Impaction

1. IMPACTED TEETH
dr.godhi IMPACTION

2. 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

3. TERMINOLOGY
•IMPACTED
•UNERRUPTED
•EMBEDDED
dr.godhi IMPACTION

4. CAUSES
•LOCAL
•SYSTEMIC
•PRE NATAL
•POST NATAL
•RARE CONDITIONS
dr.godhi IMPACTION

5. THEORIES
•PYLOGENIC THEORY
•ORTHODONTIC THEORY
•MANDELIAN THEORY
•PATHOLOGIC THEORY
•ENDOCRINAL THEORY
dr.godhi IMPACTION

9. Mylohyoid ridge

10. Lat.pterigoid
Temporalis
Buccinator
Masseter
Lev.labi.inferioris Lev.anguli.oris
Mentalis
Med.pterigoid

11. Buccinator
Med.pterigoid
Temporalis
Genio hyoid
&Gen.glossus
Mylohyoid
Antr belly of
digastric

12. Buccinator
Temporalis
Masseter
Lev.labi.inferioris Lev.anguli.oris
Mentalis

13. Facial. a
Facial. v

14. Facial. a
Facial. v
Facial. nerve

16. 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

17. 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..)

19. 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

20. CONTRAINDICATIONS
-Extreme’s of age
-Compromised medical status
-Excessive damage to adjacent structure

21. 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

22. 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

23. Angulation
Impacted tooth
2nd Molar
Inferior alveolar canal
Thickness
of bone
Depth of impaction

31. Radiographic assessment of inferior alveolar canal

32. Nerve damage can be prevented by removing buccal plate
& delivering the tooth through the resultant defect
Grooved tooth

33. Tooth division minimizes the risk of damage
to the nerve

34. where mandibular canal gets injured
Different occasions

35. 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

36. 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

37. 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

38. Degree of difficulty
based on
configuration &
number of roots

39. 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

40. Pre operative check list

41. 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

42. *Ward’s Incision *Modified Ward’s Incision
(Standard 3rd molar incision)
Incision

43. Reflection of mucoperiosteal flap

44. Reflection Buccal Guttering

45. Application of
elevator
Smoothening of bony
margin

46. Wound closure

50. Removal of distal bone & sectioning of tooth

51. Lateral trephination
technique

55. 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

56. 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

57. Incision used for canine impaction
*Labial approach

58. Incision used for canine impaction
*Palatal approach

59. Bone removal

60. Tooth delivery Wound closure

63. EXAMPLES OF STEROIDS

64. Anti-inflammatory medications

65. Thank You