Radiographic assessment of impacted teeth

1. RADIOGRAPHIC ASSESSMENT
OF IMPACTED TEETH
KAUSTAV TARAN
MCODS,MANIPAL
FINAL YEAR BDS

2. What is an impacted teeth?
• A tooth which is completely or partially unerupted.
• The eruption failure is because of the presence of another
tooth, bone or soft tissue in its path of eruption.

3. TYPES OF RADIOGRAPHS USED
• IOPA

4. • BITEWING
• OCCLUSAL

5. • OPG

6. • LATERAL OBLIQUE

7. FREQUENCY OF IMPACTED TEETH OCCURS IN
THE FOLLOWING ORDER
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

8. INTERPRETATION OF THE RADIOGRAPH
1. ASSESSMENT OF ORIENTATION

9. 2. ASSESSMENT OF POSITION AND DEPTH
WAR LINES (white, amber, red)
given by George Winter

12. 3. ASSESSMENT OF ACCESS
Easy access to the impacted teeth is determined by the
inclination of the radiopaque line caused by the
external oblique ridge.
When the radiographic line is more horizontal, access is easy.
When the radiographic line is more vertical, access is poor.

14. 4. ASSESSMENT OF THE ROOTS OF THE IMPACTED
TOOTH
LENGTH OF THE ROOT
• The ideal time to remove the impacted tooth is when the roots are
2/3rd formed. In this stage the roots will be blunt and removal will be
very easy.
• When the roots are 1/3rd formed,the tooth tends to roll like a ball in a
socket, which prevents its easy elevation.
• If the entire length of the root develops, then the possibility increases
for abnormal root morphology and for fracture of the root tips during
extraction.

15. FUSION OF ROOTS
• The fused conical roots are easier to remove than widely separated
roots.
CURVATURE OF ROOTS
• Severely curved or dilacerated roots are more difficult to remove than
straight or convergent roots.
WIDTH OF THE ROOTS
• The greater is the width of the roots, the more difficult is the
extraction of the impacted tooth.

16. 5. ASSESSMENT OF BONE TEXTURE
In younger age groups the bone is cancellous and elastic
whereas it becomes dense and sclerosed as the age advances.
The nature of the bone is the factor which decides the choice
of burs or chisel used to remove bone.
If the bone is less dense , it is easier to cut with a bur or chisel.

17. 6. ASSESSMENT OF RELATIONSHIP WITH INFERIOR
ALVEOLAR NERVE
CHANGES RELATED TO TOOTH ROOT
Normaly a tooth is uniformly radiopaque.
A decrease in radioopacity indicates that the density of the tooth
structure and the cortical lining of the inferior alveolar nerve canal is
decreased in that area. This is due to the grooving of the tooth by the
canal and its contents.
When the canal crosses only the apex of the tooth, apical notching or
bifid root apex is seen.

18. CHANGES RELATED TO CANAL
• The inferior alveolar nerve canal is represented by 2
radiopaque lines.
• Disruption or interruption in continuity of these radiopaque
lines indicates that a deep grooving of the tooth root by the
canal is present.
• When there is a break in continuity of only the upper
radiopaque line, an apical notch is present which indicates
that only the tooth apex is grooved by the canal.

20. CONCLUSION
• The purpose of radiological evaluation is to complement the clinical
examination by providing additional information about the related
teeth and the surrounding anatomical structures.
• This is necessary in order to make a sound decision about the
proposed surgical procedure.

21. THANK YOU!