Clinical Management and Pharmacological Support in Surgical Extraction of Unerupted Teeth: An Updated Review for Dentists, Pharmacists, Laboratory Workers.

Mai Abdullah M Alqunfdi (1) , Hanan Muntaha Hassan Al-Moashi (2) , Zohour Abduqader Baamer (3) , Khdigah Mansour Sarhan (3) , Mohammed Almutairi (4) , Ali Mohammed Qassim Hazzazi (5) , Amal Ahmad Ali Hardi (6) , Fatimah Saad Alotaibi (7) , Hanan Awad Awaad Alosaimi (8) , zaki yahya bawkar hawbani (9) , Abdullah Rashid Alharbi (10) , Reem Mohammad alhumaidan (11) , Mohammed Othma AlRethy (12) , Dawla Ali Al aqili
(1) Ministry Of Health, Directorate of health affairs - Jeddah, Saudi Arabia,
(2) Ministry Of Health, Bahar Health Center, Saudi Arabia,
(3) Ministry Of Health, Bahra PHC, Saudi Arabia,
(4) Ministry Of Health, Security forces hospital Dammam, Saudi Arabia,
(5) Ministry Of Health, Abu-Arish General Hospital, Saudi Arabia,
(6) Ministry Of Health, PharmD, Saudi Arabia,
(7) Ministry Of Health, General Directorate of Nursing.MoH Agency for Therapeutic Services, Saudi Arabia,
(8) Ministry Of Health, King Abdullah Bin Abdulaziz University Hospital, Saudi Arabia,
(9) Ministry Of Health ,Irada Hospital for Mental Health in Jazan, Saudi Arabia,
(10) Ministry Of Health, Al Shifa First Health Center, Saudi Arabia,
(11) Ministry Of Health,Nursing Affairs General Agency for Therapeutic Services, Saudi Arabia,
(12) Ministry Of Health ,King Salman Hospital, Saudi Arabia

Abstract

Background: The extraction of unerupted and impacted teeth is a common yet complex surgical procedure in dentistry. These teeth, which fail to erupt into the dental arch, can lead to pathologies such as cysts, infections, and damage to adjacent structures, necessitating careful surgical management.


Aim: This review aims to provide an updated, comprehensive guide for dental professionals on the clinical management and pharmacological support for the surgical extraction of unerupted teeth, emphasizing a multidisciplinary approach to optimize patient outcomes.


Methods: The article synthesizes current evidence on diagnosis, classification (utilizing systems like Pell and Gregory and Winter), and surgical techniques. It details the roles of pre-operative assessment, including advanced imaging like Cone Beam Computed Tomography (CBCT) for risk stratification, and outlines the step-by-step surgical protocol from flap design to socket management.


Results: Successful outcomes depend on meticulous planning and execution. Key findings highlight the importance of CBCT in assessing proximity to neurovascular bundles, the efficacy of techniques like tooth sectioning and coronectomy in reducing complications, and the critical need for tailored pharmacological management for pain, infection, and bleeding control. Complications such as alveolar osteitis, nerve injury, and oroantral communication are discussed with evidence-based prevention and management strategies.


Conclusion: The surgical extraction of unerupted teeth requires a systematic, team-based approach. Integrating precise surgical techniques with appropriate pharmacological support and interdisciplinary collaboration among dentists, pharmacists, and laboratory workers is essential for minimizing risks and ensuring patient safety and effective recovery.

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References

Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol. 1985 Apr;59(4):420-5.

Tecco S, Lacarbonara M, Dinoi MT, Gallusi G, Marchetti E, Mummolo S, Campanella V, Marzo G. The retrieval of unerupted teeth in pedodontics: two case reports. J Med Case Rep. 2014 Oct 09;8:334.

Jain P, Rathee M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 20, 2023. Anatomy, Head and Neck, Tooth Eruption.

Msagati F, Simon EN, Owibingire S. Pattern of occurrence and treatment of impacted teeth at the Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Oral Health. 2013 Aug 06;13:37.

Bayar GR, Ortakoglu K, Sencimen M. Multiple impacted teeth: report of 3 cases. Eur J Dent. 2008 Jan;2(1):73-8.

