# **Wisdom Teeth** ### An Overview **Dr Richard Hague** Richard.hague@uwa.edu.au **Dr Richard Hague** Richard.hague@uwa.edu.au # Learning Outcomes * **Recognise and describe 3rd molar impactions** * Explain how to identify proximity of other close anatomical structures * Management of pericoronitis * Discuss the management strategies for 3rd molars * Explain the basic steps of a surgical removal of a 3rd molar - Recognise and describe 3rd molar impactions - Explain how to identify proximity of other close anatomical structures - Management of pericoronitis - Discuss the management strategies for 3rd molars - Explain the basic steps of a surgical removal of a 3rd molar **Why might wisdom teeth become impacted?** * Last teeth to develop * 3rd molar germ will not appear until ages 4-5yrs * Mineralization of the crown between 7-10yrs * Crown formation complete 12-16yrs * Eruption varies 17-25yrs * Lack of space * Irregularity in position - most likely to be ectopic * Density of overlying and surrounding bone #### Developmental Timeline Wisdom teeth are the last teeth to develop, following a specific chronological sequence: - The third molar germ does not appear until ages 4–5 years. - Mineralization of the crown occurs between 7–10 years. - Crown formation is completed between 12–16 years. - Eruption typically varies between 17–25 years.\n #### Physical and Positional Factors Several anatomical factors contribute to the impaction of third molars: - Lack of available space in the dental arch. - Irregularity in position, as these teeth are the most likely to be ectopic. - The density of the overlying and surrounding bone. **What symptoms might a patient complain about?** * Pain * May be very specific. * May be very vague “dull ache”, “pressure” * Earache? * Headache? * Swelling * Infection * Trismus #### Pain Characteristics Patients may report various types of discomfort, ranging from localized to referred pain: - Specific localized pain. - Vague sensations described as a "dull ache" or "pressure." - Referred pain manifesting as an earache or headache. #### Clinical Presentations Other common symptoms reported by patients include: - Swelling in the affected area. - Signs of infection. - Trismus (restricted jaw movement). **Impaction Types** **It is a useful exercise to classify impactions as it assists with:** * **Estimation of difficulty**\* * **Surgical approach** Classifying impactions is a useful exercise as it assists with: - Estimation of difficulty - Surgical approach **Impaction Types** 1. Overlying Tissue Classification ▶ Soft tissue impaction  #### Soft Tissue Impaction - Soft tissue impaction Split-view visual demonstrating 'Soft tissue impaction'. Left panel is a clinical photograph of the oral cavity showing inflamed gingival tissue and teeth. Right panel is a diagrammatic illustration with a red overlay indicating the soft tissue covering an impacted tooth. # Impaction Types ## 1. Overlying Tissue Classification - Soft tissue impaction - Bony impaction - partial  #### Tissue and Bone Coverage - Soft tissue impaction - Bony impaction - partial Clinical radiograph (panoramic X-ray) of the mandibular region showing impacted teeth. The image displays dental anatomy with visible roots and crowns, including a tooth with endodontic treatment (root canal filling). This visual supports the 'Overlying Tissue Classification' section for identifying soft tissue or partial bony impaction types. **Impaction Types** 1. Overlying Tissue Classification - Soft tissue impaction - Bony impaction – partial - Bony impaction - complete  #### Degree of Impaction - Soft tissue impaction - Bony impaction – partial - Bony impaction - complete Clinical radiograph (panoramic or periapical X-ray) showing a mandibular molar region with an impacted tooth. The image demonstrates the classification of impaction types based on overlying tissue: soft tissue impaction and bony impaction (partial/complete), as referenced in the accompanying text. **Impaction Types** 2. Winter’s classification, 1926 * Third molars classified based on their inclination compared to the long axis of the 2nd molar * 6 Classifications: * Vertical * Mesio-angular * Horizontal * Disto-angular * Transverse (buccolingual) * Inverted  Third molars are classified based on their inclination compared to the long axis of the 2nd molar. There are 6 classifications: - Vertical - Mesio-angular - Horizontal - Disto-angular - Transverse (buccolingual) - Inverted Labelled diagram illustrating Winter's classification of third molar impaction types. The image features a circular coordinate system with concentric circles and angular markers (10, -10, 80, -80, 100) representing degrees of inclination relative to the long axis of the second molar. Six tooth diagrams are positioned at specific angles within the circle, each labeled or associated with one of the six classifications: Vertical, Mesio-angular, Horizontal, Disto-angular, Transverse (buccolingual), and Inverted. Red arrows indicate directional vectors for mesial, distal, and vertical inclinations. # Impaction Types ## 3. Pell and Gregory, 1933 <!--IMAGE Placeholder-->   Pell and Gregory, 1933 Table titled 'Depth' classifying impaction types by depth level. Level A: Highest portion of impacted third molar is level with or above occlusal plane. Level B: Below occlusal plane but above cervical line of 2nd molar. Level C: Below cervical line of 2nd molar. Diagram illustrating Pell and Gregory classification with three labeled illustrations: Position A shows highest portion of impacted tooth at or above occlusal plane; Position B shows it below occlusal plane but above cervical line of second molar; Position C shows it below cervical line of second molar. Impaction Types **3. Pell and Gregory, 1933** > Looks at depth and space between the ramus **Space between the ramus** <table> <thead> <tr> <td><b>Class 1</b></td> <td>Sufficient space between the anterior border of the ascending ramus and the distal aspect of the 2$^{nd}$ molar. I.e. greater than the mesio- distal width of the 3$^{rd}$ molar crown.</td> </tr> <tr> <td><b>Class 2</b></td> <td>The space available between the anterior border of the ascending ramus and the distal aspect of the 2$^{nd}$ molar is less than the mesio-distal width of the 3$^{rd}$ molar crown.</td> </tr> <tr> <td><b>Class 3</b></td> <td>The third molar is embedded in the bone of the ascending ramus because of the lack of space</td> </tr> </thead> </table>   This system evaluates the depth and the space between the ramus. #### Space Between the Ramus 1. **Class 1**: Sufficient space between the anterior border of the ascending ramus and the distal aspect of the 2nd molar. I.e. greater than the mesio-distal width of the 3rd molar crown. 2. **Class 2**: The space available between the anterior border of the ascending ramus and the distal aspect of the 2nd molar is less than the mesio-distal width of the 3rd molar crown. 3. **Class 3**: The third molar is embedded in the bone of the ascending ramus because of the lack of space. Table titled 'Space between the ramus' outlining Pell and Gregory classification. It contains three rows for Class 1, Class 2, and Class 3, detailing the space available between the ascending ramus and the distal aspect of the 2nd molar relative to the mesio-distal width of the 3rd molar crown. Set of three line drawings illustrating the three classes of impaction depth defined by the table on the left. Each drawing shows a mandibular ramus and teeth (2nd and 3rd molars). The images are labeled 'Class 1', 'Class 2', and 'Class 3' respectively, visually demonstrating sufficient space, reduced space, and lack of space within the bone. **Depth** | Level A | Highest portion of the impacted third molar is level with, or above the occlusal plane | | Level B | Highest portion of the impacted third molar is below the occlusal plane BUT above the cervical line of the 2nd molar. | | Level C | Highest portion of the impacted third molar is below the cervical line of the 2nd molar | **Space between the ramus** | Class 1 | Sufficient space between the anterior border of the ascending ramus and the distal aspect of the 2nd molar. I.e. greater than the mesio-distal width of the 3rd molar crown. | | Class 2 | The space available between the anterior border of the ascending ramus and the distal aspect of the 2nd molar is less than the mesio-distal width of the 3rd molar crown. | | Class 3 | The