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Impacted Teeth
INTRODUCTION
The word IMPACTION is derived from latin
word “impactus”.
2 Dr. Apoorva Mowar, Subharti Dental College, SVSU
IMPACTED TEETH
Definition
A tooth which is completely or partially
unerupted & is positioned against another
tooth, bone or soft tissue, so that further eruption
is unlikely, described according to its anatomic
position and its eruption potential has been lost.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Etiological theories
1. PHYLOGENIC THEORY -- Civilization
has eliminated the human need for large &
powerful jaws which leads to decreases the size
of jaws. Due to this IIIrd molar occupies an
abnormal position & may be consider a vestigial
organ( with out purpose or function).
Dr. Apoorva Mowar, Subharti Dental College, SVSU
. 2. MENDELIAN THEORY
HERIDIETRY OR GENETIC INFLUNCE LEADS TO SMALL
JAWS & RESULTING IMPACTED TEETH.
3.ENDOCRINE THEORY
Due to lack of function of anterior lobe of pituitary gland,
leads to hampering the growth of jaws.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
5. ORTHODONTIC THEORY • Supported by constricted & narrowed
dental arches of early mouth breathers
• Depend on Position & alignment of
permanent teeth.
4. PATHOLOGICAL THEORY
As a result of early diseases of adjacent
molars leads to existence of osteosclerosis
in IIIrd molar area.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
• Mandibular third molar most commonly
impacted tooth, 98% of impacted teeth are
mandibular third molars
• Maxillary canines 1.3%
• Mandibular premolars and other teeth
make up the remainder.
7 Dr. Apoorva Mowar, Subharti Dental College, SVSU
FREQUENCY OF IMPACTION
• Mandibular 3rd molar
• Maxillary 3rd molar
• Maxillary canine
• Mandibular premolar
• Maxillary premolar
• Mandibular canine
• Maxillary central incisor
• Maxillary lateral incisor 8 Dr. Apoorva Mowar, Subharti Dental College, SVSU
Causes of Impaction
LOCAL CAUSES --
1.Irregularity in position & pressure of an
adjacent tooth.
2. Density of overlying or surrounding
bone.
3.Long continued chronic inflammation
with resultant increase in density of
overlying mucous membrane.
4. Premature loss of primary teeth.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Systemic causes • Prenatal Cause :-
Heredity
• Post Natal Cause – Rickets, Anemia
• Congenital Syphilis ,Tuberculosis, Malnutrition,
endocrine dysfunction.
• RARE CONDITION –
Cleidocranial dysostosis
Oxycephaly (Steeple head-pointed head)
Progeria - Premature old age
Achondroplasia (Cartilage fails to develop)
Cleft Palate
Dr. Apoorva Mowar, Subharti Dental College, SVSU
INDICATIONS 1 Recurrent pericoronitis – 70 – 80% of
patients are adults with impacted teeth.
2 Root resorption – It may occur due to
pressure effect from 3rd molar to 2nd
molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
3.Caries or periodontal
problems-It occurs in impacted
teeth
Dr. Apoorva Mowar, Subharti Dental College, SVSU
4 Recurrent infection around pericoronal flap may lead to TMJ problems
5 Preventive dentistry- Extraction of impacted tooth can be done as a preventive measure.
6. Paresthesia or Nonspecific pain may sometimes be relieved by removal of impacted teeth.
7.Impacted teeth are sometimes removed when they become foci of infection.
8. Trauma – Impacted teeth are extracted to avoid recurrent cheek bite.
9.Orthodontic problems- Impacted teeth may lead to malocclusion or overcrowding in adolescent period.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
10.Cyst or ameloblastic changes – Impacted
teeth are sometimes associated with cysts.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
11Autotransplantation – Impacted third
molar can be used to replace the lost 1
molar.
12 Prosthetic consideration- An unerupted
Teeth may cause ulceration under the
denture or later denture failure may occur.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
CONTRAINDICATION
• Health consideration – Due to systemic
disorder patient is not fit for minor surgery.
• Prosthetic consideration- Partially erupted
tooth has to be retained sometimes for utilization
as an abutment for fixed partial denture.
• Availability of adequate space – Sometimes if
there is an adequate space between 3 rd molar
and ascending border of ramus operculectomy
can be done.
• Socioeconomic reason -
Dr. Apoorva Mowar, Subharti Dental College, SVSU
IMPACTED MANDIBULAR 3RD MOLAR
• One of the most common impaction in all
impacted teeth
– Dense bone
– Last to erupt
Dr. Apoorva Mowar, Subharti Dental College, SVSU
CLASSIFICATION
WHY WE HAVE TO STUDY?
