Impacted Wisdom Teeth Treatment
in Honolulu, HI
 An impacted wisdom tooth is a third molar that cannot fully erupt into the mouth because it is blocked by gum tissue, bone, or an adjacent tooth.
At Pacific Maxillofacial Center, our board-certified oral and maxillofacial surgeons remove impacted wisdom teeth at our Honolulu and Waipi’o offices, with cone beam CT planning for nerve and sinus proximity and all five sedation levels available in-office.
Impacted wisdom teeth are a specific category of surgical tooth extractions. Because the tooth is not fully accessible, the removal involves a small incision in the gum, often the removal of a thin layer of bone over the tooth, and sometimes sectioning the tooth into pieces for safer extraction.
For general information about wisdom teeth, including when removal is not necessary, our broader wisdom teeth removal overview is the better starting point. This page focuses on the impacted cases specifically.
On This Page
What Is an Impacted Wisdom Tooth?
 Impaction has degrees. The amount of gum tissue or bone covering the tooth, and the angle at which the tooth is sitting, both determine how complex the removal will be and what kind of sedation makes sense.
Impaction by Tissue Coverage
A soft tissue impaction means the tooth has emerged through the bone but is still covered by gum tissue. The crown is visible on imaging but not in the mouth. A partial bony impaction means part of the tooth is still covered by bone, with the crown partially erupted through the gum. A complete bony impaction means the tooth is fully encased in bone and requires the most extensive surgical access of the three categories.
Impaction by Angulation
The direction the tooth is pointing also affects the procedure:
- Vertical – Tooth pointing straight up, the closest to normal eruption.
- Mesial – Tooth tilted forward toward the second molar. The most common angulation.
- Distal – Tooth tilted backward away from the second molar.
- Horizontal – Tooth lying sideways, often the most surgically demanding.
Not every wisdom tooth requires removal. If a wisdom tooth is fully erupted, in functional position, and able to be cleaned with normal brushing and flossing, watchful waiting is reasonable. The cases that warrant removal involve active problems or impending risks.
Risks of Leaving Impacted Wisdom Teeth Untreated
When an impacted wisdom tooth does need to come out, the reasons usually trace back to one of a few specific complications:
- Pericoronitis – Inflammation and infection of the gum tissue surrounding a partially erupted wisdom tooth. Bacteria and food debris get trapped under the gum flap, and the area becomes painful and swollen. Recurring pericoronitis is one of the most common reasons we remove impacted wisdom teeth.
- Cyst Formation – A dentigerous cyst can form around the crown of an impacted tooth. Untreated, these cysts can damage surrounding bone, nerves, and adjacent teeth.
- Damage to the Second Molar – A wisdom tooth pressing against the second molar can cause root resorption, decay on the back surface of the second molar where it cannot be cleaned, or pocket formation along the gumline.
- Decay and Periodontal Disease – Partially erupted wisdom teeth are difficult to clean. The result is often decay on the wisdom tooth itself, or periodontal pocketing around it.
- Orthodontic Considerations – While the role of wisdom teeth in late-life crowding is debated, your orthodontist may recommend removal if pressure from impacted teeth is a concern in your specific case.
The earlier these complications are caught, the simpler the surgical solution tends to be. Roots are not fully formed in younger patients, and the bone is less dense, both of which make the procedure faster and recovery easier.
Your Oral Surgery Team in Honolulu
Pacific Maxillofacial Center was founded in 1999 by Dr. Todd K. Haruki, who completed 12 years of graduate and post-graduate surgical training, including a hospital-based oral and maxillofacial surgery residency at the University of Louisville. He is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Dental Society of Anesthesiology.
Dr. Neil Oishi holds DDS and MD degrees from the University of Southern California and the University of Florida College of Medicine respectively, and completed his oral and maxillofacial surgery residency at the University of Florida. He is also a Diplomate of the American Board of Oral and Maxillofacial Surgery and serves as an on-call facial trauma surgeon at Queen’s Medical Center.
