When extracting maxillary molars, what is the rationale for starting with the third molar?

Starting with the extraction of the third maxillary molar is fundamentally aimed at minimizing the risk of breaking off the tuberosity. The tuberosity is a bony prominence at the back of the maxilla, and it can be compromised during the extraction process if not managed properly. By removing the third molar first, practitioners can avoid placing undue stress on the tuberosity when extracting the second molar and the first molar afterward. This approach helps to preserve the integrity of the surrounding structures, including the adjacent teeth and the maxillary sinus walls, thereby enhancing the overall success of the extraction procedure.

Additionally, starting with the third molar allows for a more favorable environment during the subsequent extractions, as it can create additional space and improve accessibility in the anatomical area. This methodical approach is beneficial for maintaining the health of the surrounding oral structures.