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Dentists - How would you extract this 3rd molar?



Jan 7, 2017
#16 is my problem child. It seems to have gone completely nuts and grew in upside down and backwards.

Here are my main problems with this:

1. I am a hygienist who is terrified of dental work
2. I don't want to get it taken out unless it absolutely must be taken out
3. I don't exactly know where #16 is or where it's going and I am concerned that it might rupture my sinus. Where is it???
4. I have issues with TMD and worry that the surgery will damage the joint further and leave me in pain
5. I don't know what type of approach the surgeon will do with regards to where he will make the incisions, flaps, drill bone, ect. and I'd like to know what exactly you would do if presented with this case.
6. I am scared that IV sedation won't be enough for me and that I'll be awake, in pain, and remember the surgery. I am considering general anesthesia but worried about the cost of that.

I have attached the most recent pano and CT scans.

Please advise

(Note: 17 and 32 never formed)

Why does it need to come out?
Just an observation from dentist?

No pain, then leave it.
Little discomfort then leave it.

Most upper wisdom teeth are relatively easy to remove. This one might may need a small amount of bone shaving off but I don't expect it to be difficult. I guess the only tricky bit is reaching it and sedation or GA would help relax your muscles and make it easier to get there.

BTW it is not that close to the sinus.
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There is no discomfort associated with it. The only thing I am concerned with is if the roots grow into the roots of #15. It seems to have been steadily growing according to yearly panos. I've have multiple consults and half say leave it, half say take it out, and occasionally I will hear "Take that out ASAP!" so it's kind of hard to make a decision when everyone keeps saying something different.

I would obviously prefer to leave it in but I know it's better to get them out when you're younger (I am 22) but I don't want to have unnecessary surgery, especially because of my phobia.
If you're not getting any pain or discomfort then I do not believe the wisdom tooth is pressing against the roots of the adjacent teeth. Your CBCT 3d scan should show that!
Anyway as we normally say: "If it ain't broke, don't fix it!"
How often should I get a CT scan to make sure that the roots are not growing into the roots of 15? I'm a little bit obsessive about my dental health as you might be able to tell :giggle: and I get free imaging at work so insurance is not a problem. I'm also married to a surgeon... It's a hypochondriacs dream!
Honestly it doesn't look that bad at all. If you wait another year it may be easier to take out while if you wait a few years it may be more difficult. Looks like the surgeon would take a direct buccal approach so you won't have your mouth open wide but will stretch your lip.