Removal of retained, atypically located teeth of category II

An impacted tooth has not erupted and remains in the jawbone. Most often it is a lower wisdom tooth, less often a canine or premolar. Category II covers complex cases: the tooth lies deep in bone, horizontally or at an angle, and its roots come close to the mandibular nerve or maxillary sinus. At UKRMED Maxillofacial Surgery, impacted tooth surgery is performed by surgeon Anna Kravchenko based on CT.

What an impacted tooth is

A tooth becomes stuck in bone when there is not enough space, a neighbouring tooth or dense bone blocks it, or the tooth bud formed in the wrong position. An impacted wisdom tooth is the most common case: the modern jaw is shorter, leaving no room for third molars. A malpositioned wisdom tooth may lie horizontally and press against the root of the next tooth.

An impacted tooth may cause no trouble for years, but sometimes a cyst forms around it, the neighbouring root is damaged or inflammation develops. A 2020 Cochrane review found no convincing evidence for prophylactic removal of symptom-free impacted wisdom teeth, so removal is decided by indication.

What category II means

• the tooth is fully in bone, deep;
• horizontal or inverted position;
• roots close to the mandibular canal or sinus floor;
• curved or fused roots;
• a cyst around the crown.

Simpler cases — partly erupted and shallow teeth — are category I.

Why CT is mandatory

CT shows the exact tooth position, root shape and distance to the nerve canal in three planes. A 2026 systematic review confirmed that the risk of lip numbness after lower wisdom tooth removal depends mostly on how close the roots are to the canal. Knowing this, the surgeon plans the access and sectioning to avoid the nerve.

The operation

1. Local anaesthesia or sedation supervised by an anaesthesiologist.
2. Gum incision and flap.
3. A bone window using a piezosurgical (ultrasonic) instrument, which is gentler on soft tissue and the nerve.
4. Sectioning the tooth and removing it piece by piece.
5. Socket care, your own plasma (PRGF) if needed, and stitches.

Impacted canines and orthodontics

Not every impacted tooth is removed. An impacted canine can often be brought into place: the surgeon exposes the crown (bone window) and bonds a button, and the orthodontist gradually pulls the tooth down with braces. The patient keeps their own tooth.

Recovery

Swelling peaks on days two to three and settles within a week. Mouth opening may be limited for a few days. Cold packs, soft food, painkillers and careful hygiene help. A 2026 meta-analysis found that autologous platelet concentrates reduce the risk of dry socket after lower wisdom tooth removal by about two-thirds. If your lip or tongue feels numb, tell the surgeon — it is usually temporary. See also wisdom tooth removal under sedation.

Prices at UKRMED

Sources

1. Ghaeminia H., Nienhuijs M. E., Toedtling V. et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev, 2020. https://doi.org/10.1002/14651858.CD003879.pub5
2. Raj K., Arulrasan S. G., Murugesan K. et al. Anatomical Risk Factors Associated with Inferior Alveolar Nerve Injury During Third Molar Surgery: A Systematic Review. J Maxillofac Oral Surg, 2026. https://doi.org/10.1007/s12663-025-02582-5
3. Brar G., Sodhi A., Brar G. S. et al. The Effect of Platelet-Rich Fibrin in Preventing Alveolar Osteitis Following Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. Cureus, 2026. https://doi.org/10.7759/cureus.103522