxillary junction. MSE + surgical assist foregoes the ptergomaxillary junction cut, reducing the bleeding risk and allowing the procedure to be performed in an outpatient setting. At least that’s my understanding. Individual surgeons might have their own variations. For example, sometimes the bone can be scored through only the outer cortical layer without cutting all the way through. If the zygomatic buttress is cut, the floor of the nose will expand but the walls of the nasal aperture wouldn’t expand, so the effects on the nasal airway would be reduced. It’s possible MSDO could create room for lower wisdom teeth after mesialization of the whole arch, but I’m not personally familiar with that procedure.

 

 

 
Posted : 25/11/2022 1:43 pm

THE GREAT WORK