Exam 1 - Removal of impacted Teeth 1 and 2 Flashcards
Impacted teeth definition
one that fails to erupt into the dental arch within the expected time. Eruption has been impeded by adjacent teeth, dense bone, or excessive soft tissue.
Top 3 incidence of impacted teeth
- Maxillary and Mand 3rd molars
- Max canines are next most comon
- Mandibular premolars
Why Maxillary canine
erupts after the max lateral incisor and after the max first olar
Why mand premolars
erupts after the mand 1st molar and after the mandibular canine
Should all impacted teeth be removed?
yes unless it is contraindicated
Normal development for the lower 3rd molar?
Begins in a horizontal angulation that changes to mesioangular and then to vertical
ideal time for removal of 3rd molars?
when roots of teeth are at least 1/3rd formed but before they are 2/3rd
Indications for removal of impacted teeth
prevention of
- periodontal disease
- dental caries
- periocornitis
- root resorption
- impacted teeth under a dental prosthesis
- prevention of cysts
The retention of third molars is associated with increased risk of second molar pathology in middle-aged and older adult men
true
What is pericornitis
infection of the soft tissue around the crown of a tooth.
Caused by normal oral flora
What is pericornitis caused by:
streptococci and anaerobic bacteria
Mild tx is irrigation
Moderate Tx is abx
Severe would be hospital admit/referral
Do we need to remove the offending mandibular third molar once the infection has resolved?
YES
Diagnosis of a dentigerous cyst
if follicular space around the crown of a tooth is greater than 3mm
Most common odontogenic tumor in the third molar region
Ameloblastoma
Contraindications to taking out 3rd molars
- Age > 40
- Medical Status
- Probable damage to adjacent structures
- long standing asymptomatic impacted tooth
Classification of Impacted teeth: Angulation
- Mesioangular
- Horizontal
- Vertical
- Distoangular
Mesioangular impaction
least difficult to remove in mandible
tilted toward the second molar in a MESIAL direction
43% of all impacted mandibular third molars
Horizontal angulation
Approx. 3% of mandibular impaction
second most easiest to remove on mandible
Vertical Angulation
Long axis of the impacted tooth runs in the same direction as the long axis of the second molar
38% of impactions
3rd most difficult to remove in mandible
Distoangular
MOST difficult to remove
long axis of the third molar is distally or posteriorly angled away from the second molar
6% of impacted mandibular 3rd molars
Classification of impacted teeth (Pell and Gregory)
- Relationship to the anterior border of the ramus (1,2, and 3)
- Relationship to the occlusal plane (A, B and C)
Classification 1
The mesiodistal diameter of the crown is completely anterior to the anterior border of the ramus
Classification 2
Approximately half of the crown is covered by the anterior border of the ramus
Classification 3
The crown is covered entirely by the anterior border of the ramus
Classification A
The occlusal plane of the impacted tooth is at the same level as the occlusal plane of the second molar
Classification B
The occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the second molar
Classification C
The occlusal plane of the impacted tooth is below the cervical line of the second molar
Classifications can be combinations
ex. Distoangular, Class 3, C
Classification
-Nature of overlying tissue
Soft tissue -Full -Partial Bone -Full -Partial
Root Morphology
Length Single or fused curvature width PDL space
Density of surrounding bone is:
Age dependent
young (18) - less dense
Older >35 - more dense
Maxillary Classification
Vertical (63%)
Distoangular (25%)
Mesioangular (12%)
PG classification
A, B, and C
What makes impaction surgery less difficult
- mesioangular position in the mandible
- class 1 ramus
- class A depth
- roots one third to two thirds formed
- large follicle
- wide periodontal ligament
- separated for IAN
- soft tissue impaction
What makes impaction surgery more difficult
- distoangular in mandible
- class III ramus
- Class C depth
- Long, thin roots
- Narrow periodontal ligament
- Thin follicle
- Close to IAN
- Contact with the second molar
Is increased age associated with a higher complication rate for M3 extractions?
Yes, age >25
What about impacted max. Canine?
May expose and ligate tooth and through ortho can aid in eruption of the tooth
Impacted Maxillary Teeth
Rarely section
Mostly bone removal
Concern with max sinus
Do not use chisel to section a maxillary tooth
Perioperative patient management
Anxiety control: IV sedation or GA Long acting local anesthetics IV steroids to prevent/decrease swelling Ice packs on the face Possible use of antibiotics
What is normal postoperative experience?
Swelling
Discomfort
Mild/moderate trismus
All of symptoms are less intense in a young, healthy patient
Can routine use of CT for extraction of third molars be recommended? LISTEN TO LECTURE AT THIS SLIDE 41
NO, data obtained form the CT had MINIMAL effect on surgical outcome
Can cone-beam technology improve presurgical planning?
Yes
Alveolar Osteitis
The development moderate to severe throbbing pain usually occurring around the third to fifth day after surgery and is often confused with an earache, headache, or pain from another tooth with no evidence of pathologic condition
Halitosis usually present
Alveolar osteitis clinical examination
extraction socket is partially or completely devoid of a clot or is often filled with debris and shows evidence of poor healing
Exposed bone is source of pain
Area of socket has a bad odor
NO USUAL SIGNS or symptoms of infection present
Alveolar osteitis incidence
0.3% - 26%
Occurs more frequently in the mandible
