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Oral Surgery > Exam 1 - Removal of impacted Teeth 1 and 2 > Flashcards

Exam 1 - Removal of impacted Teeth 1 and 2 Flashcards

1
Q

Impacted teeth definition

A

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.

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2
Q

Top 3 incidence of impacted teeth

A
  1. Maxillary and Mand 3rd molars
  2. Max canines are next most comon
  3. Mandibular premolars
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3
Q

Why Maxillary canine

A

erupts after the max lateral incisor and after the max first olar

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4
Q

Why mand premolars

A

erupts after the mand 1st molar and after the mandibular canine

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5
Q

Should all impacted teeth be removed?

A

yes unless it is contraindicated

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6
Q

Normal development for the lower 3rd molar?

A

Begins in a horizontal angulation that changes to mesioangular and then to vertical

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7
Q

ideal time for removal of 3rd molars?

A

when roots of teeth are at least 1/3rd formed but before they are 2/3rd

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8
Q

Indications for removal of impacted teeth

A

prevention of

  1. periodontal disease
  2. dental caries
  3. periocornitis
  4. root resorption
  5. impacted teeth under a dental prosthesis
  6. prevention of cysts
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9
Q

The retention of third molars is associated with increased risk of second molar pathology in middle-aged and older adult men

A

true

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10
Q

What is pericornitis

A

infection of the soft tissue around the crown of a tooth.

Caused by normal oral flora

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11
Q

What is pericornitis caused by:

A

streptococci and anaerobic bacteria

Mild tx is irrigation
Moderate Tx is abx
Severe would be hospital admit/referral

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12
Q

Do we need to remove the offending mandibular third molar once the infection has resolved?

A

YES

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13
Q

Diagnosis of a dentigerous cyst

A

if follicular space around the crown of a tooth is greater than 3mm

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14
Q

Most common odontogenic tumor in the third molar region

A

Ameloblastoma

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15
Q

Contraindications to taking out 3rd molars

A
  1. Age > 40
  2. Medical Status
  3. Probable damage to adjacent structures
  4. long standing asymptomatic impacted tooth
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16
Q

Classification of Impacted teeth: Angulation

A
  1. Mesioangular
  2. Horizontal
  3. Vertical
  4. Distoangular
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17
Q

Mesioangular impaction

A

least difficult to remove in mandible
tilted toward the second molar in a MESIAL direction
43% of all impacted mandibular third molars

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18
Q

Horizontal angulation

A

Approx. 3% of mandibular impaction

second most easiest to remove on mandible

19
Q

Vertical Angulation

A

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

20
Q

Distoangular

A

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

21
Q

Classification of impacted teeth (Pell and Gregory)

A
  1. Relationship to the anterior border of the ramus (1,2, and 3)
  2. Relationship to the occlusal plane (A, B and C)
22
Q

Classification 1

A

The mesiodistal diameter of the crown is completely anterior to the anterior border of the ramus

23
Q

Classification 2

A

Approximately half of the crown is covered by the anterior border of the ramus

24
Q

Classification 3

A

The crown is covered entirely by the anterior border of the ramus

25
Q

Classification A

A

The occlusal plane of the impacted tooth is at the same level as the occlusal plane of the second molar

26
Q

Classification B

A

The occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the second molar

27
Q

Classification C

A

The occlusal plane of the impacted tooth is below the cervical line of the second molar

28
Q

Classifications can be combinations

A

ex. Distoangular, Class 3, C

29
Q

Classification

-Nature of overlying tissue

A 
Soft tissue
-Full
-Partial
Bone
-Full
-Partial
30
Q

Root Morphology

A 
Length
Single or fused
curvature
width
PDL space
31
Q

Density of surrounding bone is:

A

Age dependent
young (18) - less dense
Older >35 - more dense

32
Q

Maxillary Classification

A

Vertical (63%)
Distoangular (25%)
Mesioangular (12%)

PG classification
A, B, and C

33
Q

What makes impaction surgery less difficult

A
  • 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
34
Q

What makes impaction surgery more difficult

A
  • 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
35
Q

Is increased age associated with a higher complication rate for M3 extractions?

A

Yes, age >25

36
Q

What about impacted max. Canine?

A

May expose and ligate tooth and through ortho can aid in eruption of the tooth

37
Q

Impacted Maxillary Teeth

A

Rarely section
Mostly bone removal
Concern with max sinus
Do not use chisel to section a maxillary tooth

38
Q

Perioperative patient management

A 
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
39
Q

What is normal postoperative experience?

A

Swelling
Discomfort
Mild/moderate trismus
All of symptoms are less intense in a young, healthy patient

40
Q

Can routine use of CT for extraction of third molars be recommended? LISTEN TO LECTURE AT THIS SLIDE 41

A

NO, data obtained form the CT had MINIMAL effect on surgical outcome

41
Q

Can cone-beam technology improve presurgical planning?

A

Yes

42
Q

Alveolar Osteitis

A

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

43
Q

Alveolar osteitis clinical examination

A

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

44
Q

Alveolar osteitis incidence

A

0.3% - 26%

Occurs more frequently in the mandible

Oral Surgery (7 decks)

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