Impacted teeth /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Impacted teeth /certified fixed orthodontic courses by Indian dental academy

  1. 1. The Management of Impacted Teeth www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. Impacted Teeth  The aim of this lecture is to explain the principles relating to the management of commonly encountered impactions  It is a guide to further study and an introduction to topics that will be addressed elsewhere in your course www.indiandentalacademy.com
  3. 3. Impacted Teeth  The third molars  The canines  The premolars  The supernumerary or mesdiodens  The submerged deciduous tooth or teeth  Others www.indiandentalacademy.com
  4. 4. The Mandibular Third Molar  Introduction  Evolution  Preservation of teeth  Eruption variability  Incidence www.indiandentalacademy.com
  5. 5. The Mandibular Third Molar  Indications for removal  Pericoronitis  Caries  Periodontal disease  Eruption under denture  Associated pathology  Facial pain  Previous unsuccessful surgery  Prophylacticwww.indiandentalacademy.com
  6. 6. The Mandibular Third Molar  Diagnosis  History  Examination  Special tests  Radiology  Periapical  OPT  Lateral Oblique www.indiandentalacademy.com
  7. 7. The Mandibular Third Molar  Assessment of surgical difficulty  Patient compliance  Access  Tooth related factors  Root pattern  Degree of eruption  Depth of impaction  Angulation  Associated structures  Age, gender and race www.indiandentalacademy.com
  8. 8. The Mandibular Third Molar  Classification  Soft tissue  Hard tissue  Vertical  Mesioangular  Distoangular  Horizontal  Aberrant www.indiandentalacademy.com
  9. 9. The Mandibular Third Molar  Structures at risk  Contents of inferior alveolar canal  Lingual nerve  Mandibular second molar  Soft tissue  Flap  Lips and cheek  Tongue  Jaw fracture www.indiandentalacademy.com
  10. 10. The Mandibular Third Molar  Radiological assessment of the proximity of the tooth to the inferior alveolar canal  Decrease in width of the canal as it crosses the roots  Relative radiolucency of the roots as they are crossed by the canal  Divergence of the canal as it crosses the roots  Loss of the lamina dura of the canal www.indiandentalacademy.com
  11. 11. The Mandibular Third Molar  Results of damage to the inferior alveolar canal  Haemorrhage  Arterial  Venous  Intraneural  Nerve damage  Anaesthesia  Paraesthesia  Dysaesthesiawww.indiandentalacademy.com
  12. 12. The Mandibular Third Molar  Neurological Damage  Neuropraxia  Paraesthesia  Rapid recovery  Axonotmesis  Anaesthesia / Dysaesthesia  Slow and unpredictable recovery  Neurotmesis  Anaesthesia  Little chance of recovery www.indiandentalacademy.com
  13. 13. The Mandibular Third Molar  Surgical Process  Diagnosis  Explanation  Consent  Surgical treatment  Post operative care  Discharge www.indiandentalacademy.com
  14. 14. The Mandibular Third Molar  Surgical Management  Anaesthesia  Local  General  Raising the flap  Distal relieving incision  Envelope  Buccal relieving  Lateral trepanation  Flap retraction  Lingual nerve protectionwww.indiandentalacademy.com
  15. 15. The Mandibular Third Molar  Bone removal  Hand instruments  Chisels  Lingual split technique of Sir William Kelsey-Fry  Gouges  Rongeurs  Rotating instruments  Round bur  Fissure bur  NO LINGUAL TISSUE TRANSGRESSED www.indiandentalacademy.com
  16. 16. The Mandibular Third Molar  Tooth division  To convert into a single rooted tooth  Osteotome  Fissure bur  To provide space to relieve the impaction  Fissure bur  Axial  Decoronation  Combination www.indiandentalacademy.com
  17. 17. The Mandibular Third Molar  Elevation  Point of application  Controlled force with elevators  Couplands  Warwick James  Cryers  Debridement www.indiandentalacademy.com
  18. 18. The Mandibular Third Molar  Wound closure  Postoperative care  Prevention of infection  Analgesia  Patient instructions  Follow up  Discharge www.indiandentalacademy.com
  19. 19. The Mandibular Third Molar  Complications  Prior to surgery  Syncope  During surgery  Failure of anaesthesia  Fractured crown/roots  Damage to associated structures  After surgery  Haemorrhage  Infectionwww.indiandentalacademy.com
