What type of 3rd molar impaction is considered the most difficult?

The type of third molar impaction considered the most difficult is distoangular impaction. This classification often leads to more complex surgical extractions due to the position of the tooth in relation to surrounding anatomical structures. Distoangular impacted third molars are positioned at an angle toward the back of the mouth, which can make access more challenging for the dentist or oral surgeon.

This position is particularly troublesome because the tooth may be situated close to the mandibular ramus and the associated neurovascular structures. The angulation not only complicates the extraction but also increases the risk of injury to adjacent teeth and nerves, particularly the inferior alveolar nerve. These factors contribute to a higher likelihood of complications during surgery and an increase in post-operative discomfort and swelling.

In contrast, mesioangular and vertical impactions, while they can present their own challenges, are generally easier to manage. Mesioangular impactions tend to have a more favorable angle that allows for easier access during extraction. Vertical impactions also provide straightforward extraction pathways since the tooth is oriented in the same direction as the other molars. Horizontal impactions can be complicated because of their positioning, but they do not typically pose the same level of risk to adjacent structures as distoangular impactions do