Impacted wisdom teeth can be removed safely with careful 3D planning, IV sedation and a surgeon who explains every step, including how the nerve is protected.
A wisdom tooth is impacted when it can't come in fully because something is in the way, usually the molar in front of it, the jawbone or the gum. Some impacted teeth sit completely under the bone. Others are tilted forward or sideways, or break through only partway. Impaction is very common, and it is the main reason oral surgeons remove wisdom teeth.
Types of impaction, and why they matter
Your surgeon describes impaction by angle and depth. A soft tissue impaction is covered only by gum. A partial bony impaction is partly covered by bone. A full bony impaction sits entirely within the jaw. Teeth can also be tilted toward the front (mesioangular, the most common), lying on their side (horizontal), or angled toward the back (distoangular).
These details shape how long surgery takes and how recovery is likely to go. A tooth that is tilted into the molar in front of it can trap food and cause decay or bone loss on that molar, even when nothing hurts. A partly erupted tooth often leads to pericoronitis, a recurring infection of the gum flap over it. Less often, a cyst forms around a tooth that has stayed in the bone.
Careful planning near the nerve
Lower wisdom teeth sit close to the inferior alveolar nerve, which gives feeling to the lower lip, chin and teeth, and to the lingual nerve on the tongue side. When a panoramic X-ray suggests the roots and nerve are close, your Molly surgeon adds a 3D cone-beam CT (CBCT) scan. It shows in three dimensions whether the nerve runs beside, beneath or between the roots.
Most of the time the scan simply confirms the tooth can be removed in the usual way. When the roots wrap closely around the nerve, your surgeon may recommend a coronectomy: removing the crown of the tooth and leaving the roots, which reduces the risk of nerve injury. Temporary numbness after removal is uncommon and lasting numbness is rare, and your surgeon will explain your own risk using your own scan.
Surgery and recovery
Impacted teeth are usually removed under IV sedation, with continuous monitoring of heart rhythm, oxygen and breathing. The surgeon makes a small opening in the gum, removes a little bone if needed, and often divides the tooth into sections so it can be lifted out through a smaller space. Dissolving stitches close the area.
Recovery from impacted teeth can take a day or two longer than from erupted ones. Swelling and stiffness usually peak on day two or three, and most people are back to school or desk work in three to seven days. Your surgeon calls you the evening after surgery, and the 24/7 surgeon line answers any night of the week.
