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Oral Surgery III > Management of Impacted Teeth > Flashcards

Management of Impacted Teeth Flashcards

1
Q

what is an impacted tooth

A

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

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2
Q

what is the etiology of impacted teeth

A
  • inadequate arch length
  • prolonged deciduous tooth retention
  • malposition of impacted tooth
  • malposition of adjacent tooth/teeth
  • excessive bone and/or soft tissue
  • associated pathology
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3
Q

what is the order of frequency of impacted teeth

A
  • mandibular third molars
  • maxillary third molars
  • maxillary canines
  • mandibular premolars
  • mandibular canines
  • maxillary incisors
  • supernumeraries
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4
Q

what are the classification of impacted teeth

A
  • degree of impacted (depth in bone)
  • position of tooth (long axis of tooth in bone)
  • pell and gregory
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5
Q

what are the classifications of impacted teeth - degree of impaction- depth in bone

A
  • erupted- normal levels of surrounding bone
  • soft tissue impaction
  • partial bone impaction
  • complete bone impaction
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6
Q

what are the classifications of impacted teeth - position of tooth

A
  • vertical
  • mesioangular
  • horizontal
  • distoangular
  • inverted
  • buccal/palatal or lingual
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7
Q

what type of position of tooth (long axis of tooth in bone) is most common in the maxilla

A

vertical

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8
Q

what type of position of tooth (long axis of the tooth in bone) is most common in the mandible

A

mesioangular

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9
Q

what is class 1 pell and gregory

A

-sufficient amount of space between the anterior border of the ramus and the distal of the second molar for the accomodation of the entire crown (mesio-distal diameter) of the third molar
- situated anterior to the anterior border of the ramus and there is adequate room to erupt

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10
Q

what is the order of frequency with reference to position of tooth - long axis of the tooth in bone in the mandible

A
  • mesioangular
  • vertical
  • distoangular
  • horizontal
  • buccal/lingual
  • inverted
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11
Q

is the pell and gregory classification commonly used

A

no

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12
Q

what is class 1,2,3 in pell and gregory classification

A

relation of the mandibular third molar to the anterior border of the ramus

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13
Q

what is class A,B, C in pell and gregory classification

A

depth of the impaction of maxillary or mandibular 3rd molar in bone relative to the adjacent tooth

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14
Q

what is pell and gregory class 2

A
  • 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
  • crown 1/2 covered by the anterior border of the ramus
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15
Q

what is the order of frequency with reference to position of tooth in the maxilla

A
  • vertical
  • distoangular
  • mesioangular
  • disto horizontal
  • mesio horizontal
  • buccal/palatal
  • inverted
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16
Q

what is pell and gregory class 3

A
  • all of the third molar is within the ramus
  • crown fully covered by the anterior border of the ramus
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17
Q

what is pell and gregory class A and where is it located

A

the occlusal plane of the impacted tooth is at the same level as the adjacent tooth
- maxilla

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18
Q

what is pell and gregory class B and where is it

A
  • the occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the adjacent tooth
  • mandible and maxilla
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19
Q

what is pell and gregory class 3 and where is it

A
  • the occlusal plane of the impacted tooth is apical to the cervical line of the adjacent tooth
  • mandible and maxilla
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20
Q

all impactions are potentially_____so _____ is important

A

pathologic, prevention

21
Q

prudent care requires:

A

removal, exposure, or repositioning

22
Q

pathologic conditions are more common with:

A

increasing age

23
Q

surgery is more difficult and associated with more complications with:

A

increased age and oral and systemic compromises

24
Q

surgery is more difficult if _____ such as ______

A

symptoms present, acute pain and infectionsu

25
Q

surgery in younger patients is associated with:

