principles of management of impacted teeth part i

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Principles of Management of Impacted Teeth Part I BY : Dr.Faisal M Alzahrani

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Page 1: Principles of Management of Impacted Teeth Part I

Principles of Management of Impacted Teeth

Part I BY : Dr.Faisal M Alzahrani

Page 2: Principles of Management of Impacted Teeth Part I

Content v  INDICATIONS FOR REMOVAL OF IMPACTED

TEETH

v  CONTRAINDICATIONS FOR REMOVAL OF IMPACTED

v  CLASSIFICATION SYSTEMS FOR MANDIBULAR THIRD MOLAR IMPACTIONS

v  CLASSIFICATION SYSTEMS FOR MAXILLARY THIRD MOLARIMPACTIONS

v  ROOT MORPHOLOGY

Page 3: Principles of Management of Impacted Teeth Part I

v  An impacted tooth is one that fails to erupt into the dental arch within the usual range of expected time.

v  The tooth becomes impacted because :

adjacent teeth, dense overlying bone, excessive soft tissue, or

a genetic abnormality prevents eruption.

Page 4: Principles of Management of Impacted Teeth Part I

v  As a general rule, all impacted teeth should be removed unless removal is contraindicated.

v  Removal of impacted teeth becomes more difficult with advancing age of the patient.

v  The dentist should typically not recommend that impacted teeth be left in place until they cause difficulty. If the impacted teeth are left in place until problems arise, the patient may experience an increased incidence of local tissue morbidity, loss of or damage to adjacent teeth and bone, and potential injury to adjacent vital structures

Page 5: Principles of Management of Impacted Teeth Part I

INDICATIONS FOR REMOVAL OF IMPACTED TEETH

v  Prevention of Periodontal Disease

v  Prevention of Dental Caries

v  Prevention of Pericoronitis

v  Prevention of Root Resorption

v  Impacted Teeth under a Dental Prosthesis

v  Prevention of Odontogenic Cysts and Tumors

v  Treatment of Pain of Unexplained Origin

v  Prevention of Jaw Fractures

v  Facilitation of Orthodontic Treatment

v  Optimal Periodontal Healing

Page 6: Principles of Management of Impacted Teeth Part I

CONTRAINDICATIONS FOR REMOVAL OF IMPACTED

TEETH v  Extremes of Age.

v  Compromised Medical Status.

v  Probable Excessive Damage to Adjacent Structures

Page 7: Principles of Management of Impacted Teeth Part I

The preceding discussion of indications and contraindications

for the removal of impacted third molars has been designed to

point out that there are various risks and benefits in removing

impacted teeth in patients. Patients who have one or more

pathologic symptoms or problems should have their impacted

teeth removed. Most of the symptomatic, pathologic

problems that result from impacted third molars occur

because of partially erupted teeth and occur less commonly

with complete bony impaction.

Page 8: Principles of Management of Impacted Teeth Part I

A tooth that appears to be a mesioangular impaction at age 17 years

may eventually become more vertical and erupt into the mouth. If

insufficient room exists to accommodate the tooth and a soft tissue

operculum exists over the posterior aspect, then pathologic sequelae

are likely to occur.

Page 9: Principles of Management of Impacted Teeth Part I

v  What should be done with impacted teeth before they cause symptoms or problems is, however, less clear. In making a decision as to whether an impacted third molar should be removed, one must consider a variety of factors. First, the available room in the arch into which the tooth can erupt must be considered. If adequate room exists, the clinician may choose to defer removal of the tooth until eruption is complete.

v  A second consideration is the status of the impacted tooth and the age of the patient.

v  It is critical to remember that the average age of complete eruption is 20 years, but that eruption may continue to occur up to age 25 years.

