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OSOMOP > Impacted Teeth > Flashcards

Impacted Teeth Flashcards

1
Q

What are 2 common types of impacted teeth?

A
  1. Mandibular 3rd molars

2. Maxillary canines

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2
Q

Describe a possible history during the clinical assessment of a patient with impacted mandibular 3rd molars

A
  • Pain / Swelling
  • Bad taste
  • Number of episodes
  • Severity of the pain
  • Antibiotic treatment
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3
Q

Describe 3 clinical issues in the mouth which impacted mandibular 3rd molars do not cause

A
  1. Facial pain
  2. Lower incisor crowding
  3. Movement of other teeth
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4
Q

Describe the intra oral examination for a suspected impacted mandibular 3rd molar

A
  • Access to the impacted tooth
  • Degree of eruption if any
  • Decay in the impacted tooth or adjacent 7
  • Any evidence of food packing
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5
Q

Describe the radiological assessment of an impacted mandibular 3rd molars

A
  • IOPA usually not sufficient to show inferior boarder of mandible
  • OPT is most commonly used
  • CBCT use where increased risk or surgical difficulty as precise interpretation of relationship between tooth and IDN
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6
Q

What are essential components of the radiological assessment of impacted mandibular 3rd molars?

A

Allow assessment of:

  • all of third molar
  • type and orientation of impaction
  • crown size and condition
  • root morphology
  • bone level / periodontal status
  • relationship between ID canal and lower boarder of mandible
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7
Q

Name 2 types of impaction of impacted mandibular 3rd molars

A
  1. Soft tissue

2. Boney

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8
Q

Describe 4 types of boney impaction of mandibular 3rd molars

A
  1. Mesioangular (crown towards 7 and roots distal)
  2. Distoangular (crown towards ramus of mandible and roots mesial)
  3. Vertical
  4. Horizontal
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9
Q

What are Winters Lines (WAR Lines) used for?

A

Imaginary lines on a radiographs used to estimate depth and angle of impaction

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10
Q

What 3 lines make up Winters Lines?

A
  1. White line
  2. Amber line
  3. Red line
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11
Q

Describe the white line in Winters Lines

A
  • Drawn along the occlusal surface or erupted mandibular molars
  • Extended over the 3rd molar posteriorly
  • Indicates difference in occlusal level of 1st + 2nd molars and third molar
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12
Q

Describe the amber line in Winters Lines

A
  • Drawn from the surface of the bone on distal aspect of 3rd molar to crest of interdental septum between 1st and 2nd molar
  • Denotes margin of alveolar bone covering 3rd molar and gives indication of amount of bone which will need removed
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13
Q

Describe the red line in Winters Lines

A
  • Imaginary line drawn perpendicular from amber line to point of application
  • Usually cemento-enamel junction on the mesial aspect of the tooth
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14
Q

Which type of boney impaction tends to be the hardest to extract?

A

Distoangular as the path of withdrawal for these teeth tends to be straight into the angle of the mandible

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15
Q

What are 4 signs that the IDN is in close proximity to the tooth?

A
  1. Deviation of the nerve canal
  2. Narrowing of the nerve canal
  3. Loss of tram lines
  4. Change in radiodensity of the tooth
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16
Q

Describe perforation of the tooth by IDN

A
  • Uncommon
  • Difficult to tell from an OPT if this is the case
  • Need to obtain CBCT to verify perforation
  • Difficult to extract the tooth if perforation occurs
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16
Q

Describe perforation of the tooth by IDN

A
  • Uncommon
  • Difficult to tell from an OPT if this is the case
  • Need to obtain CBCT to verify perforation
  • Difficult to extract the tooth if perforation occurs
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17
Q

Describe the treatment options for impacted mandibular 3rd molars

A
  1. Surgical removal
  2. Coronectomy
  3. Operculectomy
  4. Remove opposing tooth
  5. Surgical exposure
  6. Monitor
18
Q

Describe coronectomy as a treatment option for impacted mandibular 3rd molars

A
  • Reserved for teeth which are bigger risk
  • Remove the crown of the tooth and leave the roots
  • Risk of infection especially if the roots are mobile
19
Q

Describe operculectomy as a treatment option for impacted mandibular 3rd molars

A
  • Flap of the gum is removed from over the tooth

- Not carried out often as does not work particularly well

20
Q

Describe removal of the opposing tooth as a treatment option for impacted mandibular 3rd molars

A
  • Encourage lower wisdom tooth to erupt further

- Less risks associated with the upper wisdom tooth extraction

21
Q

Describe surgical exposure as a treatment option for impacted mandibular 3rd molars