• Methodical approach to surgical procedure
• Difficulty assessment in intra – op and post - op
complications
• Type of instrument needed
• Correct information to the patient about likely
complications Dr. Apoorva Mowar, Subharti Dental College, SVSU
Classification is based on:
• Angulation
• of long axis of impacted tooth is compared to
long axis of adjacent erupted tooth.
• importance – to know the path of withdrawal
• to decide – tooth splitting or removal of bone or
both, which obstructs the path of withdrawal of
tooth Dr. Apoorva Mowar, Subharti Dental College, SVSU
RELATIONSHIP TO ANTERIOR BORDER OF
RAMUS
• amount of bone covering the impacted tooth
RELATIONSHIP TO OCCLUSAL PLANE
• depth of impacted tooth in bone when compared to
height of adjacent 2nd molar
• importance - degree of difficulty for removal
assessed by thickness of bone overlying the tooth or
depth of tooth in bone. Dr. Apoorva Mowar, Subharti Dental College, SVSU
George Winter’s classification – 1926
• classified impacted 3rd molar according to
relationship of their long axis to 2nd molar.
• Mesioangular
• Vertical
• Distoangular
• Horizontal
• Transverse
• Buccoangular
• Linguoangular
• Inverted Dr. Apoorva Mowar, Subharti Dental College, SVSU
• Mesioangular – crown of tooth is tilted towards
the 2nd molar mesially
• it is most common and least difficult to remove
Dr. Apoorva Mowar, Subharti Dental College, SVSU
MESIOANGULAR IMPACTION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Vertical : long axis of impacted tooth runs in same
direction of 2nd molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
VERTICAL
IMPACTION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Distoangular: long axis of impacted tooth is
angulated distally or posteriorly away from 2nd molar.
This is most difficult to remove because path of
withdrawal is into the ramus.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
DISTOANGULAR IMPACTION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Horizontal : severe mesial inclination of 3rd molar
towards the 2nd molar
Dr. Apoorva Mowar, Subharti Dental College, SVSU
HORIZONTAL IMPACTION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Bull’s Eye Sign
TRANSVERSE IMPACTION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Pell’s Gregory Classification
In 1933 Pell’s Gregory classified impacted
mandibular 3rd molar.
• Class I : space between the ramus and the distal
side of 2nd molar is more than mesiodistal diameter
of crown of impacted 3rd molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Class II: space is less than mesiodistal diameter of
crown of impacted 3rd molar
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Class III: most of the 3rd molar is located within the
ramus, no space between 2nd molar and ascending
border of ramus.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Position: relative depth of 3rd molar in the bone
Position A: Highest portion of impacted tooth is on a
level with or above the occlusal plane of 2nd molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Position B: highest portion of impacted tooth is below
the occlusal plane but above the CEJ of 2nd molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Position C: highest portion of tooth is below the CEJ
of 2nd molar.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Long axis of impacted tooth in relation to that of
2nd molar:
• Mesioangular
• Vertical
• Distoangular
• Horizontal
• Transverse
• Buccoangular
• Linguoangular
• Inverted
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Kay’s Classification:
1.Based on angulation and position:
• Mesioangular
• Vertical
• Distoangular
• Horizontal
2.Based on state of eruption:
• Fully erupted
• Partially erupted
• Embedded Dr. Apoorva Mowar, Subharti Dental College, SVSU
3. Based on number of roots
• Fused roots
• Two roots
• Multiple roots
FUSED ROOTS MULTIPLE ROOTS
Dr. Apoorva Mowar, Subharti Dental College, SVSU
4. Based on root pattern:
• Favorable roots
• Unfavorable roots
Dr. Apoorva Mowar, Subharti Dental College, SVSU
UNFAVOURABLE ROOTS
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Preoperative assessment:
1. History : medical problems must be weighed
against the danger of leaving the tooth.
2. Age: older age group more difficult then younger
age group.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
3.Facial form:
1. Tapered facial form: such patient have a high
zygomatic arch and flexible Orbicularis Orris
muscle, therefore access is better.