third molar is embedded in the bone of the ascending ramus because of the lack of space |    #### Depth Classification - **Level A**: Highest portion of the impacted third molar is level with, or above the occlusal plane. - **Level B**: Highest portion of the impacted third molar is below the occlusal plane BUT above the cervical line of the 2nd molar. - **Level C**: Highest portion of the impacted third molar is below the cervical line of the 2nd molar. #### Space Between the Ramus - **Class 1**: Sufficient space between the anterior border of the ascending ramus and the distal aspect of the 2nd molar. I.e. greater than the mesio-distal width of the 3rd molar crown. - **Class 2**: The space available between the anterior border of the ascending ramus and the distal aspect of the 2nd molar is less than the mesio-distal width of the 3rd molar crown. - **Class 3**: The third molar is embedded in the bone of the ascending ramus because of the lack of space. Table titled 'Depth' defining three levels of impacted third molar position: Level A (highest portion level with or above occlusal plane), Level B (below occlusal plane but above cervical line of 2nd molar), and Level C (below cervical line of 2nd molar). Table titled 'Space between the ramus' defining three classes based on available space relative to the mesio-distal width of the 3rd molar crown: Class 1 (sufficient space, greater than crown width), Class 2 (insufficient space, less than crown width), and Class 3 (no space, embedded in bone). Set of six labelled diagrams illustrating the Pell-Gregory classification system. The top row shows sagittal views of the mandibular ramus and teeth for Class 1 (sufficient space), Class 2 (limited space), and Class 3 (no space). The bottom row shows corresponding transverse views labeled Position A, Position B, and Position C. # Impaction Types ## 4. Archer’s classification of upper 3rd molars ### ▲ Classified on inclination and depth ### Inclination | | | | :--- | :--- | | **1** | mesioangular | | **2** | distoangular | | **3** | vertical | | **4** | horizontal | | **5** | buccoangular | | **6** | linguoangular | | **7** | inverted | ### Depth | | | | :--- | :--- | | **a** | Occlusal surface of the 3rd molar level with the 2nd molar | | **b** | Occlusal surface of the 3rd molar at the middle of the crown of the 2nd molar | | **c** | Occlusal surface of the 3rd molar at the cervical line of the of the 2nd molar | | **d** | Occlusal surface of the 3rd molar at along the root of the of the 2nd molar | | **e** | Occlusal surface of the 3rd molar above the root of the of the 2nd molar |    Maxillary third molars are classified based on inclination and depth. #### Inclination 1. Mesioangular 2. Distoangular 3. Vertical 4. Horizontal 5. Buccoangular 6. Linguoangular 7. Inverted #### Depth - **a**: Occlusal surface of the 3rd molar level with the 2nd molar - **b**: Occlusal surface of the 3rd molar at the middle of the crown of the 2nd molar - **c**: Occlusal surface of the 3rd molar at the cervical line of the 2nd molar - **d**: Occlusal surface of the 3rd molar along the root of the 2nd molar - **e**: Occlusal surface of the 3rd molar above the root of the 2nd molar Table labeled 'Inclination' listing Archer's classification types for upper 3rd molars. Rows numbered 1-7 with corresponding terms: mesioangular, distoangular, vertical, horizontal, buccoangular, linguoangular, and inverted. Table labeled 'Depth' describing occlusal surface positions of the 3rd molar relative to the 2nd molar. Rows labeled a-e detailing levels from occlusal surface alignment to above root level. Illustrative diagram showing various impaction types of upper 3rd molars. Labels include numbers 1-7 (corresponding to inclination types) and letters a-e (corresponding to depth types). Each illustration depicts tooth anatomy with positional relationships between 2nd and 3rd molars. # **Complications of removal of lower 3rd molars** * Displacement of root or tooth * Dry socket * Bony defect distal to the 2nd molar * Periodontal defect distal to the 2nd molar * Altered sensation to the lip, chin or tongue (injury to the IAN or lingual nerve) The removal of lower third molars is associated with several