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8/8/2019 impaction part1

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DENTOALVEOLAR SURGERY

IMPACTION-CLASSIFICATION

& ASSESSMENT

BY: DR. ABDUL RAZAKPOSTGRADUAT ORAL SURGERY

B.I.D.S.,BANGALORE


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Definition

Incidence Etiology

Indication

Contraindication Classification

Assessment


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Definition

A impacted tooth is that tooth which cannot or will not erupt

into its normal functioning position due to any soft tissue or

hard tissue impedement & requires treatment

Order of Incidence

Third Molars

Maxillary Canine

Mandibular Premolars

Etiology

Improper position of the developing third molar

Arch length-tooth size discrepancy

Lack of co-ordination between skeletal growth & maturation

of third molar

Lack of co-ordination of eruption of permanent teeth


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Indications

Pericoronitis

Periodontal Bone Loss

Dental Caries


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Orthodontic Considerations

Odontogenic Cyst & Tumours

Root Resorption of Adjacent Teeth


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Teeth under Prosthesis

Prevention of Jaw factures

Management of Unexplained Pain

Contraindications

Extreme of Ages

Compromised Medical Status Surgical Damage to Adjacent Structures


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Classification & Assessment

Angulation - Winter Classification

a. Mesioangular

b. Horizontal


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c. Vertical

d. Distoangular


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Relation to the Anterior Border of Ramus

Pells & Gregory Classification

a. Class 1

b. Class 2

c. Class 3


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Relation to Occlusal Plane

Pells & Gregory Classification

a. Class A b. Class B

c. Class C


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Petersons Difficulty Index

Winter Classification

a. Mesioangular 1

b. Horizontal 2

c. Vertical 3d. Distoangular 4

Depth

a. Class A 1

b. Class B 2

c. Class C 3

Ramus Relationship

a. Class 1 1

b. Class 2 2

c. Class 3 3

Difficulty Index

Very Difficult 7-10

Difficult 5-7

Minimally Difficult 3-4


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Root Morphology

a. Length of the Root

b. Curvature of the Rootc. Direction of the Curvature

d. Mesiodistal Width of the Root

e. Periodontal Ligament Space

Size of the Follicular Sac

Density of the Surrounding Bone

Contact with the Second Molar

Relationship with the Inferior Alveolar Nerve Relationship with the Maxillary Sinus

Nature of the overlying Tissue


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Classification of Impacted Maxillary Canine

Class 1- Palatally placed

Class 2- Labially placedClass 3- Involving both buccal & palatal plate

Class 4- Impacted within the alveolar bone

Class 5- Impacted in edentulous maxilla


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Wharfe Assessment

1.Winters classification

horizontal 2

distoangular 2 mesioangular 1

vertical 0

2.Height of mandible

1-30mm 0

31-34mm 1

35-39mm 2

3.Angulation of third molar

1-50 0

60-69 1

70-79 2

80-89 3

90+ 4


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4.Root shape complex 1 favourable curvature 2 unfavourable curvature 3

5.Follicles normal 0 possibly enlarged 1 enlarged 2

6.Path of Exit space available 0 distal cusp curved 1 mesial cusp also curved 2 both curved 3


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Reference

Petersons Principles of Oral & Maxillofacial Surgery

Impacted Teeth Charles C. Ailing, John F. Helfrick


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THANK YOU

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