This document discusses the principles of management of impacted teeth. It begins by defining an impacted tooth and listing indications for extraction such as neuralgias, pericoronitis, and restricting dentures or eruption of other teeth. It recommends extraction when patients are young for easier bone removal and healing. The surgical procedure is described in 4 steps and impacted third molars are classified by position, depth, and space available. Different flap types for exposure are covered and examples of various impacted tooth extractions and exposures are shown.

1. Principles of management of
impacted teeth
Dr.Mohamed Rahil
(( Maxillofacial surgeon ))
Tikrit dentistry college
2015 – 2016

2. impaction
An impacted tooth is any tooth that is
prevented from reaching its normal position in
the mouth by tissue, bone, or another tooth.

3. Indications for Extraction

4. • Localized or Generalized Neuralgias
• Pericoronitis
• Production of Caries
• Destruction of Adjacent Teeth Due
to Resorption of Roots
• Participation in the Development of
Various Pathological condition
• Restrict the Placement of a Partial
or Complete Denture.
• Restrict the Normal Eruption of
Permanent Teeth
• Provoking or Aggravating
Orthodontic Problems

5. Timing
most suitable time is when the patient is young due to :
younger patients generally well tolerate surgical
procedure and stress .
faster postsurgical wound healing compared with older
patients.
Bone removal more easy in young than older patient.

6. Steps of Surgical Procedure
1. Incision and reflection of the mucoperiosteal flap
2. Removal of bone to expose the impacted tooth
3. Luxation of the tooth
4. Care of the postsurgical socket and suturing of the
wound

7. Impacted Third Molar
Classifications
• Mesioangular
• Distoangular
• Vertical
• Horizontal
• Buccoangular
• linguoangular
• Inverted

8. • Class A: The occlusal surface of the impacted tooth is at the
same level as, or a little below that of, the second molar
• Class B: The occlusal surface of the impacted tooth is at the
middle of the crown of the second molar or at the same level as
the cervical line
• Class C: The occlusal surface of the impacted tooth is below the
cervical line of the second molar

9.  Class 1: The distance between the second molar and the anterior
border of the ramus is greater than themesiodistal diameter of
the crown of the impacted tooth
 Class 2: The distance is less and the existing space is less than the
mesiodistal diameter of the crown of the impacted tooth
 Class 3: There is no room between the second molar and the
anterior border of the ramus, so that the entire impacted tooth
or part of it is embedded in the ramus

10. Types of Flaps
Triangular flap:
• The incision for this type of
flap begins at the anterior
border of the ramus (external
oblique ridge) with special
care for the lingual nerve and
extends as far as the distal
aspect of the second molar,
• while the vertical releasing
incision is made obliquely
downwards and forward,
ending in the vestibular fold .

11. Types of Flaps

12. Horizontal (envelope) flap:
• The incision for the flap also
begins at the anterior border
of the ramus and extends as
far as the distal aspect of the
second molar, continuing
along the cervical lines of the
last two teeth, and ending at
the mesial aspect of the first
molar.
• This type of flap is usually
used in cases where
impaction is relatively
superficial.
Types of Flaps

13. Removal of Bud of Impacted Mandibular
Third Molar

23. Extraction of Impacted Third Molar
in Horizontal Position

32. Extraction of Third Molar with
Mesioangular Impaction

41. Extraction of Third Molar
with Distoangular Impaction

45. Extraction of Impacted Third Molar
in Edentulous Patient

47. Impacted Premolar

54. Impacted Canine

56. Extraction of Impacted Maxillary Teeth

57. Impacted Third Molar

60. Impacted Canines

61. Extraction Using Labial Approach

66. Extraction Using Palatal Approach

70. Ectopic Impacted Canine

73. Exposure of Impacted Teeth
for Orthodontic Treatment

75. Impacted Mandibular Canine
with Labial Position

77. Thank you for listening