MANDIBULAR THIRD MOLAR IMPACTION MANAGEMENT

2. MANDIBULAR THIRD MOLAR
IMPACTED TEETH AND THEIR
MANAGEMENT

3. CONTENTS
Introduction.
Definition.
Tooth eruption.
Terminologies.
Commonly impacted teeth.
Theories.
Etiology.
Indications and
contraindications.
Surgucal anatomy.
Classification.
Pre-op assessment.
Surgical technique.
Complications.
Recent advances.
Conclusion.
References.

4. INTRODUCTION
Although the scope of oral and maxillofacial surgery has expanded
in many directions recently, the mainstay of practice remains
dentoalveolar surgery.
The atraumatic removal of impacted teeth is one of the most
commonly performed surgical procedure in the speciality of oral and
maxillofacial surgery.
 A study by Berge (1995) has shown that there is a four fold
increase in the incidence of complications when the surgery was
performed by the general practitioner as compared that performed by
the oral surgeon.
 It was Dr George B Winter who more than anyone else helped to
rationalize the technique of removal of impacted mandibular third
molar.
Got their name 'Wisdom teeth' from the age during which they
erupt:17 to 25.This is the age at which men and women
become adults and presumably wiser.

5. DEFINITION
Latin-Impactus an organ or structure which because of an abnormal
mechanical condition has been prevented from
assuming its normal position
Webster an impaction as the wedging of one part into another.
The medical dictionaries applying the word to dentistry
mention the lodging of a tooth between the jaw bone
and another tooth
Rounds (1962) the condition in which a tooth is embedded in the
alveolus so that its further eruption is prevented
Archer (1975) tooth as one which is completely or partially
unerupted and is positioned against another tooth or
bone or soft tissue so that its further eruption is
unlikely
Lytle (1979) one that has failed to erupt into normal functional
position beyond the time usually expected for such
appearance.

6. Andreasen(1997) A cessation of the eruption of a tooth caused
by a clinically or radiographically detectable
physical barrier in the eruption path or by an
ectopic position of the tooth.
Peterson A tooth is considered impacted when it has
failed to fully erupt into the oral cavity within
its expected developmental time period and
can no longer reasonably be expected to do
so.
American society of
oral surgeons(1971)
A tooth which has already passed chronological age
of eruption and failed to come to oral cavity inspite
of normal eruptive forces due to some mechanical
obstruction.
WHO Any tooth that is prevented from reaching its
normal position in the mouth by tissue, bone or
another tooth.

25. Lingual pouch.
External
oblique ridge.
Submandibular
fossa.

36. v

41. PRE-OPERATIVE
ASSESSMENT

42. Clinicalassessment
Generalassessment
Age/sex
Systemic
condition
Drug history
Anaesthesia
history
General
physical
examination

43. Extraoral examination
Facial form
Ramus
flare
Cheek bulk Swelling
Presence of
sinus/fistula
Lymph
node
Trismus

44. Intra-oral examination
Soft tissues
Mouth
opening
Position of
mandible
Tongue size
Extensibility
of lips and
cheeks
Soft tissue
trauma

45. Hard tissues
Dentition
status
External
oblique
ridge

57. v

87. POST-OPINSTRUCTIONS
Pressure pack, ice application.
 Soft diet-first 2 days.
 First dose of analgesics should be taken before the anesthetic
effect of LA wears off.
 Antibiotics.
 Avoid strenous exercises for first 24 hrs.
 Avoid gargling/spitting/smoking/drinking with straw.
 Warm water saline
gargling after 24hrs,mouthwash regularly thereafter.
 Suture removal on 5th post-op day.

103. CONCLUSION
Surgery for removal of impacted 3rd molar surgeries
may be associated with several post-op
complications,these complications.
All third molars need not be removed independently of
disease finding and patients need not unnecessarily
have to accept adverse consequences associated with
the surgery risks and discomfort in the absence of
pain,radiographic finding of pathology.However when
surgery is indicated several new concepts and
techniques are to be considerd

104. REFERENCES
 Principles of OMFS-PETERSON.
 Text book of OMFS-NEELIMA ANIL MALIK.
 Killey and Kays outline of oral surgery.
 A practical guide to the management of impacted teeth-
K.GEORGE VARGHESE.

105. Thank you