The dual DDS-MD training matters specifically for impacted wisdom teeth because lower third molars often sit close to the inferior alveolar nerve, the nerve that supplies sensation to the lower lip and chin. Reading CBCT imaging accurately, planning around that nerve, and adjusting the surgical approach when the tooth is touching or wrapped around it is what hospital-based oral surgery training prepares for. Both surgeons handle these cases routinely.
The Impacted Wisdom Teeth Removal Process
Most impacted wisdom teeth removals follow a predictable sequence, though the time spent on each step varies with the depth of impaction.
Step 1: Consultation and CBCT Imaging
At your first visit, we review your medical and dental history, examine the area, and take cone beam CT imaging. For lower impacted wisdom teeth specifically, CBCT shows the exact relationship between the tooth roots and the inferior alveolar nerve, which a standard two-dimensional X-ray cannot reliably reveal. That imaging changes the surgical plan in cases where the nerve is unusually close.
Step 2: Sedation Discussion
For impacted wisdom teeth, sedation is rarely just a preference. Bony impaction or removal of all four teeth in one visit typically calls for IV sedation or general anesthesia, both of which we administer in-office under continuous monitoring. We walk through the full menu of sedation options during the consultation, and for patients dealing with significant anxiety, our dentistry for anxious patients coverage walks through the deeper levels.
Step 3: Day of Surgery
On surgery day, we numb the area with local anesthesia, administer your chosen sedation, and proceed with the removal. We make a small incision in the gum, remove bone covering the tooth if the impaction is bony, section the tooth into pieces if angulation requires it, and remove each section. We then irrigate the site, smooth the bony edges, and close with sutures.
Step 4: Recovery
Most patients return home the same day with detailed home-care instructions. Our after wisdom tooth removal guide walks through what to expect day by day, including swelling management, the soft-food timeline, and warning signs to watch for. Most patients are back to normal eating within 7 to 14 days, with the first three days being the most uncomfortable.
A typical four-tooth removal under IV sedation runs 60 to 90 minutes of actual chair time, plus check-in and recovery. Single-tooth and partially impacted cases are faster.
Benefits of Specialist Care for Impacted Wisdom Teeth
Impacted wisdom teeth removal is one of the procedures where the difference between an oral and maxillofacial surgeon and a general dentist matters most.
The most concrete reason is nerve mapping. For lower impacted wisdom teeth, the inferior alveolar nerve can sit directly against the tooth roots. Misjudging that relationship can produce temporary or permanent numbness of the lower lip and chin. CBCT imaging plus surgical experience reading those scans is how we plan around that nerve. Both Dr. Haruki and Dr. Oishi work with these cases regularly.
We also have all five levels of sedation available in our own offices. Bony impactions and four-tooth cases typically need IV sedation or general anesthesia, both of which we administer and monitor in-house. There is no referral to an outside anesthesiologist and no separate appointment to coordinate.
Combining all four impacted wisdom teeth into a single sedation appointment is the standard approach when all four need removal. One appointment, one recovery window, one round of soft food. Most patients prefer that over coming back four times.
Why Choose Our Practice for Impacted Wisdom Teeth
Our two-office structure on Oahu means patients in Honolulu and the West Oahu corridor can both reach a board-certified oral surgeon without a long drive. The Honolulu office is at 1060 Young St #312, and the Waipi’o office is at 94-1221 Ka Uka Blvd #B-204 in Waipahu.
Our dental technology stack matters for these cases specifically. We use cone beam CT for 3D imaging of the impaction site and surrounding anatomy, including the inferior alveolar nerve in the lower jaw and the maxillary sinus floor in the upper jaw. Both structures sit close enough to wisdom teeth that 2D imaging alone can miss critical detail.
