3. INTRODUCTION
DEFINITION:
An impacted tooth is one that is partially erupted or unerupted
beyond the chronological date of eruption, and will not
eventually assume a normal relationship with the other teeth
and tissues.
4. Frequency of impacted tooth
1. Mandibular third molar
2. Maxillary third molar
3. Maxillary cuspid
4. Mandibular bicuspid
5. Mandibular cuspid
6. Maxillary bicusp
7. Maxillary central incisor
8. Maxillary lateral incisor
5. Classification
Field and Akerman classification:
Maxillary canine impaction
Labial position
1. Crown in intimate relation with incisors
2. Crown well above the incisors
Palatal position
1. Crown near the surface, in close relationship to roots of incisors
2. Crown deeply embedded in close relationship to apices of
incisors
Intermediate position
1. Crown in between lateral incisor and first premolar roots
2. Crown between these teeth with crown labially placed and root
palatally placed or vice versa
Unusual position
1. In nasal or antral wall
2. In infraorbital region
6. Mandibular canine impaction
Labial position
1. Vertical
2. Oblique
3. Horizontal
Unusual position
1. At inferior border
2. In mental protuberance
3. Migrated to opposite side
7. Classification based on position in
dental arch
CLASS 1:impacted cuspid located in the palate
1-horizontal
2-vertical
3-semivertical
CLASS 2:impacted cuspid located in the labial or buccal surface of
maxilla
1-horizontal
2-vertical
3-semivertical
CLASS 3:impacted cuspid located in both palatal process and labial or
buccal maxillary bone.
CLASS 4:impacted cuspid located in the alveolar process located in the
alveolar process usually verticaly between the incisor anf first bicuspid.
CLASS 5: impacted cuspid located in an edentulous maxilla
8.
9. Theories of canine imapction
Two theories:
1. Genetic theory
2. Guidance theory
10.
11.
12. Indication
Impacted canine located very far from the occlusal
plane
No other methods are possible to retain the tooth
Patient not willing for orthodontic treatment
Leaving behind may result in resorption of adjacent
tooth
Pathological changes like cyst, infection
No adequate space for tooth to be in functional
position
Unfavourable anatomy of tooth
13. Contraindication
When tooth can be brought to normal position by
orthodontically or surgically
Medically compromised patients
14. IMPACTED MAXILLARY CUSPID
The removal of impacted
maxillary cuspid is one of the
most difficult procedure in oral
cavity.
The frequency of impaction of
maxillary cuspid is 20 times
greater than that of
mandibular cuspid.
15. Etiological factors
Prolonged retention of deciduous tooth
Dilacerated root
Ankylosed cuspid fails to erupt
Presence of canine in relation to cleft lip or palate
Lack of space
Thick mucoperiosteal covering
Endocrinal changes
16. Clinical Evaluation
GENERAL EXAMINATION
Presence of any systemic disorders and precaution should be
taken
Patient should be assesed for undergoing certain therapies
like radiation therapy and organ transplantation
LOCAL EXAMINATION
1- when lateral incisor is deflected distally, impacted canine
might be present in close approximation with mesial aspect
root apex of lateral incisor
17. 2-when lateral incisor is tipped labially it implies that
impacted canine is present on the buccal or labial aspect
of the root of lateral incisor
When lateral incisor is inclined lingually ,canine is
impacted on the palatal aspect of the root of lateral
incisor
18. Radiographic Evaluation
The periapical and panoramic radiograph are available for
localizing the impacted canine, the exact location of the
impacted cuspid cannot be determined.
19. CLARKS TUBE SHIFT METHOD
Two periapical radiograph are taken in same position.
The first radiograph is taken usual manner
In the second radiograph the film is positioned in the
same place but tube or cone of the x ray is moved
horizontally in any one direction.
Principle:
Due to changes in horizontal direction while taking the
second radiograph, unerupted tooth seems to be moving
in a mesial or distal direction with respect to adjacent
anatomical structures.
SLOB
20. REMOVAL OF IMPACTED MAXILLARY
CUSPID
IMPACTION IN PALATE
Administer LA
Incision is made starting from palatal aspect of neck of the
maxillary central incisor of the involved side, and extending
around the neck partially impacted canine.
Another incision is made in midline starting from crest of
interdental papilla
Mucoperiosteum is elevated
21. The bulge of crown of impacted canine is seen
Bone is removed by bur or chisel
Holes are drilled around the crown of the impacted canine,
appropriate elevator is applied and the tooth delivered out
of the socket.
The crown should be sectioned first and removed followed
by the root which can be pushed into the space created by
removal of crown
22.
23. Impaction on the labial or buccal side
The crown of impacted teeth should be exposed
with appropriately designed flap
1. Trapezoidal flap
2. Semilunar flap
3. Triangular flap
Bone overlying the impacted tooth should be
removed with bur
The tooth is elevated from the socket using elevator
24.
25. Impaction on both palatal and buccal aspect
On buccal side a semicircular incision is made and the root
sectioned to remove it.
On palatal aspect, a palatal flap is reflected as previously
mentioned and the crown of the impacted tooth is exposed
by removing the overlying bone using bur or chisel.
Appropriate instrument is inserted in the root end of the
crown through the buccal crypt and the instrument is now
tapped with mallet to remove it through the palatal
exposure.
26.
27. Removal of bilaterally impacted canine differs in the
type of incision and elevation of the flap.
The incision is made around the neck of the teeth
extending from one periosteal flap of bicuspid to
other, and a full thickness mucoperiosteal flap is
elevated incising the nasopalatine nerve bundle and
vessels.
28. REMOVAL OF IMPACTYED MANDIBULAR
CANINE
Mandibular cuspids are mostly impacted in a vertical
position either buccally or lingually
29. Removal of vertically impacted cuspid tooth on
the buccal aspect
An incision is made and mucoperiosteal flap is
reflected adequately on the buccal side to expose the
site of operation
Bone removed with bur or chisel
Using labial cortical plate as fulcrum, the tooth is
luxated out of the socket
If there is any resistance to normal delivery of tooth,
tooth sectioning should be considered
30.
31. After removing the impacted tooth, the sharp bony
edges are trimmed and smoothened
The socket is irrigated profusely using sterile saline
solution
The flap is sutured back
32.
33. Post-operative management
Sockets should be thoroughly debrided with a surgical curette
Sharp bony edges should be smoothened
Proper irrigation
Primary haemorrhage occurs immediately after tooth
removal. Firm pressure should be applied atleast for a period
of 2 minutes
Secondary haemorrhage treated by a gauze sponge held
between jaws and operative site for half an hour
Patient should not rinse his/her mouth for 6 hours
Swelling occuring immediately after surgery can be treated by
applying ice cap, followed by heat application in subsequent 4
days
mastication of hard food should be avoided
Strict oral hygiene
34. Post operative complications
Injury to nerves
Infection
Injury to surrounding tissues
Disturbance to normal blood supply
Fracture of roots or accidental displacement of
fractured root into antrum
Oroantral fistula
Postoperative sequelae like excessive swelling, severe
dysphagia, severe pain
35. Conclusion
Removal of impacted teeth is mandatory only if it
cannot be brought into its normal functional position
Retaining the tooth in impacted position can lead to
infection, fracture of bone, cystic or neoplastic
changes, malocclusion and crowding
Proper diagnosis should be made on impacted tooth
and appropriate treatment modality should be
followed
36. REFERENCES
Textbook of Oral And Maxillofacial Surgery –Balaji
Textbook of Oral And Maxillofacial Surgery –
Neelima Anil Malik
