This document summarizes information about impacted teeth. It begins by defining an impacted tooth and listing the most common sites of impaction. It then discusses several theories for the causes of impaction, including lack of space from small jaws, heredity, pathology, endocrinology, and nature versus nurture. Risk factors and classifications of impacted teeth are also outlined. The document provides details on the rationale for removal, contraindications, surgical techniques, complications, and postoperative care for impacted teeth.
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery
The objective of this study was to investigate the incidence of sensory impairment of the lingual nerves following lower third molar surgery and to compare the outcome with various operative variables.
Factors that predicted lingual nerve injury were lingual flap retraction, tooth sectioning, and buccal guttering.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery
The objective of this study was to investigate the incidence of sensory impairment of the lingual nerves following lower third molar surgery and to compare the outcome with various operative variables.
Factors that predicted lingual nerve injury were lingual flap retraction, tooth sectioning, and buccal guttering.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
Lower 3rd molar impaction,its assessment and the buccal approach vz the lingu...Waikhom Singh
The clinical and radiological assessment of lower 3rd molar impaction,as well as the comparison between the buccal approach and the lingual split technique of trans-alveolar extraction of impacted lower 3rd molar is illustrated..
Lower 3rd molar impaction,its assessment and the buccal approach vz the lingu...Waikhom Singh
The clinical and radiological assessment of lower 3rd molar impaction,as well as the comparison between the buccal approach and the lingual split technique of trans-alveolar extraction of impacted lower 3rd molar is illustrated..
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Detailed description on management of impacted maxillary and mandibular third molars. Surgical approaches and complications are also discussed in details.
Impacted teeth - learn everything about it (classification - complications - indications of removal - contraindications for removal - operative and post operative complications - and more about it)
موضوع باوربوينت عن الاسنان المنحصرة : تتعلم فيها كل ما يتعلق عنها:
(الاعراض والاختلاطات - دواعي الازالة - موانع الازالة - اختلاطات المعالجة واختلاطات بعد المعالجة - والمزيد..)
Prepared by:
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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1. PRESENTED BY –
Dr.ANKITA RAJ (MDS Reader)
Oral & Maxillofacial Surgery
Department
Rama Dental College, Kanpur
2.
3. Impacted tooth is a tooth that is partially or
completely unerupted and is positioned against
another tooth or bone or soft tissue so that its
further eruption is unlikely beyond the normal
chronological age.
~ARCHER 1975
4. 1. Mandibular third molars
2. Maxillary third molars
3. Maxillary cuspids
4. Mandibular bicuspids
5. Mandibular cuspids
6. Maxillary bicuspids
7. Maxillary central incisors
8. Maxillary lateral incisors
5. •Orthodontic theory (small jaw-decreased
space):
Growth of the jaw and movement of teeth occurs in forward
direction, anything that interferes with such moment will
cause an impaction (small jaw-decreased space).
A dense bone decreases the movement of the teeth:
(1)acute infection
(2)Local inflammation of PDL
(3)Malocclusion,
(4)Trauma
(5)Early loss of primary teeth and arrested growth of the jaw
6. •Mendelian theory:
Heredity is the most common cause. An individual may
inherit small jaws from one parent and a complement of
large teeth from the other, i.e. hereditary transmission of
small jaws and large teeth from parents to children.
7. • Pathological theory:
Osteosclerosis in the third molar area, caused by the early disease of
adjacent molars, cause chronic infections affecting an individual and may
bring the condensation of osseous tissue further preventing the growth
and development of the jaws.
• Endocrinal theory:
Increase or decrease in the growth hormone secretion may
affect the size of the jaws.
• Nature and nurture theory:
A. J. MacGregor explains that impaction can occur due to a
mismatch in size and shape of teeth and jaws.
8. ETIOLOGY
• Irregularity in the position and pressure of
the adjacent tooth.
•Density of the overlying or surrounding
bone.
•Localised chronic inflammation
•Lack of space due to underdeveloped jaws.
•Obstructions (soft or hard tissue )
•Dilaceration
•Over retained deciduous teeth.
•Ectopic position of tooth bud.
10. RATIONALE FOR REMOVING IMPACTED
TOOTH
Indications:
Preventing and treating Pericoronitis.
Recurrent Pericoronitis
For prevention of dental caries.
Orthodontic considerations.
To prevent pathosis.
Prevention of root resorption.
Impacted teeth and dental
prosthesis.
Prevention of dental diseases.
11. CONTRAINDICATIONS:
Extremes of age.
Medically compromised patient.
Probable excessive damage to the adjacent
structures.
Prevention of fracture of jaws.
Prevention of pain of unexplained origin.
12. Based on the nature of the overlying
tissue
Winter’s classification
Pell and Gregory’s classification
Killey & Key’s classification
13. A. BASED ON THE NATURE OF
THE OVERLYING TISSUE
i. Soft tissue impaction
ii. Hard tissue impaction
14. I. Mesioangular: Long axis of 3rd molar bisects the long axis
2nd molar at or above occlusal plane
Mesioangular 38—(A) long axis of 38 bisects the long axis 37
above the occlusal plane. (B) Interradicular bone width
between 37 and 38 is more than interradicular bone width
between 36 and 37.
15. Distoangular—(A) long axis of 48 is away from long axis of 47 at the
level of occlusal plane. (B) The interradicular bone between 47 and 48
is almost obliterated and less than that between 46 and 47.
17. (A)Vertical—the long axis of the impacted 48 runs parallel to the long
axis of the 47.
(B)Vertical—interradicular bone width between 47 and 48 equal to
interradicular bone width between 46 and 47.