  20. 20. The Maxillary Third Molar  As for mandibular third molar except  Often removed as non-functional in a prophylactic manner  Classification by height rather than angulation www.indiandentalacademy.com
  21. 21. The Maxillary Third Molar  Surgical Technique  Erupted teeth  Usually an elevator better than forceps  Can also be used with relieving incision for partly erupted teeth  Unerupted teeth  Buccal and distal flap  Retraction of flap to prevent dislodgment of tooth  Bone removal with hand instruments prior to elevationwww.indiandentalacademy.com
  22. 22. The Maxillary Third Molar  Complications as for mandibular molar except  No inferior alveolar canal  Fracture of tuberosity  Oro antral communication  Dislodgement into infra temporal fossa www.indiandentalacademy.com
  23. 23. The Impacted Maxillary Canine  Causes  Incorrect eruption pathway  Crowded maxillary arch  Non-resorbing deciduous teeth  Presence of pathology  Trauma www.indiandentalacademy.com
  24. 24. The Impacted Maxillary Canine  Sequelae  Resorbtion of tooth roots  Dentigerous cyst formation  Infection  Nothing www.indiandentalacademy.com
  25. 25. The Impacted Maxillary Canine  Clinical presentation  Non appearance of tooth at appropriate age  As incidental finding on OPT  Buccal or palatal swelling  Inclination or rotation of lateral incisors www.indiandentalacademy.com
  26. 26. The Impacted Maxillary Canine  Radiology  Periapical (especially parallax technique)  Occlusal  Anterior  Vertex  OPT  Lateral skull www.indiandentalacademy.com
  27. 27. The Impacted Maxillary Canine  Localisation  Aim to be able to decide on whether the tooth lies buccal or palatal to the arch  Obtain films at right angles to each other  Hint  On OPT Buccal tooth often looks larger www.indiandentalacademy.com
  28. 28. The Impacted Maxillary Canine  Treatment planning  Age, attitude and oral hygiene  Crowding or spacing  Degree of displacement/impaction  Associated pathology  Root morphology www.indiandentalacademy.com
  29. 29. The Impacted Maxillary Canine  Treatment options  Do nothing  Elderly, sick and asymptomatic  Risk to surrounding structures  Informed refusal of treatment  Surgical exposure  To allow orthodontic treatment to align the tooth in the arch  Only in favourable cases www.indiandentalacademy.com
  30. 30. The Impacted Maxillary Canine  Surgical removal  In cases of pathology or tissue damage  Impossible to expose or transplant  very crowded arch (with orthodontic agreement only)  poor patient cooperation  Transplantation  Last resort  Overtaken by use of implantology www.indiandentalacademy.com
  31. 31. The Impacted Maxillary Canine  Surgical removal  Similar basic principles  Buccal or palatal flaps  Bone removal  Tooth division  Elevation  Debridement  Closure www.indiandentalacademy.com
  32. 32. The Impacted Maxillary Canine  Surgical removal  Complications  As for other surgery  Include  Flap necrosis  Palatal haematoma  Reactionary haemmorhage  Oro Nasal Communication www.indiandentalacademy.com
  33. 33. The Impacted Mandibular Second Premolar  Commonly crowded out from the arch  Crown displaced lingually or buccally  Radiology  Periapicals  OPT www.indiandentalacademy.com
  34. 34. The Impacted Mandibular Second Premolar  Surgical options  Masterly inactivity  If suitable arch space, orthodontic treatment  If crowded arch, extraction of first premolar and orthodontic treatment  Surgical removal www.indiandentalacademy.com
  35. 35. The Impacted Mandibular Second Premolar  Surgical technique  Buccal mucoperiosteal flap  Identification and protection of mental nerve  Bone removal  Tooth division  Elevation  Debridement  Repair www.indiandentalacademy.com
  36. 36. Further Reading  MacGregor: The Third Molar Tooth  Petersen: Contemporary Oral and Maxillofacial Surgery  Moore and Gillbe: Principles of Oral Surgery www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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