Page 10: Principles of Management of Impacted Teeth Part I

CLASSIFICATION SYSTEMS FOR MANDIBULAR THIRD MOLAR

IMPACTIONS v  Angulation

v  Relationship to Anterior Border of Ramus

v  Relationship to the Occlusal Plane

Page 11: Principles of Management of Impacted Teeth Part I

Angulation Distoangular impaction: the long axis of the third molar is distally or posteriorly angled away from the second molar. most

difficult angulation for removal Mesioangula impaction crown of the tooth is tilted toward the second molar in amesial direction . least difficult

impaction to remove Horizontal When the long axis of the third molar is perpendicular to the

second molar . more difficult to remove compared with mesioangular impaction Vertical impaction: long axis of the impacted tooth runs parallel to the long axis of the second molar. considered third in ease of removal

Page 12: Principles of Management of Impacted Teeth Part I

Relationship to Anterior Border of Ramus

v  CLASS 1 If the mesiodistal diameter of the crown is completely anterior to the anterior border of the mandibular ramus,

v  CLASS 2 If the tooth is positioned posteriorly so that approximately one half is covered by the ramus

v  CLASS 3 the tooth is located completely within the mandibular ramus

Page 13: Principles of Management of Impacted Teeth Part I

Relationship to the Occlusal Plane

v  In this classification, the degree of difficulty is measured by the thickness of overlying bone; that is, the degree of difficulty increases as the depth of the impacted tooth increases.

v  A class A impaction is one in which the occlusal surface of the impacted tooth is level or nearly level with the occlusal plane of the second molar

v  A class B impaction involves an impacted tooth with an occlusal surface between the occlusal plane and the cervical line of the second molar

v  class C impaction is one in which the occlusal surface of the impacted tooth is below the cervical line of the second molar

Page 14: Principles of Management of Impacted Teeth Part I
Page 15: Principles of Management of Impacted Teeth Part I

CLASSIFICATION SYSTEMS FOR MAXILLARY

THIRD MOLAR IMPACTIONS

v  (1) vertical (2) distoangular impaction (3) mesioangular impaction other positions such as a transverse, inverted, or horizontal position are encountered these unusual positions account for less than 1%

v  The same angulations in mandibular third molar extractions cause opposite degrees of difficulty for maxillary third molar extractions. Vertical and distoangular impactions are the less complex to remove, whereas mesioangular impactions are the most difficult (exactly the opposite of impacted mandibular third molars).

Page 16: Principles of Management of Impacted Teeth Part I
Page 17: Principles of Management of Impacted Teeth Part I

Factors That Make Impaction Surgery Less Difficult

v  1. Mesioangular position

v  2. Pell and Gregory class 1 ramus

v  3. Pell and Gregory class A depth

v  4. Roots one third to two thirds formed*

v  5. Fused conical roots

v  6. Wide periodontal ligament*

v  7. Large follicle*

v  8. Elastic bone*

v  9. Separated from second molar

v  10. Separated from inferior alveolar nerve*

v  11. Soft tissue impaction

Page 18: Principles of Management of Impacted Teeth Part I

Factors That Make Impaction Surgery More Difficult

v  1. Distoangular position

v  2. Pell and Gregory class 2 or 3 ramus

v  3. Pell and Gregory class B or C depth

v  4. Long, thin roots*

v  5. Divergent curved roots

v  6. Narrow periodontal ligament

v  7. Thin follicle*

v  8. Dense, inelastic bone*

v  9. Contact with second molar

v  10. Close to inferior alveolar canal

v  11. Complete bony impaction*

Page 19: Principles of Management of Impacted Teeth Part I

v  Size of the Follicular Sac: The size of the follicle around the impacted tooth can help determine the difficulty of the extraction.

v  Contact with Mandibular Second Molar: If space exists between the second molar and the impacted third molar, the extraction will be easier to approach because damage to the second molar is less likely.

v  Relationship to Inferior Alveolar Nerve: Impacted mandibular third molars frequently have roots that are superimposed on the inferior alveolar canal on radiographs. Although the canal is usually on the buccal aspect of the tooth, it is still in proximity to the roots. Therefore, one of the potential sequelae of impacted third molar removal is damage to the inferior alveolar nerve.

Page 20: Principles of Management of Impacted Teeth Part I

Nature of Overlying Tissue

v  The preceding systems classify factors that make third molar extraction more straightforward or difficult.

v  The classification system discussed now does not fit into these categories. However, this classification is the system used by most dental insurance companies and is the one by which the surgeon charges for the services.

v  The three types of impactions are

(1) soft tissue, (2) partial bony, and (3) full bony.

Page 21: Principles of Management of Impacted Teeth Part I

Thank you