Management of Impacted Teeth Part 2

Question 1

what are the important considerations for surgical removal of impacted mandibular third molars

Answer 1

-history
- clinical exam
- adequate radiographic imaging
- anesthesia plan
- surgery plan
- preoperative, operative, and postoperative instructions

Question 2

what are the anesthesia options

Answer 2

• local anesthesia
• local anesthesia with nitrous oxide
• local anesthesia with IV sedation- light or deep
• general anesthesia

Question 3

what are the day of surgery instructions

Answer 3

• responsible guardian available
• time off work or school
• clothing, make up contact lenses
• medications
• IV sedation/anesthesia

Question 4

what is postoperative care

Answer 4

• diet
• wound care
• medications: analgesics, antibiotics, anti inflammatory
• postoperative follow up visit

Question 5

what are the predictors of difficulty

Answer 5

• 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

Question 6

what is the most difficult tooth angulation

Answer 6

distoangular

Question 7

what is the most difficult tooth position

Answer 7

pell and gregory class 3 ramus and class C depth

Question 8

what is the ideal degree of root development

Answer 8

1/2-2/3

Question 9

is it preferred to contact second molar

Answer 9

no

Question 10

what are the surgical techniques for removal of impacted third molars

Answer 10

• flap elevation
• bone removal
• sectioning of tooth
• delivery of sectioned tooth
• removal of follicle, granulation tissue, debris
• closure

Question 11

what are the types of flaps

Answer 11

• full thickness mucoperiosteal flap
• envelope flap
• triangular/trapezoid flap
• vital structures

Question 12

what needs to be done in bone removal

Answer 12

• surgical drill- not high speed handpiece
• occlusal bone removal
• buccal trough
• distal bone removal
• expose CEJ

Question 13

why do you section impacted teeth

Answer 13

creates space
- minimized bone removal

Question 14

do you need to section maxillary teeth

Answer 14

rarely

Question 15

what are the important considerations for the delivery of tooth

Answer 15

• following appropriate exposure and sectioning
  -unimpeded pathway
• controlled light forces
• elevators, forceps, root picks, crane picks, cryers

Question 16

what needs to be considered in wound debridement and closure

Answer 16

• 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

Question 17

what are the steps for surgical removal of impacted upper third molar

Answer 17

• raise a mucoperiosteal flap
• flap design - envelope flap, two sided flap
• bone removal
• rule out establishment of OAF
• closure of wound

Question 18

surgical exposure with orthodontic guided eruption most commonly involves:

Answer 18

the maxillary canines and mandibular 2nd molars

Question 19

what is the incidence of impacted maxillary canines

Answer 19

• second most common tooth impaction
• 1-3.5% of general population
• 80% are located palatally

Question 20

the treatment for impacted maxillary canines involves:

Answer 20

-creation or maintenance of space by orthodontist
- identification of location of impaction canine
- surgical exposure and orthodontic bonding
- orthodontic actiVation to facilitate proper positioning

Question 21

how are impacted canines identified

Answer 21

-clinical exam
- SLOB
- CBCT scan

Question 22

what are the complications associated with impacted teeth surgery

Answer 22

• hemorrhage
• fractured root
• damage to adjacent tooth, tooth displacement
• oro-antral or oro-nasal communication
• fracture mandible/maxillary tuberosity
• nerve injury (paresthesia)
• infection