potential complications: - Displacement of the root or the entire tooth - Dry socket - Bony defect distal to the second molar - Periodontal defect distal to the second molar - Altered sensation to the lip, chin, or tongue (resulting from injury to the inferior alveolar nerve or lingual nerve) **Mandibular 3rd molars & IAN proximity** * Risk of an altered sensation to the lip, chin and tongue which may be temporary or permanent * Temporary paraesthesia reported 0.5-5%¹ * Permanent paraesthesia reported <1%¹ * There are some signs to look out for on an OPG: * Darkening of the roots * Interruption of the radiopaque line (loss of the corticated border) * Diversion of the ID canal * Dark and bifid apex * Deflection of the roots * Narrowing of the ID canal * Narrowing of the roots * Juxta-apical area² --- 1. Huang, C.-K., et al. (2015). "Use of panoramic radiography to predict postsurgical sensory impairment following extraction of impacted mandibular third molars." *Journal of the Chinese Medical Association* **78(10)**: 617-622. 2. T. Renton, M. Hankins, C. Sproate, M. McGurk, *A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars*, *British Journal of Oral and Maxillofacial Surgery*, Volume 43, Issue 1, 2005, Pages 7-12. #### Sensory Impairment Risks Extraction of mandibular third molars carries a risk of altered sensation to the lip, chin, and tongue, which may be temporary or permanent: - Temporary paraesthesia: Reported in 0.5–5% of cases - Permanent paraesthesia: Reported in <1% of cases #### Radiographic Indicators of Nerve Proximity Specific signs on an Orthopantomogram (OPG) can indicate a high risk of nerve involvement: - Darkening of the roots - Interruption of the radiopaque line (loss of the corticated border) - Diversion of the inferior dental (ID) canal - Dark and bifid apex - Deflection of the roots - Narrowing of the ID canal - Narrowing of the roots - Juxta-apical area <div> Darkening of roots Deflection of roots </div>   #### Root Morphology Indicators - Darkening of roots - Deflection of roots Radiograph showing 'Darkening of roots' in a circled region of the mandibular area, indicating radiolucent changes around tooth roots. Radiograph showing 'Deflection of roots' in a circled region, illustrating abnormal curvature or displacement of tooth roots. Changes to canal Juxta-apical area   #### Canal and Periapical Indicators - Changes to canal - Juxta-apical area Dental radiograph showing a molar tooth with a red circle highlighting the canal structure. The label 'Changes to canal' is positioned above the image, indicating an observation or modification within the root canal system. Dental radiograph of a molar tooth with a red circle around the apical region of the roots. The label 'Juxta-apical area' is displayed above, pointing to the tissue or bone immediately adjacent to the root tips. # Maxillary 3<sup>rd</sup> molars * Complications of removal can include<sup>1</sup>: * Oroantral communication * Displacement into adjacent anatomical spaces * Fracture of the maxillary tuberosity * Root fracture * Assessment is difficult from PA/OPGs due to projection * CBCT is best for showing relationship but not necessarily indicated 1. Lewusz-Butkiewicz, K., Kaczor, K., & Nowicka, A. (2018). Risk factors in oroantral communication while extracting the upper third molar: Systematic review. *Dental and Medical Problems*, 55(1), 69–74. https://doi.org/10.17219/dmp/80944 #### Potential Complications Complications associated with the removal of maxillary third molars include: - Oroantral communication - Displacement into adjacent anatomical spaces - Fracture of the maxillary tuberosity - Root fracture #### Diagnostic Assessment - Assessment is often difficult using Periapical (PA) radiographs or OPGs due to projection limitations. - Cone Beam Computed Tomography (CBCT) provides the best visualization of anatomical relationships, though it is not necessarily indicated for every case. No overlap Overlap Root intimate with sinus    #### Sinus Relationship Classifications - No overlap - Overlap - Root intimate with sinus Dental radiograph labeled 'No overlap' showing maxillary anterior teeth with multiple restorations; no superimposition of adjacent tooth