2. Compact facial form: more challenging,
because such patient have small mouth,
mandibular retrusion, limited opening and
access to operating site is poor. Dr. Apoorva Mowar, Subharti Dental College, SVSU
4. Extraoral:
1. swelling
2. redness of the cheek
3. submandibular lymphadenopathy
4. lower lip tested for anesthesia or
parasthesia
Dr. Apoorva Mowar, Subharti Dental College, SVSU
5. Intraoral:
1. mouth opening
2. lateral surface of body of mandible in close
alignment with ramus with little flare makes
procedure difficult
3. relationship of external oblique ridge to 3rd
molar
1. if ridge is posterior to tooth access is good
2. if ridge is alongside the tooth or anterior to
it access is poor Dr. Apoorva Mowar, Subharti Dental College, SVSU
4. General inspection – oral hygiene
5. Adjacent 2nd molar
1. crown
2. Inlay
3. Fillings – which can be dislodged during
elevation
6. Condition of overlying soft tissue
1. fibrosis
2. inclination of upper third molar
3. active pericoronitis
4. pus beneath the flap
Dr. Apoorva Mowar, Subharti Dental College, SVSU
RADIOGRAPHIC EVELUATION
IOPA should show entire tooth structure, investing
structures, as well as adjacent tooth
• How to take an ideal IOPA?
• patient is seated such that occlusal plane is
parallel to the floor
• anterior edge of the film should be in line with
mesial surface of 1st permanent molar. Dr. Apoorva Mowar, Subharti Dental College, SVSU
CENTRAL RAY DIRECTION
a. Average case – distal part of 2nd molar
b. Horizontal impaction – through crown of 3rd molar
Dr. Apoorva Mowar, Subharti Dental College, SVSU
• X ray tube positioned in such way that central beam
is parallel to occlusal surface of 2nd molar and should
pass through distal cusp of 2nd molar at right angle to
film packet.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
•lingual and Buccal cusp of 2nd molar should
superimpose on each other giving an enamel cap
appearance.
• entire length of 2nd molar and impacted 3rd molar
should be visible.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Occlusal films:
•occlusal view provides an alternative to periapical
view in case of horizontally impacted tooth for a
clearer picture of the root pattern.
• Important role in buccolingually placed teeth to
identify which way the crown is pointing.
• helpful in showing the thickness of lingual cortical
plate Dr. Apoorva Mowar, Subharti Dental College, SVSU
• Lateral oblique projection
• provides greater periapical coverage
• shows amount of bone below an
impacted tooth in a thin mandible
Dr. Apoorva Mowar, Subharti Dental College, SVSU
•OPG:
• difficult access for positioning of the film or
when patient cannot tolerate IOPA film.
• where the tooth is so far below that it cannot
be projected on to the periapical film.
• when there is associated pathological process
larger than the film to exclude any other
pathology of the jaw.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
CBCT
Dr. Apoorva Mowar, Subharti Dental College, SVSU
RADIOLOGICAL
ASSESSEMENT
Dr. Apoorva Mowar, Subharti Dental College, SVSU
1. TECHNIQUE
2. TYPES OF IMPACTION
3. ACCESS: External Oblique Ridge – position
1. Horizontal – access is good
2. Vertical – access is poor
3. behind the tooth – access is good
4. along or in front of impacted tooth – access is poor
Dr. Apoorva Mowar, Subharti Dental College, SVSU
4. EXISTING PATHOLOGY:
1. Dental caries in 2nd or 3rd molar
2. Periodontal disturbances
3. Presence or absence of 1st molar
4. Any fusion of crowns between 2nd and 3rd molars
5. Conical or fused roots of 2nd or third molars
6. Any associated dental pathology like odontome, cyst or
neoplasm.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
5. SCORING DETAILS FOR WHARF ASSESSMENT
Contd- Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
6. POSITION AND DEPTH – George Winter
1. WHITE LINE: - represents the occlusal plane
a) Joining the white enamel caps of the erupted
molars it is extended posteriorly over the 3rd molar.
b) The maximum contour of the impacted tooth and its
relation to the white line will indicate the relative
depth of its location.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
2. AMBER LINE: - represents the bone level, distal to the 3rd
molar and extended anteriorly along the crests of
intrdental septum between the molars. Represents the
amount of bone covering the impacted tooth which will
have to be removed
3. RED LINE: indicates depth at which impacted tooth is
located. It is a line drawn perpendicular to the amber line
to point of application of the elevator. If red line is less than
5 mm long – tooth can be conveniently removed under
L.A. for each mm increase in length difficulty increases by
3 times. Length > 9mm and tooth below apices of 2nd
molar then G.A. case
Dr. Apoorva Mowar, Subharti Dental College, SVSU
White line
Amber line
Red line
Dr. Apoorva Mowar, Subharti Dental College, SVSU
6. BUCCOVERSION AND LINGUOVERSION:
can be identified – more radioopacity of the
tooth overlapped by the 2nd molar and the
portion of tooth nearer to the film.