Dr. Haruki’s ADSA Fellowship and both surgeons’ MD-level training give the office in-house anesthesia oversight for the deeper sedation that most impacted cases require. We do not refer patients to outside anesthesiologists for general anesthesia, which keeps the surgical and anesthesia plan with the same team.
If anxiety has kept you from scheduling impacted wisdom teeth removal even after your dentist recommended it, our dentistry for anxious patients coverage explains how we structure visits to make the work possible.
Impacted Wisdom Teeth Cost and Insurance
Cost matters, and the honest answer for impacted wisdom teeth is that the fee scales with the depth of impaction and the number of teeth removed. A single soft tissue impaction is priced differently than removal of four fully bony impacted teeth in one visit. CBCT imaging and the sedation level you choose also factor in.
Dental insurance often covers impacted wisdom teeth removal, and many plans cover it well, particularly when the impaction is documented as medically necessary because of pain, infection, or cyst risk. Medical insurance sometimes contributes when the case meets specific criteria. Our front office staff handles benefits verification before treatment, and our insurance and financing section covers payment options for any remaining patient responsibility.
Call our Honolulu office at 808-585-8455 if you want benefits checked before scheduling.
Schedule Your Consultation
If you or your dentist suspect your wisdom teeth are impacted, the next step is a consultation with CBCT imaging. Call our Honolulu office at 808-585-8455 or request an appointment online. Our Honolulu office is at 1060 Young St #312, Honolulu, HI 96814. We also see patients at our Waipi’o office. The Contact page is the easiest way to reach us in writing.
Frequently Asked Questions
How do I know if my wisdom teeth are impacted?
Impaction is usually identified on dental imaging. Your general dentist will see it on a routine panoramic X-ray and refer you for evaluation. You may also notice symptoms like pain or pressure in the back of your jaw, swelling around the gums of the back molars, or recurring infections in that area.
Do all impacted wisdom teeth need to be removed?
No. Asymptomatic, fully bony impacted teeth that are not causing problems and are not at risk for cyst formation can sometimes be monitored rather than removed. The decision depends on the angulation, depth, age, and risk profile of each specific tooth. We give you a clear recommendation after reviewing your CBCT imaging.
Will the procedure hurt?
The area is fully numbed with local anesthesia before any surgical work begins, and IV sedation or general anesthesia from our sedation options menu is standard for bony impactions. Most patients have no memory of the procedure itself. After the numbing wears off, mild to moderate soreness and swelling are typical for two to four days and respond to the pain control we send home.
How long is recovery?
Most patients are back to normal eating within 7 to 14 days, with the first three days being the most uncomfortable. Swelling typically peaks on day 2 or 3 and improves from there. Our after wisdom tooth removal instructions walk through what to expect day by day.
Can all four impacted wisdom teeth be removed in one appointment?
Yes, and this is the more common approach when all four are impacted. Doing them under a single IV sedation or general anesthesia appointment combines four recoveries into one, which most patients prefer over coming back four times. The appointment typically runs 60 to 90 minutes of chair time.
Am I too old to get my wisdom teeth out?
There is no upper age limit. The procedure is generally easier and recovery faster in younger patients because the roots have not fully formed and the bone is less dense, but older patients can absolutely have wisdom teeth removed safely. Recovery may take a few additional days, and the consultation gives us the information to estimate your specific case.
What is dry socket and how do you prevent it?
Dry socket is a painful complication that occurs when the blood clot in the extraction site dislodges before the area has healed. We give you specific post-op instructions to reduce the risk, including no smoking, no straws, no aggressive rinsing for the first 48 hours, and a soft-food diet for the first few days. Following those instructions cuts the risk significantly.
Will my insurance cover impacted wisdom teeth removal?
Many dental insurance plans cover impacted wisdom teeth removal, especially when the case is documented as medically necessary because of pain, infection, or cyst risk. Coverage levels vary widely between plans. Our front office staff verifies your specific benefits before treatment so you have a clear estimate. The insurance and financing section lists the plans we typically work with. |
