Management of Impacted Teeth Flashcards
what is an impacted tooth
a tooth that fails to erupt into the dental arch within a specific time frame
what is the etiology of impacted teeth
- inadequate arch length
- prolonged deciduous tooth retention
- malposition of impacted tooth
- malposition of adjacent tooth/teeth
- excessive bone and/or soft tissue
- associated pathology
what is the order of frequency of impacted teeth
- mandibular third molars
- maxillary third molars
- maxillary canines
- mandibular premolars
- mandibular canines
- maxillary incisors
- supernumeraries
what are the classification of impacted teeth
- degree of impacted (depth in bone)
- position of tooth (long axis of tooth in bone)
- pell and gregory
what are the classifications of impacted teeth - degree of impaction- depth in bone
- erupted- normal levels of surrounding bone
- soft tissue impaction
- partial bone impaction
- complete bone impaction
what are the classifications of impacted teeth - position of tooth
- vertical
- mesioangular
- horizontal
- distoangular
- inverted
- buccal/palatal or lingual
what type of position of tooth (long axis of tooth in bone) is most common in the maxilla
vertical
what type of position of tooth (long axis of the tooth in bone) is most common in the mandible
mesioangular
what is class 1 pell and gregory
-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
what is the order of frequency with reference to position of tooth - long axis of the tooth in bone in the mandible
- mesioangular
- vertical
- distoangular
- horizontal
- buccal/lingual
- inverted
is the pell and gregory classification commonly used
no
what is class 1,2,3 in pell and gregory classification
relation of the mandibular third molar to the anterior border of the ramus
what is class A,B, C in pell and gregory classification
depth of the impaction of maxillary or mandibular 3rd molar in bone relative to the adjacent tooth
what is pell and gregory 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
- crown 1/2 covered by the anterior border of the ramus
what is the order of frequency with reference to position of tooth in the maxilla
- vertical
- distoangular
- mesioangular
- disto horizontal
- mesio horizontal
- buccal/palatal
- inverted
what is pell and gregory class 3
- all of the third molar is within the ramus
- crown fully covered by the anterior border of the ramus
what is pell and gregory class A and where is it located
the occlusal plane of the impacted tooth is at the same level as the adjacent tooth
- maxilla
what is pell and gregory class B and where is it
- the occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the adjacent tooth
- mandible and maxilla
what is pell and gregory class 3 and where is it
- the occlusal plane of the impacted tooth is apical to the cervical line of the adjacent tooth
- mandible and maxilla
all impactions are potentially_____so _____ is important
pathologic, prevention
prudent care requires:
removal, exposure, or repositioning
pathologic conditions are more common with:
increasing age
surgery is more difficult and associated with more complications with:
increased age and oral and systemic compromises
surgery is more difficult if _____ such as ______
symptoms present, acute pain and infectionsu
surgery in younger patients is associated with:
better healing and less morbidity
what age is considered a young patient
less than 25 years old
when is third molar surgery ideally performed
when roots are 1/2 to 2/3rds formed
what are the 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
- 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
what are examples of orthodontic abnormalities
- arch length/tooth size discrepancies
- malposed/impacted second molars
what are examples of indications for prophylactic removal in patients with certain medical or surgical conditions or treatments
- organ transplant
- alloplastic implants
- chemotherapy
- radiation therapy
what are the contraindications for removal of impacted teeth
- extremes in age
- medical condition
- surgical morbidity
- good outcome with orthodontic eruption
what are examples of medical conditions that would be contraindications to removal of impacted teeth
- poor surgical candidate like patient on IV bisphosphonates
- head and neck irradiation
- significantly compromised cardiac status
what are examples of surgical morbidities that would be contraindications to removal of impacted teeth
good outcome with orthodontic eruption
the evaluation of the impacted tooth and diagnosis of associated problems are based on:
- history
- clinical exam
- radigoraphy
what history should be evaluated in impacted teeth
- 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
what is pericoronitis and what can it be caused by
- 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
what are the treatments for pericoronitis
- removal of offending tooth
- removal of opposing tooth
- irrigation/debridement
- removal of operculum
- incision and drainage of infection
- antibiotic therapy
what needs to be examined in the clinical exam for impacted teeth
- identify caries and periodontal diseases
- vitality test of all teeth in doubt
- examination for sign of infection
- facial asymmetry and jaw bone expansion
why is it important to identify caries and periodontal disease in impacted teeth
pain might be from adjacent carious tooth
what are the signs of infection
swelling, discharge, trismus, and enlarged lymph nodes
what are the possible statuses of tooth in question based on clinical eval
- 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
what needs to be done in radiographic assessment
- PA radiograph
- orthopantomogram
- CBCT
what is the radiographic assessment standard of care
orthopantomogram (OPG)
what are the purposes of radiographic examination
- 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
what are the possible configurations of the rooths
- curvature
- numbers
- hypercementosis
- bulbous
-fused or diverged
what are the vital structures to be concerned with
maxillary sinus and inferior alveolar canal
what are the radiogrpahic predictors of nerve injury
- 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
what are the radiographic signs of increased risk of inferior alveolar nerve injury
- 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
what can CBCT identify
- number, location, relative position
- cystic degeneration
- effect on adjacent teeth, nerve, sinus floor