7. CROWN OF IMPACTED TOOTH: large
bulbous crown with prominent cusps – difficulty
in delivery – tooth division technique indicated.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
8. CONFIGURATION OF THE ROOTS OF THE
IMPACTED 3RD MOLAR: point of application of the
elevator and the path of delivery of the tooth vary
greatly with the configuration of the root of the
impacted molar. Radiograph to be examined for
1. Fused or separate roots
2. Number of roots
3. Straight or curved roots
1. if curved – favorable or unfavorable
4. Long and slender or short and stout roots
Dr. Apoorva Mowar, Subharti Dental College, SVSU
5. Convergent or divergent
6. Texture and type of investing bone e.g.
hypercementosis
7. Root of the 2nd molar:
a) smaller in relation to 3rd molar
b) fused and conical
8. Absence of 1st molar
Dr. Apoorva Mowar, Subharti Dental College, SVSU
8. BONE TEXTURE: texture and density of the
investing bone varies with:
1. Individuals
2. Age
3. Sex
4. Systemic constitution
Dr. Apoorva Mowar, Subharti Dental College, SVSU
9. RELATIONSHIP WITH INFERIOR ALVEOLAR
CANAL: if root apices closely related to the canal
then warn patient about possible impairment of
labial sensations, and better to use tooth division
technique.
RELATIONSHIP OF THE ROOT TO THE CANAL
a) Related but not involving the canal
i. Seperated
ii. Adjacent
iii. Superimposed
Dr. Apoorva Mowar, Subharti Dental College, SVSU
b) Related to changes in the roots
i. Darkening of the root
ii. Dark and bifid root
iii. Narrowing of the root
iv. Deflected root
c) Related to changes in the canal
a) Interruption (loss) of lines
b) Converging canal (narrowing)
c) Diverted canal Dr. Apoorva Mowar, Subharti Dental College, SVSU
10. OTHER RADIOGRAPHIC TECHNIQUES:
1. IOPA is a 2-dimensional view, another view in
the 3rd dimension can be helpful.
2. Tube shift technique:
a) 2 IOPAs : first at normal position, second at
mesiocentric or distocentric position. The
movement is – same side lingual and
opposite side Buccal (SLOB) ie if the tube
and the object in question both move in the
same direction – object is on lingual side.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
TRANS - ALVEOLAR EXTRACTION
Some teeth are unsuitable for removal using
forceps and the technique of intra - alveolar
extraction.
Surgical or trans – alveolar technique gives the
operator a direct access to the alveolar bone and
tooth roots after raising the mucoperiosteal flap,
and bone removal and sectioning of the roots is
under direct vision. Dr. Apoorva Mowar, Subharti Dental College, SVSU
INSTRUMENT TRAY
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Principles of flap design
• access : large enough to allow clear access
without stretching or risk of tearing soft tissues.
• blood supply : base of all flaps should be wider
than free margin to maintain unimpeded blood
supply to the tissues of the flap
• avoiding vital structures: the position of the
relieving incision must take into account the
proximity of vital structures. Contd-
Dr. Apoorva Mowar, Subharti Dental College, SVSU
• suture over bone: the margins of flap should be
placed away from site of bone removal so that,
incision line is supported by firm bone on suturing
• ease of closure: edges of flap should be
positioned to make their accurate replacement
simple
• extending flaps: when extracting two teeth flap
should be so designed that if needed the flap can be
extended
• oro - antral communication: when removing a
tooth in posterior maxilla then a thought should be
given for inadvertent oro – antral communication and
flap so designed that it can be closed.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
FLAP DESIGNS
one sided flap: incision along the gingival margin –
provides restricted access.
Two – sided flap: one incision along the gingival
margin and another relieving incision angled
obliquely across the attached buccal gingiva into lax
vestibular mucosa.
Three – sided flap: have a second relieving
incision at the distal end of the flap, allows greater
mobilization and exposure of the underlying bone
and roots. Dr. Apoorva Mowar, Subharti Dental College, SVSU
ENVELOPE INCISION
• SHORT
• LONG
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Ward’s incision
OCCLUSAL VIEW Dr. Apoorva Mowar, Subharti Dental College, SVSU
MODIFIED WARD’S
L – SHAPED INCISION
Dr. Apoorva Mowar, Subharti Dental College, SVSU
BONE REMOAVAL
• CHISEL MALLET
• postage stamp method
• lingual split technique
• ROTARY CUTTING INSTRUMENT – buccal
guttering technique. { GILBE MOORE TECHNIQUE }
Dr. Apoorva Mowar, Subharti Dental College, SVSU
INDICATIONS OF USE OF BUR
• Old patient – brittle, sclerotic bone
• Position of internal oblique ridge
• Operation under L.A.
