EXAM II Management of Impacted Teeth

Question 1

as a general rule, all impacted teeth should be removed unless ___

Answer 1

removal is contraindicated

Question 2

for mandibular third molars, sufficient space needs to exist between the ___ and the ___ to allow functional eruption of the third molar

Answer 2

anterior border of the ramus and the second molar

Question 3

removal of impacted teeth becomes more difficult with ___

Answer 3

advancing age

Question 4

what are indications for the removal of impacted teeth?

Answer 4

• prevention of periodontal disease
• prevention of dental caries
• prevention of pericoronitis
• prevention of root resorption
• impacted teeth under dental prosthesis
• prevention of odontogenic cysts
• treatment of pain of unexplained origin
• prevention of jaw fractures
• facilitation of orthodontic treatment

Question 5

what are the symptoms of pericoronitis?

Answer 5

• local and facial swelling
• pain
• limitation of opening

Question 6

what is the treatment for pericoronitis?

Answer 6

• antibiotics: penicillin or cleocin
• warm salt water rinses and irrigation
• extraction of 3rd molar after infection is resolved

Question 7

in cases of pericoronitis, when should you refer to the oral surgeon?

Answer 7

• trismus with opening less than 20mm
• increased swelling and/or pain
• temp greater than 101 degrees F
• pt not responding to conservative measures and is getting sicker

Question 8

what are the contraindications for removal of impacted teeth?

Answer 8

• extremes of age
• compromised medical status
• probable excessive damage to adjacent structures

Question 9

in patients at extremes of age who require the extraction of an impacted tooth, what should you do?

Answer 9

it is contraindicated in these patients, but you should actively observe the tooth in question and perform a radiographic check every one to two years

Question 10

what are the angulation classifications for mandibular third molar impactions?

Answer 10

• mesioangular impaction - usually in proximity to the second molar

Question 11

___ impaction is the most common and easiest impaction to remove

Answer 11

mesioangular

Question 12

what is the angular classification?

Answer 12

mesioangular impaction

Question 13

___ classifications describe the relationship of an impacted tooth to the anterior border of the ramus, as well as the depth of the tooth

Answer 13

pell and gregory classification

Question 14

what is the pell and gregory classification?

Answer 14

class 1

the mandibular third molar has sufficient anteroposterior room to erupt

Question 15

what is the pell and gregory classification?

Answer 15

class 2

approximately half is covered by the anteiror portion of the ramus of the mandible

Question 16

what is the pell and gregory classification?

Answer 16

class A

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

Question 17

what is the pell and gregory classification?

Answer 17

class B

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

Question 18

what is the pell and gregory classification?

Answer 18

class C

the impacted tooth is below the cervical line of the second molar

Question 19

which classification sequence describes the easiest type of impaction to remove?

Answer 19

mesioangular impaction with class 1 ramus relationship and class A depth

Question 20

what is the classification?

Answer 20

impaction with distoangular, class 3 ramus relationship and class C depth

this is extremely difficult to remove safely

Question 21

what angular position makes impaction surgery less difficult?

Answer 21

mesioangular

Question 22

what pell and gregory classification that makes impaction surgery less difficult?

Answer 22

class 1 ramus, class A depth

Question 23

with respect to roots, what makes impaction surgery less difficult?

Answer 23

• roots that are 1/3 to 2/3 formed
• fused conical roots

Question 24

with respect to the PDL, what makes impaction surgery less difficult?

Answer 24

wide PDL

Question 25

with respect to bone, what makes impaction surgery less difficult?

Answer 25

elastic bone

Question 26

with respect to the 2nd molar, what makes 3rd molar impaction surgery less difficult?

Answer 26

3rd molar is separated from 2nd molar

Question 27

with respect to the inferior alveolar nerve, what makes impaction surgery less difficult?

Answer 27

3rd molar separated from IAN

Question 28

with respect to soft tissues, what makes impaction surgery less difficult?

Answer 28

if it is a soft tissue impaction, it makes surgery less difficult

Question 29

with respect to age, what makes impaction surgery less difficult?

Answer 29

young patient

Question 30

with respect to angular position, what makes impaction surgery more difficult?

Answer 30

distoangular position

Question 31

what pell and gregory classifications make impaction surgery more difficult?

Answer 31

class 2-3 ramus, B-C depth

Question 32

with respect to the roots, what makes impaction surgery more difficult?

Answer 32

• long, thin roots
• divergent curved roots

Question 33

with respect to the PDL, what makes impaction surgery more difficult?

Answer 33

narrow PDL

Question 34

with respect to bone, what makes impaction surgery more difficult?

Answer 34

dense, inelastic bone

Question 35

with respect to the 2nd molar, what makes 3rd molar impaction surgery more difficult?

Answer 35

contact with the 2nd molar

Question 36

with respect to the inferior alveolar nerve, what makes impaction surgery more difficult?

Answer 36

close to IAN

Question 37

with respect to the patient age, what makes impaction surgery more difficult?

Answer 37

older patient

Question 38

what are 7 radiographic signs associated with inreased risk of IAN injury?

Answer 38

1. darkening of the root
2. deflection of the root
3. narrowing of the root
4. dark and bifid apex of root
5. interruption of white line of canal
6. diversion of canal
7. narrowing of canal

Question 39

what type of imaging is effective in assessing the reslationship between a 3rd molar and the IAN?

Answer 39

CT imaging (3D)

Question 40

in order from most to least common, what are the angular impactions of maxillary 3rd molars?

Answer 40

• vertical impaction (most common)
• distoangular impaction
• mesioangular impaction (least common)