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MANAGEMENT OF IMPACTED
MANDIBULAR THIRD MOLAR

www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
• IMPACTED TOOTH – DEFINITION
• CLASSIFICATIONS

• CLINICAL EVALUATION
• RADIOLOGICAL ASSESSMENT
– WHARF’S ASSESSMENT
– “W...
IMPACTED TOOTH – DEFINITION
• Impacted tooth is one that fails to erupt & will
not eventually assume its anatomical arch
r...
PELL & GREGROY’S CLASSIFICATION
• Relationship of teeth to Ramus
• Relative depth
• Long axis of the tooth

www.indiandent...
PELL & GREGROY’S CLASSIFICATION

www.indiandentalacademy.com
Archer (1975) and Kruger (1984).

www.indiandentalacademy.com
Quek et al. (2003)
•
•
•
•
•

Vertical impaction (10° to -10°),
Mesioangular impaction (11° to 79°),
Horizontal impaction ...
www.indiandentalacademy.com
Int. J. Oral Maxillofac.
www.indiandentalacademy.com

Surg. 2003; 32: 548–552
CLINICAL EVALUATION
•
•
•
•
•

Restricted mouth opening
Retrusive mandible
Small oral commissure
Pericoronitis
Adjacent te...
CLINICAL EVALUATION

www.indiandentalacademy.com
RADIOLOGICAL ASSESSMENT
– WHARF’S ASSESSMENT
– “WAR” LINES
– PEDERSON’S INDEX

www.indiandentalacademy.com
WHARF’S ASSESSMENT
S. No

Criteria

Category

Score

1

Winter’s

Horizontal

2

classification

Distoangular

2

Mesioang...
WAR LINES

www.indiandentalacademy.com
PEDERSON’S INDEX

www.indiandentalacademy.com
INFERIOR ALVEOLAR NERVE RELATION

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
SURGICAL MANAGEMENT
•
•
•
•
•
•
•

Anesthesia
Incision & Mucoperiosteal flap
Removal of Bone
Tooth Removal
Wound Debrideme...
incisions

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
HORIZONTAL

www.indiandentalacademy.com
www.indiandentalacademy.com
MESIO ANGULAR

www.indiandentalacademy.com
www.indiandentalacademy.com
TOOTH DIVISION

www.indiandentalacademy.com
WOUND DEBRIDEMENT & SUTURING

www.indiandentalacademy.com
BONE & TOOTH REMOVAL
TECHNIQUES
•
•
•
•

Bur technique
Chisel Technique
Split Bone Technique
Lateral Trephination Techniqu...
CHISEL vs BUR
CRITERIA
Chances of fracture of bone

CHISEL & MALLET
Relatively High

BUR
Less Possibility

Healing of Bone...
Split Bone Technique
VERTICAL ‘STOP CUT’
AT ANTERIOR END

HORIZONTAL CUT
JUST ABOVE LOWER
END OF ‘STOP CUT’

DISTO LINGUAL...
Lateral Trephination Technique
• S shaped incision from retromolar fossa across
external oblique ridge
• Bur used to treph...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Management of impacted mandibular third molar /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

Management of impacted mandibular third molar /certified fixed orthodontic courses by Indian dental academy

