Wharf’s Assessment of Impacted Third Molar

Wharf’s Assessment of 3rd Molar Impaction is a very detailed assessment of the Difficulty of Impaction procedure which considers various factors to determine the difficulty of the Impaction Surgery.

The various factors which determine the Wharf’s Assessment are:

  1. Winters classification
  2. Height of the mandible
  3. Angulation of the 2nd molar
  4. Root shape & morphology
  5. Follicle development
  6. Path of Exit of the tooth during removal

The number denotes the difficulty in Surgical removal of impaction. With “0” = Easiest to extract and as the number increases the difficulty in extracting the tooth increases. Wharfs Assessment of 3rd molar Impaction winters lines

Winter’s Classification:

  • Vertical Impaction: 0
  • Mesioangular Impaction: 1
  • Horizontal Impaction: 2
  • Distoangular Impaction: 2

Height of the Mandible:

  • 1 – 30 mm: 0
  • 31-24 mm: 1
  • 35-39 mm: 2

Angulation of the 2nd Molar:

  • 1-50 degrees: 0
  • 60-69 degrees: 1
  • 70-79 degrees: 2
  • 80-89 degrees: 3
  • 90Degrees +: 4

Root Shape:

  • Complex: 1
  • Favourable Curvature: 2
  • Unfavourable curvature: 3

Path of Exit:

  • Space Available: 0
  • Distal Cusp Covered: 1
  • Mesial Cusp also covered: 2
  • Both Covered: 3

Follicles:

  • Normal: 0
  • Possibly Enlarged: 1
  • Enlarged: 2

Total Score is: 33

So during assessment of Difficulty of Impaction using Wharf’s assessment we need to look at each aspect and decide how the treatment plan is going to be. In case of Distal Impaction or Vertical Impaction Bone removal is required in most cases, where as in Mesial impaction it is not. In the same manner all the factors mentioned above will surely determine the difficulty of Surgical Impaction.

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