Management of Impacted Teeth Part 2 Flashcards
what are the important considerations for surgical removal of impacted mandibular third molars
-history
- clinical exam
- adequate radiographic imaging
- anesthesia plan
- surgery plan
- preoperative, operative, and postoperative instructions
what are the anesthesia options
- local anesthesia
- local anesthesia with nitrous oxide
- local anesthesia with IV sedation- light or deep
- general anesthesia
what are the day of surgery instructions
- responsible guardian available
- time off work or school
- clothing, make up contact lenses
- medications
- IV sedation/anesthesia
what is postoperative care
- diet
- wound care
- medications: analgesics, antibiotics, anti inflammatory
- postoperative follow up visit
what are the predictors of difficulty
- tooth angulation
- tooth position
- complete bony impaction
- narrow PDL
- degree of root development
- root morphology
- contact with second molar
- relation to inferior alveolar neurovascular bundle
- dense, inelastic bone
- patient age
what is the most difficult tooth angulation
distoangular
what is the most difficult tooth position
pell and gregory class 3 ramus and class C depth
what is the ideal degree of root development
1/2-2/3
is it preferred to contact second molar
no
what are the surgical techniques for removal of impacted third molars
- flap elevation
- bone removal
- sectioning of tooth
- delivery of sectioned tooth
- removal of follicle, granulation tissue, debris
- closure
what are the types of flaps
- full thickness mucoperiosteal flap
- envelope flap
- triangular/trapezoid flap
- vital structures
what needs to be done in bone removal
- surgical drill- not high speed handpiece
- occlusal bone removal
- buccal trough
- distal bone removal
- expose CEJ
why do you section impacted teeth
creates space
- minimized bone removal
do you need to section maxillary teeth
rarely
what are the important considerations for the delivery of tooth
- following appropriate exposure and sectioning
-unimpeded pathway - controlled light forces
- elevators, forceps, root picks, crane picks, cryers
what needs to be considered in wound debridement and closure
- debride wound of bone and tooth particles
-smooth rough, sharp edges of bone - remove the remnants of the dental follicle
- irrigate socket and beneath flap with sterile saline
- closure of the incision
- resorbable sutures- chromic
what are the steps for surgical removal of impacted upper third molar
- raise a mucoperiosteal flap
- flap design - envelope flap, two sided flap
- bone removal
- rule out establishment of OAF
- closure of wound
surgical exposure with orthodontic guided eruption most commonly involves:
the maxillary canines and mandibular 2nd molars
what is the incidence of impacted maxillary canines
- second most common tooth impaction
- 1-3.5% of general population
- 80% are located palatally
the treatment for impacted maxillary canines involves:
-creation or maintenance of space by orthodontist
- identification of location of impaction canine
- surgical exposure and orthodontic bonding
- orthodontic actiVation to facilitate proper positioning
how are impacted canines identified
-clinical exam
- SLOB
- CBCT scan
what are the complications associated with impacted teeth surgery
- hemorrhage
- fractured root
- damage to adjacent tooth, tooth displacement
- oro-antral or oro-nasal communication
- fracture mandible/maxillary tuberosity
- nerve injury (paresthesia)
- infection
