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OS II > management impacted teeth pt 1 > Flashcards

management impacted teeth pt 1 Flashcards

1
Q

Impacted tooth

A

A tooth that fails to erupt into the dental arch within a specific
time frame

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2
Q

etiologies of impacted teeth

A
  • Inadequate arch length
  • Prolonged deciduous tooth retention
  • Malposition of Impacted tooth (most common)
  • Malposition of adjacent tooth/teeth
  • Excessive bone and/or soft tissue
  • Associated pathology
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3
Q

Impacted Teeth Order of Frequency

A
  • Mandibular third molars
  • Maxillary third molars
  • Maxillary canines
  • Mandibular premolars
  • Mandibular canines
  • Maxillary incisors
  • Supernumeraries
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4
Q

Classification of Impacted Teeth (Third Molars) categories

A
  • Degree of impaction (Depth in Bone)
  • Position of tooth (Long axis of tooth in Bone)
  • Pell and Gregory
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5
Q

Degree of Impaction - Depth in Bone classes

A
  • Erupted-normal levels of surrounding bone
  • Soft tissue impaction (7220- Procedure Code)
  • Partial bone impaction (7230- Procedure Code)
  • Complete bone impaction (7240- Procedure Code)
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6
Q
A

soft tissue impacted, clinical dx

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7
Q
A

partial bone impacted

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8
Q
A

complete bone impacted

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9
Q

Classification of Impacted Teeth (Third Molars)
Position of Tooth (long axis of the tooth in bone

A
  • Vertical – Most common in the maxilla
  • Mesioangular – Most common in the mandible
  • Horizontal
  • Distoangular
  • Inverted
  • Buccal/Palatal or Lingual
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10
Q

orientation

A

veritcal

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11
Q
A

mesioangular

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12
Q
A

horizontal

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13
Q
A

distoangular

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14
Q

Order of Frequency with reference to Position of Tooth
(long axis of the tooth in bone)
Mandibular Third Molar Impactions

A
  • Mesioangular MOST COMMON
  • Distoangular
  • Horizontal
  • Buccal/Lingual
  • Inverted
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15
Q

Order of Frequency with reference to Position of Tooth
(long axis of the tooth in bone)
Maxillary Third Molar Impactions

A
  • Vertical MOST COMMON
  • Distoangular
  • Mesioangular
  • Disto-horizontal
  • Mesio-horizontal
  • Buccal/Palata
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16
Q

Pell and Gregory Classifications

A
  • Class 1,2 or 3 – Relation of the Mandibular third molar to the anterior border of the ramus.
  • Class A, B, or C – Depth of the impaction of maxillary or
    mandibular 3rd molar in bone relative to the adjacent tooth
    (Maxillary or Mandibular 2nd Molar

Helpful in predicting surgical difficulty

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17
Q

Pell and Gregory - Class 1

A

Class 1 : Sufficient amount of space between the anterior border of ramus and the distal of the second molar for the accommodation of the entire crown (mesio-distal diameter) of the third molar

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18
Q

Pell and Gregory - Class 2

A

Pell and Gregory - Class 2
Class 2 - Space between the anterior border of ramus and the distal of
the second molar less than the mesio-distal diameter of the crown of the third molar

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19
Q

Pell and Gregory - Class 3

A

Class 3 - All of the third molar is within the ramus

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20
Q

Pell and Gregory - Class A (Maxilla)

A
  • The occlusal plane of the impacted tooth is at the same level as
    the adjacent tooth
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21
Q

Pell and Gregory - Class A Mandible

A
  • The occlusal plane of the impacted tooth is at the same level as
    the adjacent tooth
22
Q

Pell and Gregory - Class B (Maxilla)

A
  • The occlusal plane of the impacted tooth is between the occlusal
    plane and the cervical line of the adjacent tooth
23
Q

Pell and Gregory - Class B (Mandible)

A
  • The occlusal plane of the impacted tooth is between the occlusal
    plane and the cervical line of the adjacent tooth
24
Q

Pell and Gregory - Class C (Maxilla)

A
  • The occlusal plane of the impacted tooth is apical to the cervical
    line of the adjacent tooth
25
Q

Pell and Gregory - Class C (Mandible)

A
  • The occlusal plane of the impacted tooth is apical to the cervical
    line of the adjacent tooth.
26
Q

Management of Impacted Teeth
General Principles
* All impactions are potentially?
* Prudent care requires?
* In certain selected cases what can be appropriate
* Pathologic conditions are more common with ?

A
  • All impactions are potentially pathologic – PREVENTION.
  • Prudent care requires removal, exposure, or repositioning.
  • In certain selected cases, long term monitoring with necessary
    patient education is appropriate.
  • Pathologic conditions are more common with increasing age.
27
Q

General Principles
* Surgery is more difficult and associated with more complications
with?
* Surgery is more difficult if what is present?
* Surgery in younger patients (<25 years old) associated with?
* Third Molar Surgery performed ideally when roots are?