Jaroń A, Trybek G. The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population. Int J Environ Res Public Health. 2021 Jun 03;18(11)

Williams M, Tollervey D. Lower third molar surgery - consent and coronectomy. Br Dent J. 2016 Mar 25;220(6):287-8.

Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990 Feb;28(1):20-5.

Muhsin H, Brizuela M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 19, 2023. Oral Surgery, Extraction of Mandibular Third Molars.

Nguyen JD, Duong H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 29, 2023. Anatomy, Head and Neck, Mental Nerve.

Pogrel MA, Smith R, Ahani R. Innervation of the mandibular incisors by the mental nerve. J Oral Maxillofac Surg. 1997 Sep;55(9):961-3.

Çorumlu U, Kopuz C, Aydar Y. Branching Patterns of Mental Nerve in Newborns. J Craniofac Surg. 2020 Oct;31(7):2025-2028.

do Nascimento EH, Dos Anjos Pontual ML, Dos Anjos Pontual A, da Cruz Perez DE, Figueiroa JN, Frazão MA, Ramos-Perez FM. Assessment of the anterior loop of the mandibular canal: A study using cone-beam computed tomography. Imaging Sci Dent. 2016 Jun;46(2):69-75.

Pelé A, Berry PA, Evanno C, Jordana F. Evaluation of Mental Foramen with Cone Beam Computed Tomography: A Systematic Review of Literature. Radiol Res Pract. 2021;2021:8897275.

Lin SXY, Sim PR, Lai WMC, Lu JX, Chew JRJ, Wong RCW. Mapping out the surgical anatomy of the lingual nerve: a systematic review and meta-analysis. J Korean Assoc Oral Maxillofac Surg. 2023 Aug 31;49(4):171-183.

Ostrowski P, Bonczar M, Wilk J, Michalczak M, Czaja J, Niziolek M, Sienkiewicz J, Szczepanek E, Chmielewski P, Iskra T, Gregorczyk-Maga I, Walocha J, Koziej M. The complete anatomy of the lingual nerve: A meta-analysis with implications for oral and maxillofacial surgery. Clin Anat. 2023 Sep;36(6):905-914.

Behnia H, Kheradvar A, Shahrokhi M. An anatomic study of the lingual nerve in the third molar region. J Oral Maxillofac Surg. 2000 Jun;58(6):649-51; discussion 652-3.

Danesh-Sani SA, Loomer PM, Wallace SS. A comprehensive clinical review of maxillary sinus floor elevation: anatomy, techniques, biomaterials and complications. Br J Oral Maxillofac Surg. 2016 Sep;54(7):724-30.

Ghaeminia H, Nienhuijs ME, Toedtling V, Perry J, Tummers M, Hoppenreijs TJ, Van der Sanden WJ, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev. 2020 May 04;5(5):CD003879.

Hounsome J, Pilkington G, Mahon J, Boland A, Beale S, Kotas E, Renton T, Dickson R. Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation. Health Technol Assess. 2020 Jun;24(30):1-116.

Sarica I, Derindag G, Kurtuldu E, Naralan ME, Caglayan F. A retrospective study: Do all impacted teeth cause pathology? Niger J Clin Pract. 2019 Apr;22(4):527-533.

Pick L, Bauer J. [Dentistry and epilepsy]. Nervenarzt. 2001 Dec;72(12):946-9.

Chaudhry S, Jaiswal R, Sachdeva S. Dental considerations in cardiovascular patients: A practical perspective. Indian Heart J. 2016 Jul-Aug;68(4):572-5.

Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, O'Gara PT, Baddour LM. Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures. J Am Coll Cardiol. 2022 Sep 13;80(11):1029-1041.

Rodríguez Martínez S, Talaván Serna J, Silvestre FJ. [Dental management in patients with cirrhosis]. Gastroenterol Hepatol. 2016 Mar;39(3):224-32.

Carter G, Goss AN, Lloyd J, Tocchetti R. Current concepts of the management of dental extractions for patients taking warfarin. Aust Dent J. 2003 Jun;48(2):89-96; quiz 138.

Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int Dent J. 2018 Feb;68(1):22-30.

Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022 May;80(5):920-943.

Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, Niepel D, Van den Wyngaert T. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Feb;127(2):117-135.

Bansal H. Medication-related osteonecrosis of the jaw: An update. Natl J Maxillofac Surg. 2022 Jan-Apr;13(1):5-10.

Martin A, Perinetti G, Costantinides F, Maglione M. Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review. Head Face Med. 2015 Apr 10;11:9.

Jephcott A. The surgical management of the oral soft tissues: 1. Flap design. Dent Update. 2007 Oct;34(8):518-20, 522.

Pippi R, Spota A, Santoro M. Prevention of Lingual Nerve Injury in Third Molar Surgery: Literature Review. J Oral Maxillofac Surg. 2017 May;75(5):890-900.

Augustin G, Davila S, Mihoci K, Udiljak T, Vedrina DS, Antabak A. Thermal osteonecrosis and bone drilling parameters revisited. Arch Orthop Trauma Surg. 2008 Jan;128(1):71-7.

Bailey E, Kashbour W, Shah N, Worthington HV, Renton TF, Coulthard P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev. 2020 Jul 26;7(7):CD004345.

Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 2014 Oct;93(10):950-8.

Nitzan DW. On the genesis of "dry socket". J Oral Maxillofac Surg. 1983 Nov;41(11):706-10.

Sweet JB, Butler DP. The relationship of smoking to localized osteitis. J Oral Surg. 1979 Oct;37(10):732-5.

Jaiswal P, Agrawal R, Gandhi A, Jain A, Kumar A, Rela R. Managing Anticoagulant Patients Undergoing Dental Extraction by using Hemostatic Agent: Tranexamic Acid Mouthrinse. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S469-S472.

Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res. 2014 Oct-Dec;5(4):e1.

Bhat P, Cariappa KM. Inferior alveolar nerve deficits and recovery following surgical removal of impacted mandibular third molars. J Maxillofac Oral Surg. 2012 Sep;11(3):304-8.

Oishi S, Ishida Y, Matsumura T, Kita S, Sakaguchi-Kuma T, Imamura T, Ikeda Y, Kawabe A, Okuzawa M, Ono T. A cone-beam computed tomographic assessment of the proximity of the maxillary canine and posterior teeth to the maxillary sinus floor: Lessons from 4778 roots. Am J Orthod Dentofacial Orthop. 2020 Jun;157(6):792-802.

Jolly SS, Rattan V, Rai SK. Intraoral management of displaced root into submandibular space under local anaesthesia -A case report and review of literature. Saudi Dent J. 2014 Oct;26(4):181-4.

Khandelwal P, Hajira N. Management of Oro-antral Communication and Fistula: Various Surgical Options. World J Plast Surg. 2017 Jan;6(1):3-8.

Choi, J. F., Park, D. Y., Williams, S. L. S., & Chang, P. (2025). Oral surgery, extraction of unerupted teeth. In StatPearls [Internet]. StatPearls Publishing.

Authors

Mai Abdullah M Alqunfdi
Malgonfodi@moh.gov.sa (Primary Contact)
Hanan Muntaha Hassan Al-Moashi
Zohour Abduqader Baamer
Khdigah Mansour Sarhan
Mohammed Almutairi
Ali Mohammed Qassim Hazzazi
Amal Ahmad Ali Hardi
Fatimah Saad Alotaibi
Hanan Awad Awaad Alosaimi
zaki yahya bawkar hawbani
Abdullah Rashid Alharbi
Reem Mohammad alhumaidan
Mohammed Othma AlRethy
Dawla Ali Al aqili
Alqunfdi, M. A. M., Al-Moashi, H. M. H., Baamer, Z. A., Sarhan, K. M., Almutairi, M., Hazzazi, A. M. Q., … Al aqili, D. A. (2025). Clinical Management and Pharmacological Support in Surgical Extraction of Unerupted Teeth: An Updated Review for Dentists, Pharmacists, Laboratory Workers. Saudi Journal of Medicine and Public Health, 2(2), 340–352. https://doi.org/10.64483/jmph-110

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