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IMPACTED TEETH
dr.godhi IMPACTION
IMPACTED TEETH
INTRODUCTION & TERMINOLOGY
CAUSES
THEORIES
CLASSIFICATION
INDICATION & CONTRAINDICATION
CLINICAL EXAMINATION
RADIOLOGICAL ASSESMENT
SURGICAL ANATOMY
SURGICAL TECHNIQUE
COMPLICATION OF IMPACTION
IMPACTED MAXILLARY CANINE
dr.godhi IMPACTION
TERMINOLOGY
•IMPACTED
•UNERRUPTED
•EMBEDDED
dr.godhi IMPACTION
CAUSES
•LOCAL
•SYSTEMIC
•PRE NATAL
•POST NATAL
•RARE CONDITIONS
dr.godhi IMPACTION
THEORIES
•PYLOGENIC THEORY
•ORTHODONTIC THEORY
•MANDELIAN THEORY
•PATHOLOGIC THEORY
•ENDOCRINAL THEORY
dr.godhi IMPACTION
Mylohyoid ridge
Lat.pterigoid
Temporalis
Buccinator
Masseter
Lev.labi.inferioris Lev.anguli.oris
Mentalis
Med.pterigoid
Buccinator
Med.pterigoid
Temporalis
Genio hyoid
&Gen.glossus
Mylohyoid
Antr belly of
digastric
Buccinator
Temporalis
Masseter
Lev.labi.inferioris Lev.anguli.oris
Mentalis
Facial. a
Facial. v
Facial. a
Facial. v
Facial. nerve
CLASSIFICATION
Pell & Gregory
A. Relation of the tooth to the ramus of the
mandible & the second molar.
CLASS--1
CLASS--2
CLASS--3
B. Relative depth of third molar in bone.
POSITION -- A
POSITION -- B
POSITION -- C
dr.godhi IMPACTION
George Winter’s
C. Position of long axis of 3rd molar v/s 2nd molar
- VERTICAL
-HORIZONTAL
-INVERTED
-MESIOANGULAR
-DISTOANGULAR
-BUCCOANGULAR
-LINGUOANGULAR
•BUCCOVERSION
•LINGUOVERSION
•TORSION
dr.godhi IMPACTION
Classification(contd..)
INDICATIONS
- Pericoronitis
- Periodontal disease
- Dental caries
- Pathological root resorption
- Retention in edentulous ridge
- Cyst formation
- Neoplasm's
- Pain of unexplained origin
- Crowding of dentition
- Involvement in fracture
dr.godhi IMPACTION
CONTRAINDICATIONS
-Extreme’s of age
-Compromised medical status
-Excessive damage to adjacent structure
Extra oral
- Facial symmetry
- TMJ
- Lymph nodes
- Lips
Intra oral
- Type of mandibular arch form
- Tongue
- Size & shape of 2nd & 3rd molar
- Investing tissue
- Any pathology
CLINICAL EXAMINATION
dr.godhi IMPACTION
RADIOLOGICAL ASSESMENT
RADIOGRAPHS:IOPA,OCCLUSAL,OPG, SHIFTCONE TECH.
•ACCESS
•POSITION & DEPTH
•ROOT PATTERN OF 3rd MOLAR
•SHAPE OF CROWN
•TEXTURE OF INVESTING BONE
•POSITION & ROOT PATTERN OF 2nd MOLAR
•INFERIOR ALVEOLER CANAL
dr.godhi IMPACTION
Angulation
Impacted tooth
2nd Molar
Inferior alveolar canal
Thickness
of bone
Depth of impaction
Radiographic assessment of inferior alveolar canal
Nerve damage can be prevented by removing buccal plate
& delivering the tooth through the resultant defect
Grooved tooth
Tooth division minimizes the risk of damage
to the nerve
where mandibular canal gets injured
Different occasions
DIFFICULTY INDEX
Spatial relation
Mesioangular 1
Horizontal/Transverse 2
Vertical 3
Distoangular 4
Depth
Level A 1
Level B 2
Level C 3
Ramus relation
Class 1
Class 2
Class 3
Minimally difficult---3-4
Moderately difficult--5-7
Very difficult---------7-10
dr.godhi IMPACTION
Wharfe’s Assessment
1. Winter’s 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 3rd molar 1-50 deg 0
60-69 1
70-79 2
80-89 3
90+ 4
dr.godhi IMPACTION
4. Root shape Complex 1
Favorable curvature 2
Unfavorable curvature 3
5. Follicles Normal 0
Possibly enlarged 1
Enlarged 2
6. Path of exit Space available 0
Distal cusp covered 1
Mesial cusp covered 2
Both cusp covered 3
TOTAL 33
dr.godhi IMPACTION
Degree of difficulty
based on
configuration &
number of roots
BASIC STEPS:
•Study the radiographs
Tooth/ Roots
Classify
Occlusal view
Relationship with IAC
Review of results
•Outline the soft tissue flap
•Sectioning / Bone removal
•Estimation of surrounding bone tissue
•Chose a Best method/Instruments
•Path of withdrawal
dr.godhi IMPACTION
Pre operative check list
Stages of the operation sequence
•Retraction
•Incision
•Reflection
•Bone removal - access
- point of elevation
- removal of obstruction
•Tooth section
•Delivery
•Clean-up
•Sew-up
•Check-up
•Follow-up
•Write-up
*Ward’s Incision *Modified Ward’s Incision
(Standard 3rd molar incision)
Incision
Reflection of mucoperiosteal flap
Reflection Buccal Guttering
Application of
elevator
Smoothening of bony
margin
Wound closure
Removal of distal bone & sectioning of tooth
Lateral trephination
technique
IMPACTED MAXILLARY CANINE
ETIOLOGY: - Hard palatal bone
- Mucoperiosteum
- Eruption of canine
- Distance to travel
- Development of crown
- Unfavorable environment
- Space
- Mesio-distal width of primary
dr.godhi IMPACTION
CLASSIFICATION
CLASS -1 PALATAL
(Horizontal,Vertical, Semivertical)
CLASS -2 LABIAL/BUCCAL
(Horizontal,Vertical, Semivertical)
CLASS -3 LABIAL & PALATAL
CLASS -4 ALVEOLAR PROCESS/ Vertically
between incisor & 1st premolar
CLASS -5 EDENTULOUS MAXILLA
dr.godhi IMPACTION
Incision used for canine impaction
*Labial approach
Incision used for canine impaction
*Palatal approach
Bone removal
Tooth delivery Wound closure
EXAMPLES OF STEROIDS
Anti-inflammatory medications
Thank You

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IMPACTION.ppt