structures. Dental radiograph labeled 'Overlap' showing maxillary anterior teeth with restorations; some overlapping of adjacent tooth structures is visible. Dental radiograph labeled 'Root intimate with sinus' showing maxillary posterior region with a red circle highlighting the root apex in close proximity to the maxillary sinus floor. **Suggested reading:** Themkumkwun, S et al, ‘Maxillary Molar Root Protrusion into the Maxillary Sinus: A Comparison of Cone Beam Computed Tomography and Panoramic Findings’ (2019) 48(12) International journal of oral and maxillofacial surgery 1570  #### Suggested Reading Themkumkwun, S et al, ‘Maxillary Molar Root Protrusion into the Maxillary Sinus: A Comparison of Cone Beam Computed Tomography and Panoramic Findings’ (2019) 48(12) International journal of oral and maxillofacial surgery 1570 Panoramic dental radiograph showing the maxillary and mandibular arches. A red circle highlights a specific finding in the posterior region of the upper jaw (maxilla), consistent with the suggested reading topic 'Maxillary Molar Root Protrusion into the Maxillary Sinus'. The image displays the crowns and roots of several teeth, including what appears to be impacted or supernumerary molars near the sinus floor. # Pathology associated with 3rd molars ## Pericoronitis Inflammation of the gingival tissues overlying a partially erupted tooth **Symptoms include:** * **Erythema** * **Swelling** * **Suppuration** * Radiating pain to FOM, ear or throat * **Halitosis** * **Trismus** (if severe) ## Management includes: * Flushing around the tooth / flap with saline * Antibiotics depending on severity (think spreading infection) * Remove opposing tooth - often trauma from the upper exacerbates * Remove the impacted tooth * Operculectomy (not really advised unless for very short term relief) *** **By Coronation Dental Specialty Group - Own work, CC BY-SA 3.0,** https://commons.wikimedia.org/w/index.php?curid=30408193  Pericoronitis is the inflammation of the gingival tissues overlying a partially erupted tooth. #### Clinical Presentation and Symptoms - **Erythema** - **Swelling** - **Suppuration** - Radiating pain to the floor of the mouth (FOM), ear, or throat - **Halitosis** - **Trismus** (in severe cases) #### Clinical Management - Flushing around the tooth and flap with saline - Administration of antibiotics depending on severity (indicated if there is a spreading infection) - Removal of the opposing tooth, as trauma from the upper tooth often exacerbates the condition - Removal of the impacted tooth - Operculectomy (generally not advised except for very short-term relief) Clinical photo of a human mouth showing the posterior region with an inflamed gingival flap (operculum) overlying a partially erupted third molar. The tissue is erythematous and swollen, consistent with pericoronitis as described in the text. A green arrow points to the inflamed operculum. # Pathology associated with 3rd molars * Pericoronitis * Periodontitis * Caries * Tumors * Many types described in literature1 - ameloblastoma, odontogenic keratocyst, odontogenic fibroma, squamous cell carcinoma 1. Patil S, Halgatti V, Khandelwal S, Santosh BS, Maheshwari S. Prevalence of cysts and tumors around the retained and unerupted third molars in the Indian population. J Oral Biol Craniofac Res. 2014 May-Aug;4(2):82-7. doi: 10.1016/j.jobcr.2014.07.003. Epub 2014 Aug 12. PMID: 25737923; PMCID: PMC4252379.  Pathology associated with third molars includes various conditions such as pericoronitis, periodontitis, and caries. #### Odontogenic Tumors Many types of tumors associated with retained and unerupted third molars are described in the literature, including: - Ameloblastoma - Odontogenic keratocyst - Odontogenic fibroma - Squamous cell carcinoma Panoramic dental radiograph showing the maxillary and mandibular arches. The image demonstrates pathology associated with third molars, specifically highlighting a large radiolucent lesion in the left mandible (viewer's right) consistent with an odontogenic tumor or cyst such as an ameloblastoma or odontogenic keratocyst mentioned in the slide text. Pathology associated with 3rd molars * Pericoronitis * Periodontitis * Caries * Tumors * Cysts * Dentigerous cyst being the most common * An epithelial lined developmental cyst formed by an accumulation of fluid between the formed enamel surface and the reduced enamel epithelium  Pathology associated with third molars includes pericoronitis, periodontitis, caries, and tumors. #### Odontogenic Cysts - **Dentigerous Cyst**: This is the most common type of cyst associated with third molars. It is an epithelial-lined developmental cyst formed by an accumulation of fluid between the formed enamel surface and the reduced enamel epithelium. Radiograph (X-ray) of the mandibular region showing a developing third molar with an associated radiolucent area around its crown, consistent with a dentigerous cyst as described in the text. **Pathology associated with 3rd molars** * Pericoronitis * Periodontitis * Caries * Tumors * Cysts * Local and deep space infections * Root resorption  Pathology associated with third molars includes: - Pericoronitis - Periodontitis - Caries - Tumors - Cysts - Local and deep space infections - Root resorption Dental radiograph (X-ray) showing the pathology associated with 3rd molars. The image displays the roots of the second molar and an impacted third molar in close proximity. Visible features include potential periodontal bone loss, caries on the distal surface of the second molar, and possible root resorption or cyst formation near the apex of the impacted tooth. # Indications for removal * **Ongoing pain** * **Infection** - either single severe or repeat mild * **Caries** * **Cysts/tumours** * **Resorption of the roots of the 2nd molars** * **If it is going to be in a surgical field** (e.g orthognathic surgery or ORIF) * **As part of an orthodontic treatment plan** * **$$$?¹** 1. Hanna K, Sambrook P, Armfield JM, Jamieson L, Brennan DS. Third molor extractions among Australian adults: findings from the 2013 National Dental Telephone Interview Survey. Int Dent J. 2018 Apr;68(2):77-83. English. doi: 10.1111/idj.12330. Common clinical indications for the removal of third molars include: - Ongoing pain - Infection (either a single severe episode or repeated mild episodes) - Caries - Cysts or tumours - Resorption of the roots of the second molars - Presence within a surgical field (e.g., orthognathic surgery or Open Reduction Internal Fixation - ORIF) - Requirements as part of an orthodontic treatment plan - Financial considerations and patient preferences **Management of 3rd molars: Removal** Removal difficulty can mostly be estimated based on: - Classification of impaction - Maturation stage of the tooth - Age of the patient Complications of surgery can include: - Tooth or Root displacement - Injury to nerves - Injury to blood vessels - Damage to adjacent teeth #### Assessment of Surgical Difficulty The difficulty of removing third molars is primarily estimated based on the following factors: - Classification of the impaction - Maturation stage of the tooth - Age of the patient #### Potential Surgical Complications Practitioners must be aware of risks associated with the procedure, including: - Tooth or root displacement - Injury to nerves - Injury to blood vessels - Damage to adjacent teeth # General principles  Flap  Trough  Section  Elevate  Irrigate  Close The standard surgical sequence for third molar extraction follows these general principles: 1. **Flap**: Reflection of soft tissue for access. 2. **Trough**: Removal of bone to expose the tooth. 3. **Section**: Dividing the tooth into manageable segments. 4. **Elevate**: Luxation and removal of the tooth segments. 5. **Irrigate**: Thorough cleaning of the socket to remove debris. 6. **Close**: Repositioning and suturing the soft tissue. Surgical Wisdom Tooth Removal https://www.youtube.com/watch?v=7iO3Uq_LmYM Surgical Wisdom Tooth Removal https://www.youtube.com/watch?v=7iO3Uq_LmYM **Management of 3rd molars: Coronectomy** * Deliberate retention of the roots * Procedure involves: * Flap * Sectioning off the crown, 2-4mm below the CEJ * Removal of all residual enamel * MUST NOT mobilise the roots **Figure 2.