A
  • Surgery is more difficult and associated with more complications
    with increased age (oral and systemic compromises)
  • Surgery is more difficult if symptoms present (Acute pain and
    infection)
  • Surgery in younger patients (<25 years old) associated with better
    healing and less morbidity.
  • Third Molar Surgery performed ideally when roots are 1/2 to
    2/3rds formed
28
Q

Indications For Removal of Impacted Teeth
* Facilitate the management of or limit progression of?
* caries?
* pulp?
* infection?
* Preventive or prophylactic?
* Ectopic?

A

Indications For Removal of Impacted Teeth
* Facilitate the management of or limit progression of periodontal
disease
* Non-restorable caries
* Non-treatable pulpal lesions
* Acute or chronic infection (e.g., cellulitis, abscess, pericoronitis)
* Preventive or prophylactic removal
* Ectopic position

29
Q

Indications For Removal of Impacted Teeth
* Internal or external?
* prothesis?
* ortho?

A
  • Internal or external resorption of tooth of adjacent teeth
  • Facilitate prosthetic rehabilitation
  • Facilitate orthodontic movement and promote dental stability
  • Orthodontic abnormalities (e.g., arch length/tooth size
    discrepancies, malposed/impacted second molars
30
Q

Indications For Removal of Impacted Teeth
* Pathology?
* Tooth interfering with?
* Prophylactic removal?

A
  • Pathology associated with tooth follicle (e.g., cysts, tumors)
  • Tooth interfering with orthognathic, reconstructive surgery,
    trauma or tumor surgery
  • Prophylactic removal in patients with certain medical or surgical conditions or treatments (e.g. organ transplant, alloplastic implants, chemotherapy, radiation therapy)
31
Q

chronic recurrent pericoronitis

A

indication for removal

32
Q

damage to adj teeth

A

remove

33
Q

resorb adjacent root

A

fuck dat hoe

34
Q

Contraindications to the Removal of Impacted Teeth
* age?
* Medical conditions?
* Surgical morbidity?
* Good outcome with?

A
  • Extremes in age (e.g. 80 yr old patient with full bony impaction)
  • Medical condition (e.g. poor surgical candidate like patient on I.V Bisphosphonates, Head and Neck irradiation, significantly compromised cardiac status)
  • Surgical morbidity(e.g., neurosensory disturbance, fracture,
    injury to adjacent teeth or structures,etc.)
  • Good outcome with orthodontic eruption
35
Q

Evaluation of Impacted Teeth

A

The evaluation of the impacted tooth and diagnosis of associated problems are based on:
* History
* Clinical examination
* Radiography

36
Q

Evaluation of Impacted Teeth
History

A
  • Teeth with or without history of pain and swelling of overlying mucosa.
  • Inflammation around the crown of the tooth that make more acute symptoms (Pericoronitis).
  • Mouth opening
  • Airway Exam
  • TMJ Exam
37
Q

Pericoronitis - Diagnosis
\

A
  • lnfection of the soft tissue (operculum) around the crown of a
    partially impacted tooth
  • Caused by normal oral flora
  • Compromised host defenses
  • Trauma (occlusal)
  • Food entrapment
38
Q

Pericoronitis Treatment

A
  • Removal of offending tooth
  • Removal of opposing tooth
  • Irrigation/debridement
  • Removal of operculum
  • Incision and drainage of infection
  • Antibiotic therapy
39
Q

Impacted teeth
Clinical Examination

A
  • Identify caries and periodontal diseases (pain might be fromadjacent carious tooth, this would influence the proposed treatment planning)
  • Vitality test of all teeth in doubt.
  • Examination for sign of infection (swelling, discharge, trismus and enlarged lymph nodes)
  • Facial asymmetry and jaw bone expansion.
40
Q

Status of tooth in question based on clinical evaluation

A
  • Erupted but non-functional (no opposing, tilted, carious)
  • Partially erupted (covered partially with soft tissue)
  • Partially erupted with sign of recurrent infection
  • Truly impacted (bony or soft tissue)
  • Association with pathological lesio
41
Q

Radiographic Assessments

A

Radiographic Assessment
* Periapical radiograph
* Orthopantomogram (OPG) – Standard of care
* Cone Beam C.T.Scan

42
Q

Impacted teeth
Radiographic Examination
* To identify the impacted tooth and?
* To identify the position of? relative to?
* To disclose the degree and orientation of ?
* To examine the configuration of?
* To examine the existence of?

A
  • To identify the impacted tooth and the density of the surrounding
    bone.
  • To identify the position of the impacted tooth in the jaw and its
    relation to adjacent teeth and other vital structures (Maxillary
    Sinus, Inferior Alveolar Canal)
  • To disclose the degree and orientation of impaction.
  • To examine the configuration of the roots (curvature, numbers,
    hypercemntosis, bulbous, fused or diverged)
  • To examine the existence of pathological development around the impacted tooth
43
Q

Radiographic predictors of nerve injury

A

– Darkening of root
– Deflection of root
– Narrowing of root
– Interruption of the white line of the canal
– Diversion of the canal
– Narrowing of the canal

44
Q

how can CBCT be used

A

can trace the root, positioning of teeth/supernumeraries

45
Q
A

canal deviation

46
Q
A

narrowing of canal

47
Q
A

PA radiolucency

48
Q
A

root narrowing

49
Q
A

darkening of root

50
Q
A

root curve

51
Q
A

interruption of canal wall

OS II (14 decks)

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