  1. 1. MANAGEMENT OF IMPACTED MANDIBULAR THIRD MOLAR www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. • IMPACTED TOOTH – DEFINITION • CLASSIFICATIONS • CLINICAL EVALUATION • RADIOLOGICAL ASSESSMENT – WHARF’S ASSESSMENT – “WAR” LINES – PEDERSON’S INDEX • SURGICAL MANAGEMENT www.indiandentalacademy.com
  4. 4. IMPACTED TOOTH – DEFINITION • Impacted tooth is one that fails to erupt & will not eventually assume its anatomical arch relationship beyond the chronological eruption date. www.indiandentalacademy.com
  5. 5. PELL & GREGROY’S CLASSIFICATION • Relationship of teeth to Ramus • Relative depth • Long axis of the tooth www.indiandentalacademy.com
  6. 6. PELL & GREGROY’S CLASSIFICATION www.indiandentalacademy.com
  7. 7. Archer (1975) and Kruger (1984). www.indiandentalacademy.com
  8. 8. Quek et al. (2003) • • • • • Vertical impaction (10° to -10°), Mesioangular impaction (11° to 79°), Horizontal impaction (80° to 100°), Distoangular impaction ( -11° to -79°), Others (111° to -80°) www.indiandentalacademy.com
  9. 9. www.indiandentalacademy.com
  10. 10. Int. J. Oral Maxillofac. www.indiandentalacademy.com Surg. 2003; 32: 548–552
  11. 11. CLINICAL EVALUATION • • • • • Restricted mouth opening Retrusive mandible Small oral commissure Pericoronitis Adjacent teeth www.indiandentalacademy.com
  12. 12. CLINICAL EVALUATION www.indiandentalacademy.com
  13. 13. RADIOLOGICAL ASSESSMENT – WHARF’S ASSESSMENT – “WAR” LINES – PEDERSON’S INDEX www.indiandentalacademy.com
  14. 14. WHARF’S ASSESSMENT S. No Criteria Category Score 1 Winter’s Horizontal 2 classification Distoangular 2 Mesioangular 1 Vertical 0 1-30mm 0 31-34mm 1 35-39mm 2 Angulation of third 1-50 0 molar 60-69 1 70-79 2 80-89 3 90+ 4 2 3 4 Height of mandible 3 Normal 0 1 Enlarged 2 Space available 0 Distal cusps covered 1 Mesial cusps covered 2 Both covered Path of exit 2 Possibly enlarged 6 1 Unfavorable curvature Follicles Complex Favorable curvature 5 Root shape 3 www.indiandentalacademy.com
  15. 15. WAR LINES www.indiandentalacademy.com
  16. 16. PEDERSON’S INDEX www.indiandentalacademy.com
  17. 17. INFERIOR ALVEOLAR NERVE RELATION www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. SURGICAL MANAGEMENT • • • • • • • Anesthesia Incision & Mucoperiosteal flap Removal of Bone Tooth Removal Wound Debridement Arrest of hemorrhage Wound closure www.indiandentalacademy.com
  21. 21. incisions www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. HORIZONTAL www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. MESIO ANGULAR www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. TOOTH DIVISION www.indiandentalacademy.com
  31. 31. WOUND DEBRIDEMENT & SUTURING www.indiandentalacademy.com
  32. 32. BONE & TOOTH REMOVAL TECHNIQUES • • • • Bur technique Chisel Technique Split Bone Technique Lateral Trephination Technique www.indiandentalacademy.com
  33. 33. CHISEL vs BUR CRITERIA Chances of fracture of bone CHISEL & MALLET Relatively High BUR Less Possibility Healing of Bone Good Delayed Post op Edema Less More Dry Socket Post op Infection Deeply buried tooth Incidence is less High Less More Difficult to Remove www.indiandentalacademy.com Relatively Easy
  34. 34. Split Bone Technique VERTICAL ‘STOP CUT’ AT ANTERIOR END HORIZONTAL CUT JUST ABOVE LOWER END OF ‘STOP CUT’ DISTO LINGUAL BONE FRACTURED WITH CHISEL AT AN ANGLE OF 45◦ PARALLEL TO E.O.R LINGUAL PLATE GRASPED BY HEMOSTAT TOOTH ELEVATED www.indiandentalacademy.com
  35. 35. Lateral Trephination Technique • S shaped incision from retromolar fossa across external oblique ridge • Bur used to trephine buccal cortical plate over 3rd molar crypt • Vertical cut anteriorly & posteriorly www.indiandentalacademy.com
  36. 36. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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