INDICATIONS FOR CHISEL & MALLET
• Young patient
• Procedure under G.A.
• Tooth sectioning is not required
• Position of external / internal oblique ridge
Dr. Apoorva Mowar, Subharti Dental College, SVSU
INDICATIONS FOR SECTIONING
• Tooth lock
• Unfavourable root pattern
• To protect important structures (nerve, vessel,
adjacent tooth)
Dr. Apoorva Mowar, Subharti Dental College, SVSU
ROTARY CUTTING INSTRUMENTS
• 1000 – 30, 000 RPM
• Straight hand piece – optimal control
• Plentiful irrigation- to prevent rise in temperature
as, as little as 10 degrees – lethal to osteocytes
• round burs –
• versatile and efficient
• difficult to control lateral cuts
• once bur head is inside bone difficult to gauge
depth
Dr. Apoorva Mowar, Subharti Dental College, SVSU
• fissure burs:
• cut neatly and precisely in lateral direction
• less good at cutting than round bur
• greater feel than round bur
• burs can be used to:
• drilling bone around the tooth or tooth root on
the buccal side – buccal guttering – to make
space for elevator
• bone is shaved off or block of bone outlined
and removed, then tooth or tooth root is
removed (postage stamp method).
Dr. Apoorva Mowar, Subharti Dental College, SVSU
BUCCAL GUTTERING
Dr. Apoorva Mowar, Subharti Dental College, SVSU
CHISEL AND MALLET
• Postage stamp method : a whole block of bone is
removed to facilitate the removal of the tooth. In
case of mandible a posterior stop cut (vertical) is
given so that the horizontal cut does not extend
beyond that point.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
• Lingual approach:{ Introduced by William
Kelsey Fry in 1933 & described in detail
by Warwick james in 1936 & later by
Terence ward in 1956 }
• bone covering Buccal & distal surface of 3rd
molar removed
• chisel at 45° to sagittal plane, bevel placed
lingually, facing parallel to opposite bicuspid &
driven through distal part of molar shelf, twisted to
fracture a part of lingual shelf.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
LINGUAL APPROACH
• elevator placed on Buccal side & crown lifted
in lingual & coronal direction.
• after tooth removal, the loosened fragments
on the lingual plate are repositioned by finger
pressure lingually.
Dr. Apoorva Mowar, Subharti Dental College, SVSU
LINGUAL SPLIT TECHNIQUE
FRACTURE THE LINGUAL PLATE
Dr. Apoorva Mowar, Subharti Dental College, SVSU
REMOVE BONE COVERING THE ROOT ON
DISTAL AND BUCCAL ASPECTS AND ELEVATE
THE TOOTH
Dr. Apoorva Mowar, Subharti Dental College, SVSU
LATERAL TREPANATION
{Low Buccal approach}
• INDICATION ---1.unerupted iiird molar in 9-16 years of age group for orthodontic purpose.
• 2. auto transplantation.
• 3.Prophylactic removal in unfavorable pattern-
• [a] vertical axis of 3rd molar is inclined at angle of more than 30 degree to long axis of 2nd molar. [b] space between distal margin of 2nd molar & ramus is less than one-half of crown width of 3rd molar.
• PROCEDURE -- S shape incision from retro molar fossa across external oblique ridge.5 mm. Cuff of attach mucosa at distobuccal region of 2nd molar.
Advocated by BOWDLER HENRY [ 1969] & HOWE [1973]
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Tooth splitting TOOTH BELONGS TO DENTIST & BONE
BELONGS TO THE PATIENT
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
COMPLICATIONS OF IMPACTED MANDIBULAR 3RD
MOLAR EXTRACTION
1. Haemorrhage - intraoperative
a) facial artery
b) Retromolar vessels
c) inferior alveolar vessels
2. Fracture
a) dentoalveolar
b) angle
3. Displaced root / tooth
4. Luxation or damage to adjacent tooth
Dr. Apoorva Mowar, Subharti Dental College, SVSU
4. TMJ dislocation
5. Damage to soft tissue
6. Parasthesia / anaesthesia
7. Trismus
8. Alveolar osteitis ( dry socket)
9. Infection
10. Hypersensitivity of 2nd molar or distal pocket
formation
11.Emphysema Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU
Dr. Apoorva Mowar, Subharti Dental College, SVSU