Impacted Teeth Flashcards
This is the failure of the tooth to fully erupt within the expected developmental time period
impacted tooth
This is when the tooth has not perforated the oral mucosa
unerupted tooth
True or False
Not all unerupted teeth are impacted
True
What is the age of 3rd molar crown formation
14 years
What is the age of 3rd molar root formation
approximately 50% by 16 years
What is the average age of formation of 3rds
20 years and as late as 24
Position of 3rd does not change substantially after what age
25
What are the four theories of impacted 3rds
differential root growth between mesial and distal
inadequate arch space
dental development lags skeletal development
obstruction secondary to cyst, tumor, supernumeray teeth
This winters classification of mandibular 3rd contains 43% of cases and are generally the easiest to extract
mesioangular
This winters classification of mandibular 3rds contains 6% of cases and are the most difficult to extract
distoangular
This winters classification of mandibular 3rds contains 3% of case and are difficult to extract
horizontal
This winters classification of mandibular 3rds contains 38% of cases and are generally easy to extract
vertical
This winters classification of maxillary 3rd is 63% of cases
vertical
This winters classification of maxillary 3rds is 25% of cases
distoangular
This winters classification of maxillary 3rds is 12% of cases
mesioangular
This winters classification of maxillary 3rds is rarely seen (<1%)
horizontal
What are the three different codings regarding the removal of 3rds
soft tissue
partial bony
full bony impaction
What are four things to consider regarding the roots when extracting 3rds
length
fused vs. separate and distinct
curvature
PDL space
An increase of this facilitates delivery
follicle size
What are 5 considerations before extracting 3rds
acute infection history of pericornitis ANUG herpes labialis sinusitis
What are 5 tolerance factors regarding the patient to be taken into consideration
age psychological factors prior experiences difficulty of impaction degree of opening (ROM)
This indication for removal is to treat a currently active process/disease
therapeutic
This indication for removal is to prevent future disease or other problems
prophylactic
What are some therapeutic indications for removal
pericoronitis caries pathological resorption pathology eruption pain crowding post-orthodontics orthognathic surgery in the line of a mandible fracture periodontal disease lack of attached gingiva crowding
What four things are important to document when removing 3rd
probing depths
detailed clinical and radiographic findings
patient education
CONSENT
What is the idea patient for 3rds removal
2/3rd of root formation 18-25 year old healthy no psychological contraindications no job restriction to "numb lip"
What are the age contraindications of 3rd molars
young age; mandible may grow to accommodate 3rds
old age; most common contraindications for removal
What is it about “old age (>40) bone” that is contraindicative for 3rds removal
highly calcified bone
less flexible bone
recuperate more slowly
There is an increased tendency towards these regarding 3rd removal in old age
increased tendency toward mandibular fractures
increased tendency toward non-resolving fracture
increased tendency toward infection - osteomyelitis
How should you monitor an old age patient regarding extractions
with a panoramic x-ray every 1-2 years
How much overlying bone would be a contraindication for removal in >40 years
4mm
This is a major contraindication for 3rds removal
compromised medical status
What are four adjacent anatomic structures that could be damaged from removal of 3rds
IAN
adjacent teeth/restorations
periodontal injury to adjacent teeth
sinus communication
What four things make up the assessment and planning of the patient initial exam
document the video watched
document all risks, benefits, and indications
questions answered
NPO and anesthesia plan reviewed
What anesthesia is typically used for extractions
2% lidocaine with 1:100k epi
0.5% maracaine with 1:200k epi
V2 and V3 blocks
long buccal
What is the incision/flap design for maxillary 3rds
crestal incision - sulcular
1-2 adjacent
What is the addition to the incision/flap design for really highly impacted maxillary 3rds
vertical release
What four things are important regarding the “socket toilet”
remove follicle
gentle curette of socket
irrigate with copious amounts of saline
don’t drown the patient
If there is no path of withdrawal when removing roots, do this
remove more bone or section the tooth
What could be done to ensure that all of the tooth structures have been extracted
“puzzle” them back together
If you hear this, its indicative of a root that has failed until proved otherwise
a snap or crack
This is your responsibility upon finishing the extraction
inspect and verify no debris have been retained in the socket or under the flap; smooth any prominent, rough, or unsupported areas of bone
What are the four characteristics of suturing
use 3-0 chromic
keep it simple
not too many - many lead to excessive swelling
reapproximate passively with minimal tension
This tooth is also typically impacted due to crowding from adjacent teeth and difficult route to erupt
maxillary canine
It is important to know this about an impacted maxillary canine
whether it is located buccal or palatal
What type of incision is used for maxillary canine impacted extraction
sulcular
What is an open flap design involving the maxillary canine
apically repositioned flap
best for labial impacted teeth
do not remove bone beyond the CEJ
In an open flap, the flap is sutured apically to allow what
the attached tissue to erupt with the crown of tooth
What is a closed flap design involving maxillary canine
full thickness flap
best for palatal impacted teeth
do not remove bone beyond CEJ
suture flap over tooth
