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Management for mandibular 3rd molar impaction<br />

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Vertically impacted<br />Mesio - angularly impacted<br />A. buccal and distal bone are removed to expose crown of tooth to its cervical line.<br />B. The distal aspect of the crown is then sectioned from tooth. Occasionally it is necessary to section the entire tooth into two portions rather than to section the distal portion of crown only.<br />C . A small straight elevator is inserted into the purchase point on mesial aspect of 3rd molar, & the tooth is delivered with a rotational and level motion of elevator.<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />

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distoangular impaction<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />C, The purchase point is put into the remaining root portion of the tooth, and the roots are delivered by a Cryer elevator with a wheel and-axle<br />motion. If the roots diverge, it may be necessary in some cases to split them into independent portions<br />A. Removal of mesial & distal boen. It is important to remember that more distal bone must be taken off than for a vertical or mesioangular impaction.<br />B. The crown of the tooth is sectioned off with a bur and is delivered with straight<br />elevator<br />

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A. Removal of distal and buccal underlying bone <br />B. The crown is sectioned<br />from the roots of the tooth and is delivered from socket.<br />C, The roots are delivered together or independently with a Cryer elevator used with a rotational motion. Saperation of root into 2 parts - occasionally the purchase point is made in the root to allow the Cryer elevator to engage it.<br />Horizontally impacted<br />D, The mesial root of the tooth is elevated in similar fashion<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />

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Vertically impacted<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />A. When removing a vertical impaction, the bone on the occlusal, buccal, and distal aspects of the crown is removed, and the tooth is sectioned into<br />mesial and distal portions.<br />B. The posterior aspect of the crown is elevated first with a Cryer elevator inserted into a small purchase point in the distal portion of the tooth.<br />C. A small straight no. 301 elevator is then used to lift the mesial aspect of the tooth with a rotary and levering motion.<br />

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Mandibular 3rd molar removal!<br />

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Impaction of teeth other than 3rd molar<br />

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Impaction of teeth other than 3rd molar<br />Etiology<br />

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Clinical problem : malocclusion, loss of arch length, migration/ loss of adjacent tooth, periodontal disease, root resorption (internal & external) of impacted tooth, dentigerouscsyt & pericoronitis.<br />

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Management for impacted tooth other than 3rd molar<br />

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a) Exposure (with/ without ortho band)<br />Allow natural eruption of impacted teeth <br />Most appropriate technique <br />Most common : bonded orthodontic bracket to<br />Conserve exposure of the tooth<br />Remove only enough soft tissue + bone to place bracket<br />Avoid exposure of CEJ<br />

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Palatally impacted canines<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />Labially impacted canine exposed important part of this surgical procedure using an apically repositioned flap<br />

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b) Uprighting<br />Commonly for impacted MOLARS <br />Remove 3rd molar for 2nd molar to erupt normally<br />Normal time for uprighting molar teeth : 2/3 of the root has formed<br />If root fully formed  poor prognosis<br />If  3rd molar : Remove bone to ensure  occlusal force, antibiotic<br />Molar uprighting is frequently needed to treat a malocclusion bad bite that occurs years after the extraction of the lower first molar tooth<br />

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Third molar in path of second molar eruption<br />

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c) Transplantation<br />For adult :  undergo conventional ortho movement of canine / premolar<br /> how?<br />Expose the impacted tooth<br />Move into position + stabilize with ortho app.<br />Endo treatment : calcium hydroxide paste (antimicrobial effect & bone-regeneration stimulant) 6-8 weeks after surgical procedure<br />Conventional root canal filing at 1 year following surgery<br />Extraction possible : transalveolar transplantation (max. canines)<br />PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY<br />Second Edition<br />

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iv. Removal<br />Last choice! : canines / premolar / molar<br />Surgical + Radiographic assessment<br />Conservation of bone through conservative exposure + removal with sectioning<br />

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* Molar tooth  similar to 3rd molar!<br />

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Indication for removal of impacted tooth<br />

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i. PericoronitisPrevention or Treatment<br /><ul><li>The most cases for removal of impacted tooth!

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Usually mandibular – partially erupt

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Microbes :Peptostreptococcus, Fusobacterium, and Bacteroides(Porphyromonas)

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Initial treatment :</li></ul>i.Débridement<br />ii. Disinfection with irrigation solution (hydrogen <br /> peroxide or chlorhexidine)<br />iii.surgical management – extract opposing max 3rd<br /> molar.<br />iv. Severe cases with systemic effect – antibiotic<br />Recurrent – Removal of involved tooth<br />

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ii. Preventionof DentalDisease<br />Caries! – At mand 3rd molar / adjacent tooth<br /> (mostly at cervical line)<br />unable to clean effectively & inaccessible to the restorative dentist  advanced periodontal disease : Extract!<br />

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iii. OrthodonticConsiderations<br />

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iv. Preventionof OdontogenicCystsand Tumors<br /><ul><li>Follicular sac (formation of the crown)  cystic degeneration dentigerouscyst --> odontogenictumor (rare)

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Reason for removal of asymptomatic teeth because pathology occurs, it may pose a serious health threat!</li></li></ul><li>v. Root Resorptionof Adjacent Teeth<br /><ul><li>Misaligned erupting teeth may resorb the roots of adjacent teeth just like succedaneousteeth resorb the roots of primary teeth during normal eruption.

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Most cases - adjacent tooth recalcified (deposition of a cementumover the resorbedarea) & formation of 2odentin.

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If severe resorption & the mandibular 3omolar displaces significantly into the roots of the second molar REMOVE. </li></li></ul><li>vi. Teeth underDental Prostheses<br /><ul><li>Removable tissueborne prosthesis – is constructed on a ridge where an impacted tooth is covered by only soft tissue or 1 or 2 mm of bone  overlying bone resorbed, mucosa perforate & the area become painful and inflamed. So ----> Extract!

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In older patients with tooth- or implant-borne fixed prostheses asymptomatic deeply impacted teeth can be safely left in place.</li></li></ul><li>vii. Prevention of Jaw Fracture<br /><ul><li>Patients engage in contact sports(football, rugby, martial arts) & noncontact sports (basketball)  remove to prevent jaw fracture

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An impacted third molar -  resistance to fracture in mandible  common site for fracture

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increased complications in the treatment of the fracture.</li></li></ul><li>viii. Management ofUnexplained Pain<br /><ul><li>Jaw pain in the area of an impacted third molar but  clinical or radiographic signs of pathology.

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the surgeon must make sure that all other sources of pain are ruled out before suggesting surgical removal of the third molar.

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Patient must be informed that removal of the third molar may not relieve the pain completely</li></li></ul><li>Contraindication for removal of impacted tooth<br />