A

better healing and less morbidity

26
Q

what age is considered a young patient

A

less than 25 years old

27
Q

when is third molar surgery ideally performed

A

when roots are 1/2 to 2/3rds formed

28
Q

what are the indications for removal of impacted teeth

A
  • facilitate the management of or limit progression of periodontal disease
  • non-restorable caries
  • non-treatable pulpal lesions
  • acute or chronic infection
  • preventive or prophylactic removal
  • ectopic position
  • internal or external resorption of tooth of adjacent tooth
  • facilitate prosthetic rehabilitation
  • facilitate orthodontic movement and promote dental stability
  • orthodontic abnormalities
  • pathology associated with tooth follicle
  • tooth interfering with orthognathic, reconstructive surgery, trauma or tumor surgery
  • prophylactic removal in patients with certain medical or surgical conditions or treatments
29
Q

what are examples of orthodontic abnormalities

A
  • arch length/tooth size discrepancies
  • malposed/impacted second molars
30
Q

what are examples of indications for prophylactic removal in patients with certain medical or surgical conditions or treatments

A
  • organ transplant
  • alloplastic implants
  • chemotherapy
  • radiation therapy
31
Q

what are the contraindications for removal of impacted teeth

A
  • extremes in age
  • medical condition
  • surgical morbidity
  • good outcome with orthodontic eruption
32
Q

what are examples of medical conditions that would be contraindications to removal of impacted teeth

A
  • poor surgical candidate like patient on IV bisphosphonates
  • head and neck irradiation
  • significantly compromised cardiac status
33
Q

what are examples of surgical morbidities that would be contraindications to removal of impacted teeth

A

good outcome with orthodontic eruption

34
Q

the evaluation of the impacted tooth and diagnosis of associated problems are based on:

A
  • history
  • clinical exam
  • radigoraphy
35
Q

what history should be evaluated in impacted teeth

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
  • mouth opening
  • airway exam
  • TMJ exam
36
Q

what is pericoronitis and what can it be caused by

A
  • infection 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
37
Q

what are the treatments for pericoronitis

A
  • removal of offending tooth
  • removal of opposing tooth
  • irrigation/debridement
  • removal of operculum
  • incision and drainage of infection
  • antibiotic therapy
38
Q

what needs to be examined in the clinical exam for impacted teeth

A
  • identify caries and periodontal diseases
  • vitality test of all teeth in doubt
  • examination for sign of infection
  • facial asymmetry and jaw bone expansion
39
Q

why is it important to identify caries and periodontal disease in impacted teeth

A

pain might be from adjacent carious tooth

40
Q

what are the signs of infection

A

swelling, discharge, trismus, and enlarged lymph nodes

41
Q

what are the possible statuses of tooth in question based on clinical eval

A
  • erupted but non functional (no opposing, tilted, carious)
  • partially erupted (Covered partially with soft tissue)
  • partially erupted with signs of recurrent infection
  • truly impacted (bony or soft)
  • association with pathological lesions
42
Q

what needs to be done in radiographic assessment

A
  • PA radiograph
  • orthopantomogram
  • CBCT
43
Q

what is the radiographic assessment standard of care

A

orthopantomogram (OPG)

44
Q

what are the purposes of radiographic examination

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
  • to disclose the degree and orientation of impaction
  • to examine the configuration of the roots
  • to examine the existence of pathological development around the impacted teeth
45
Q

what are the possible configurations of the rooths

A
  • curvature
  • numbers
  • hypercementosis
  • bulbous
    -fused or diverged
46
Q

what are the vital structures to be concerned with

A

maxillary sinus and inferior alveolar canal

47
Q

what are the radiogrpahic predictors of nerve injury

A
  • darkening of root
  • deflection of root
  • narrowing of root
  • interruption of the white line of the canal
  • diverserion of the canal
  • narrowing of the canal
48
Q

what are the radiographic signs of increased risk of inferior alveolar nerve injury

A
  • deviation of the canal
  • narrowing of the canal
  • PA radiolucent area
  • narrowing of root
  • darkening of roots
  • curving of root
  • interruption of the white line of the canal- loss of lamina dura of canal
49
Q

what can CBCT identify

A
  • number, location, relative position
  • cystic degeneration
  • effect on adjacent teeth, nerve, sinus floor

Oral Surgery III (6 decks)

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