19. I. Based on their relationship with the anterior
border of the mandible :
Class I: The anteroposterior diameter of the tooth is equal to the
space between the anterior border of ramus of the mandible
and distal surface of the second molar tooth
Class II: A small amount of bone covers the distal surface of the
tooth and The space is inadequate for eruption of the tooth,
i.e. mesiodistal diameter of the tooth is greater than the
space available.
Class III: Tooth is located completely within the ramus of the
mandible– least accessible.
20. Position A: Occlusal plane of the impacted tooth
is nearly in the same level as the occlusal level of the
adjacent second molar tooth occlusal level of 47.
Position B: Occlusal plane of the impacted tooth is
in the midway between the cervical line and the
occlusal plane of the adjacent second molar tooth.
Position C: Occlusal plane of the impacted tooth
below the level of cervical line of the second
tooth. This can be applied for the maxillary teeth also.
21. III. Based on long axis of the impacted tooth :
It is similar to the one as proposed in the Winter’s classification
22. D) Killey & Key’s classification
a) Based on angulation and position:
Same as George Winters.
b) Based on the state of eruption:
- Completely erupted
- Partially erupted
- Unerupted
c) Based on pattern of roots:
1) - Fused roots.
- Two roots.
- Two roots and multiple roots
2) Root pattern may be –
- Surgical favourable
- Surgical unfavourable
23.
24. • Occlusal relationship
• Presence of local infection
• Periodontal status
• Resorption of the second molars
• External oblique ridge
• Internal oblique ridge
• Upper third molar
• Soft tissue assessment
•Regional lymph nodes
25. Types of radiographs used
• Intraoral periapical (IOPA) radiograph
• Bitewing radiograph
• Occlusal radiograph
• Lateral oblique radiograph
• Orthopantomograph (OPG)
• CBCT (in indicated cases)
26. WAR lines
White line
White line is drawn along the occlusal surfaces of the erupted
mandibular molars and extended over the third molar region
posteriorly.
Indicates
▪The depth of the tooth within the mandible.
▪Relationship of occlusal surface of impacted
tooth with the erupted molars.
27. Amber line
Amber line is drawn from the surface of the bone on the distal aspect of the
third molar to the crest of the interdental septum between the first and
second mandibular molars.
This line represents the margin
of the alveolar bone covering the third molar.
28. Red line
It is the perpendicular line drawn from the amber line to the imaginary
point of application for the elevator (all types-mesial, distoangular-
distal)
The length of the red line indicates depth of the impacted tooth.
With each increase in length of the red line by 1 mm, the impacted tooth
becomes three times more difficult to remove.
29.
30.
31. A) Spatial Relationship Value
- Mesioangular 1
- Horizontal / transverse 2
- Vertical 3
- Distoangular 4
B) Depth
- Level A 1
- Level B 2
- Level C 3
C) Ramus relationship
- Class I 1
- Class II 2
- Class III 3
PEDERSON DIFFICULTY INDEX
Classification:
Difficulty scores:
Very difficult 7-10
Moderately 5-7
Minimally 3-4
Example: Mesioangular tooth 1 difficulty score is
Level B 2 5-7
Class III 3 Moderately difficult
32. Relationship of 3rd molar to the
INFERIOR DENTAL CANAL.
Darkening of
roots
Deflection of
roots
Narrowing of
roots
Dark & Bifid apex Interruption of
white line of canal
Diversion of canal Narrowing of canal
33.
34. 34
• Cheek retraction and visualization - Mouth mirror,
prop,
of the surgical area cheek retractor
• Incision - BP Handle & No. 15 blade
• Flap development & reflection - Moon’s probe, Howarth’s
periosteal elevator
• Flap retraction - Austin’s retractor
• Bone removal - Handpiece, bur, chisel
• Luxation - Elevators
• Tooth removal - Forceps
• Suturing - Sutures & needle holder
36. STEPS IN REMOVAL OF IMPACTED TEETH
1. Isolation
2. Anaesthesia
3. Incision and flap design (flap elevation and retraction)
4. Bone removal
5. Sectioning/division of tooth (if required)
6. Elevation and extraction of tooth
7. Debridement and smoothening of bone
8. Control of bleeding
9. Flap repositioning and Suturing
10. Follow up
36
39. Step 5: Buccal Mucoperiosteal flap raised
Step 6: Lingual Mucoperiosteal flap raised and complete exposure of the tooth done.
40. Step 7: Guttering of the mesial and distal bone.
Step 8: Odontectomy performed.
41. Step 10: Removal of mesial segment
Step 9: Removal of distal segment
42. Step 11: Extraoral reorientation of the extraoral fragments.
Step 12: Wound debridement and primary closure.
43. A. LATERAL TREPHINATION TECHNIQUE
The external oblique ridge is palpated and an S-shaped incision is made.
Incision line starts from the retromolar fossa and extends across the
external oblique ridge curving down along the reflection of the mucous
membrane above the vestibule and ends anterior to the first permanent molar.
44. Using a round bur, the buccal cortical plate over the third molar crypt is
trephined and is fractured to expose the third molar crypt using a chisel
Using an elevator, the impacted tooth is delivered out of the crypt.
45. Takes advantage of the thinness of the lingual cortical plate, avoids and preserves
plate and hence preserves the buccal plate and external oblique ridge.
50. Surgical Step Complication
Incision Hemorrhage
Lingual nerve damage
Bone removal Injury to soft tissues
Damage to 2nd molar
Splitting of ramus
Damage to bone
Elevation of Tooth Fracture of tooth
Damage to 2nd molar
Damage to I.D bundle
Fracture of mandible
Slipping of the tooth
Preparation of the wound Damage to I.D. nerve and vessels
Complications During Surgical Procedure
50