A

Not very commonly carried out for a wisdom tooth

22
Q

Describe 6 indications not to remove an impacted mandibular 3rd molar

A
  1. No / minimal symptoms
  2. Lower incisor crowding
  3. Treatment for TMD
  4. Contralateral tooth removal
  5. Patient wishes
  6. Close proximity to IDN
23
Q

Describe 7 indications for removal of impacted mandibular 3rd molar

A
  1. Pericoronitis (2 or more episodes)
  2. Unrestorable caries
  3. Non-treatable pulpal or periapical disease
  4. Fracture of tooth
  5. Disease of follicle e.g. cyst / tumour
  6. Tooth impeding surgery
  7. Resorption of tooth or adjacent tooth
24
Q

Describe extraction of impacted mandibular 3rd molar with regards to proximity to IDN

A
  • Does not preclude surgery
  • Indications for surgery must be clear
  • Appropriate imaging (CBCT if indicated)
  • Discuss all option and implications with patient
  • Informed consent
25
Q

Describe the risk assessment of surgical extraction of impacted mandibular 3rd molar

A
  • Balance risks v benefit to patient
  • Is the treatment required?
  • Are there risks involved in leaving the tooth?
  • Can the patient tolerate the procedure?
  • Have I the relevant expertise to carry out the procedure?
26
Q

Describe informed consent with regards to surgical extraction of impacted mandibular 3rd molar

A
  • Written informed consent must be obtained
  • Risks of surgery and leaving tooth in situ
  • General surgical risks
  • Specify risks to ID and lingual nerves
  • Cooling off period following explanation
  • Written advice sheets reinforcing verbal discussion
27
Q

What is the acronym for describing risks with regards to impacted mandibular 3rd molar?

A

STALL

  • Swelling
  • Trismus
  • Anaesthesia
  • Labial
  • Lingual
28
Q

Where are most ectopic canines found?

A

80% of impacted canines are found in the palate

29
Q

Describe the clinical assessment of ectopic canines

A
  • Aim to assess position of tooth and damage to adjacent ones
  • Bulge palpable buccally or labially
  • Proclination of upper incisors
  • Vitality of upper lateral incisors
  • Mobility of lateral upper incisors
  • Retention / mobility of deciduous canines
30
Q

What is the parallax technique?

A
  • 2 radiographs taken at different angles
  • Canine position relative to other teeth compared on both films
  • If tooth moves in same direction of beam it is palatally ectopic
  • If tooth moves in opposite direction of beam it is labially ectopic
31
Q

What 3 pairs of radiographs can be taken to parallax?

A
  1. IOPAs x2
  2. IOPA and Anterior Occlusal
  3. OPT and Anterior Occlusal
32
Q

Describe 4 treatment options for ectopic maxillary canines

A
  1. Leave and monitor
  2. Open exposure
  3. Closed exposure with bracket and chain
  4. Surgical removal
33
Q

What are the 2 main risks of ectopic maxillary canines?

A
  1. Movement in the maxilla can destroy other teeth, however risk drops off after around 14 years old
  2. Any unerupted tooth can form cysts
34
Q

What are the risks of extraction of ectopic canines?

A
  • General risks, (post-op pain, bleeding, swelling)

- Risk of damage to surrounding teeth

35
Q

Describe open exposure as a treatment option for ectopic maxillary canines

A
  • Gum has been peeled back and tooth uncovered
  • Cut taken out of the gum overlying the tooth
  • Palatal flap put back into place
  • Put bandage over the teeth to prevent gingiva overgrowing the tooth
36
Q

Describe closed exposure as a treatment option for ectopic maxillary canines

A
  • Flap lifted up overlying the tooth and gold chain and orthodontic bracket attached to tooth
  • Eventually attached to orthodontic brace
  • Main risk is chain falling off which means replacement procedure
  • Aesthetic purposes usually the reason for closed exposure
37
Q

Describe 2 risks of no surgery on ectopic maxillary canines

A
  1. Root resorption

2. Cyst formation

38
Q

Describe 2 risks of exposure on ectopic maxillary canines

A
  1. Failure of eruption
  2. Small risk of damage to adjacent teeth
  3. Gold chain risk of debond and repeat surgery
39
Q

Describe the main risk of removal of ectopic maxillary canines

A

Damage to adjacent teeth

40
Q

Name 3 examples of impacted teeth which are not mandibular 3rd molars or maxillary canines

A
  1. Mesiodens
  2. Supernumaries
  3. Lower canines
41
Q

How is an impacted tooth defined?

A

Any tooth with 2/3 or more root formed that is unlikely to erupt

42
Q

What is a mesioden?

A

A supernumerary tooth which grows between the upper central incisors

OSOMOP (14 decks)

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