EXAM II Management of Impacted Teeth Flashcards
as a general rule, all impacted teeth should be removed unless ___
removal is contraindicated
for mandibular third molars, sufficient space needs to exist between the ___ and the ___ to allow functional eruption of the third molar
anterior border of the ramus and the second molar
removal of impacted teeth becomes more difficult with ___
advancing age
what are indications for the removal of impacted teeth?
- 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
what are the symptoms of pericoronitis?
- local and facial swelling
- pain
- limitation of opening
what is the treatment for pericoronitis?
- antibiotics: penicillin or cleocin
- warm salt water rinses and irrigation
- extraction of 3rd molar after infection is resolved
in cases of pericoronitis, when should you refer to the oral surgeon?
- 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
what are the contraindications for removal of impacted teeth?
- extremes of age
- compromised medical status
- probable excessive damage to adjacent structures
in patients at extremes of age who require the extraction of an impacted tooth, what should you do?
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
what are the angulation classifications for mandibular third molar impactions?
- mesioangular impaction - usually in proximity to the second molar
___ impaction is the most common and easiest impaction to remove
mesioangular
what is the angular classification?
mesioangular impaction
___ classifications describe the relationship of an impacted tooth to the anterior border of the ramus, as well as the depth of the tooth
pell and gregory classification
what is the pell and gregory classification?
class 1
the mandibular third molar has sufficient anteroposterior room to erupt
what is the pell and gregory classification?
class 2
approximately half is covered by the anteiror portion of the ramus of the mandible
what is the pell and gregory classification?
class A
the occlusal plane of the impacted tooth is at the same level as the occlusal plane of the second molar
what is the pell and gregory classification?
class B
the occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the second molar
what is the pell and gregory classification?
class C
the impacted tooth is below the cervical line of the second molar
which classification sequence describes the easiest type of impaction to remove?
mesioangular impaction with class 1 ramus relationship and class A depth
what is the classification?
impaction with distoangular, class 3 ramus relationship and class C depth
this is extremely difficult to remove safely
what angular position makes impaction surgery less difficult?
mesioangular
what pell and gregory classification that makes impaction surgery less difficult?
class 1 ramus, class A depth
with respect to roots, what makes impaction surgery less difficult?
- roots that are 1/3 to 2/3 formed
- fused conical roots
with respect to the PDL, what makes impaction surgery less difficult?
wide PDL
with respect to bone, what makes impaction surgery less difficult?
elastic bone
with respect to the 2nd molar, what makes 3rd molar impaction surgery less difficult?
3rd molar is separated from 2nd molar
with respect to the inferior alveolar nerve, what makes impaction surgery less difficult?
3rd molar separated from IAN
with respect to soft tissues, what makes impaction surgery less difficult?
if it is a soft tissue impaction, it makes surgery less difficult
with respect to age, what makes impaction surgery less difficult?
young patient
with respect to angular position, what makes impaction surgery more difficult?
distoangular position
what pell and gregory classifications make impaction surgery more difficult?
class 2-3 ramus, B-C depth
with respect to the roots, what makes impaction surgery more difficult?
- long, thin roots
- divergent curved roots
with respect to the PDL, what makes impaction surgery more difficult?
narrow PDL
with respect to bone, what makes impaction surgery more difficult?
dense, inelastic bone
with respect to the 2nd molar, what makes 3rd molar impaction surgery more difficult?
contact with the 2nd molar
with respect to the inferior alveolar nerve, what makes impaction surgery more difficult?
close to IAN
with respect to the patient age, what makes impaction surgery more difficult?
older patient
what are 7 radiographic signs associated with inreased risk of IAN injury?
- darkening of the root
- deflection of the root
- narrowing of the root
- dark and bifid apex of root
- interruption of white line of canal
- diversion of canal
- narrowing of canal
what type of imaging is effective in assessing the reslationship between a 3rd molar and the IAN?
CT imaging (3D)
in order from most to least common, what are the angular impactions of maxillary 3rd molars?
- vertical impaction (most common)
- distoangular impaction
- mesioangular impaction (least common)