** Method used for coronectomy. Renton, T et al, ‘A Randomised Controlled Clinical Trial to Compare the Incidence of Injury to the Inferior Alveolar Nerve as a Result of Coronectomy and Removal of Mandibular Third Molars’ (2005) 43(1) *British journal of oral & maxillofacial surgery* 7   Coronectomy involves the deliberate retention of the roots to minimize risks to adjacent structures. #### Procedural Steps - **Flap**: Surgical access to the site. - **Sectioning**: The crown is sectioned off 2-4mm below the Cementoenamel Junction (CEJ). - **Enamel Removal**: All residual enamel must be removed from the remaining root structure. - **Root Stability**: A critical requirement is that the procedure must not mobilise the roots. Figure 2. Method used for coronectomy. Labelled diagram showing three sequential steps of the procedure: left panel shows a tooth (labeled '8') with crown and roots; middle panel illustrates drilling 2-4mm below the crown to section it off, indicated by an orange arrow pointing to the drill depth; right panel depicts removal of the crown while leaving the roots intact, with a yellow triangle marking the 3-4mm sectioning zone and tooth '7' adjacent. Clinical radiograph (panoramic X-ray) showing the mandibular region with visible third molars. The image demonstrates anatomical context relevant to coronectomy, particularly illustrating the proximity of the inferior alveolar nerve canal to the roots of the impacted teeth — critical for understanding why roots are retained rather than extracted in this procedure. # Management of 3rd molars: Active surveillance Consider monitoring symptoms Monitor periodontal pocketing Surveillance OPG periodically In cases where immediate intervention is not required, active surveillance may be employed. This strategy includes: - Monitoring for clinical symptoms - Regular assessment of periodontal pocketing - Periodic surveillance using Orthopantomogram (OPG) imaging [^1]: Original PDF page 1: [[L3 Wisdom Teeth.pdf#page=1|L3 Wisdom Teeth, p.1]] [^2]: Original PDF page 2: [[L3 Wisdom Teeth.pdf#page=2|L3 Wisdom Teeth, p.2]] [^3]: Original PDF page 3: [[L3 Wisdom Teeth.pdf#page=3|L3 Wisdom Teeth, p.3]] [^4]: Original PDF page 4: [[L3 Wisdom Teeth.pdf#page=4|L3 Wisdom Teeth, p.4]] [^5]: Original PDF page 5: [[L3 Wisdom Teeth.pdf#page=5|L3 Wisdom Teeth, p.5]] [^6]: Original PDF page 6: [[L3 Wisdom Teeth.pdf#page=6|L3 Wisdom Teeth, p.6]] [^7]: Original PDF page 7: [[L3 Wisdom Teeth.pdf#page=7|L3 Wisdom Teeth, p.7]] [^8]: Original PDF page 8: [[L3 Wisdom Teeth.pdf#page=8|L3 Wisdom Teeth, p.8]] [^9]: Original PDF page 9: [[L3 Wisdom Teeth.pdf#page=9|L3 Wisdom Teeth, p.9]] [^10]: Original PDF page 10: [[L3 Wisdom Teeth.pdf#page=10|L3 Wisdom Teeth, p.10]] [^11]: Original PDF page 11: [[L3 Wisdom Teeth.pdf#page=11|L3 Wisdom Teeth, p.11]] [^12]: Original PDF page 12: [[L3 Wisdom Teeth.pdf#page=12|L3 Wisdom Teeth, p.12]] [^13]: Original PDF page 13: [[L3 Wisdom Teeth.pdf#page=13|L3 Wisdom Teeth, p.13]] [^14]: Original PDF page 14: [[L3 Wisdom Teeth.pdf#page=14|L3 Wisdom Teeth, p.14]] [^15]: Original PDF page 15: [[L3 Wisdom Teeth.pdf#page=15|L3 Wisdom Teeth, p.15]] [^16]: Original PDF page 16: [[L3 Wisdom Teeth.pdf#page=16|L3 Wisdom Teeth, p.16]] [^17]: Original PDF page 17: [[L3 Wisdom Teeth.pdf#page=17|L3 Wisdom Teeth, p.17]] [^18]: Original PDF page 18: [[L3 Wisdom Teeth.pdf#page=18|L3 Wisdom Teeth, p.18]] [^19]: Original PDF page 19: [[L3 Wisdom Teeth.pdf#page=19|L3 Wisdom Teeth, p.19]] [^20]: Original PDF page 20: [[L3 Wisdom Teeth.pdf#page=20|L3 Wisdom Teeth, p.20]] [^21]: Original PDF page 21: [[L3 Wisdom Teeth.pdf#page=21|L3 Wisdom Teeth, p.21]] [^22]: Original PDF page 22: [[L3 Wisdom Teeth.pdf#page=22|L3 Wisdom Teeth, p.22]] [^23]: Original PDF page 23: [[L3 Wisdom Teeth.pdf#page=23|L3 Wisdom Teeth, p.23]] [^24]: Original PDF page 24: [[L3 Wisdom Teeth.pdf#page=24|L3 Wisdom Teeth, p.24]] [^25]: Original PDF page 25: [[L3 Wisdom Teeth.pdf#page=25|L3 Wisdom Teeth, p.25]] [^26]: Original PDF page 26: [[L3 Wisdom Teeth.pdf#page=26|L3 Wisdom Teeth, p.26]] [^27]: Original PDF page 27: [[L3 Wisdom Teeth.pdf#page=27|L3 Wisdom Teeth, p.27]] [^28]: Original PDF page 28: [[L3 Wisdom Teeth.pdf#page=28|L3 Wisdom Teeth, p.28]] [^29]: Original PDF page 29: [[L3 Wisdom Teeth.pdf#page=29|L3 Wisdom Teeth, p.29]] [^30]: Original PDF page 30: [[L3 Wisdom Teeth.pdf#page=30|L3 Wisdom Teeth, p.30]]