management of impacted teeth pt. 2 Flashcards
Surgical Management of Impacted Teeth
- Surgical removal of?
- exposure and orthodontic assisted eruption?
- Surgical repositioning and transplantation?
Surgical Management of Impacted Teeth
- Surgical removal of the Impacted tooth(Third Molars).
- Surgical exposure and orthodontic assisted eruption
(canines and 2nd molars)
- Surgical repositioning and transplantation, removal of unfavorable 2nd molar and replacement with 3rd molar.
Surgical Removal of Impacted Mandibular Third Molars Important Considerations
- History
- Clinical exam
- Adequate Radiographic Imaging
- Anesthesia plan
- Surgery plan
- Preoperative, operative and postoperative instructions
Anesthesia Options
- Local Anesthesia
- Local Anesthesia with nitrous oxide
- Local Anesthesia with intravenous sedation
– Light Sedation
– Deep Sedation - General anesthesia
Day of Surgery Instructions
- Responsible guardian available
- Time off work/school
- Clothing, Make-up, Contact Lens
- Medications
- I.V. Sedation / Anesthesia
– NPO
Postoperative Care
- Soft Diet
- Wound care
- Medications
– Analgesics, Antibiotics, Anti-inflammatory - Postoperative follow up visit
Surgical Removal of Impacted Mandibular Third Molars
* Tooth angulation?
* Tooth position?
* impaction?
* PDL?
- Tooth angulation (Distoangular Impaction- Lower Third Molars)
- Tooth position (Pell & Gregory - Class 3 ramus & Class C depth (More difficult)
- Complete bony impaction
- Narrow PDL
Surgical Removal of Impacted Mandibular Third Molars
Predictors of difficulty
– root?
– morph?
– Contact with?
– Relation to?
– bone?
– age?
Surgical Removal of Impacted Mandibular Third Molars
Predictors of difficulty
– Degree of root development (ideally ½ - 2/3rd)
– Root morphology (conical vs. dilacerated)
– Contact with second molar (separation preferred)
– Relation to Inferior alveolar neurovascular bundle (separation
preferred)
– Dense, inelastic bone
– PATIENT AGE
Surgical Removal of Impacted Mandibular Third Molars steps
- Flap elevation (Adequate exposure-soft tissue incision/flap reflection)
- Bone removal (Assess need for bone removal/removal of sufficient bone)
- Sectioning of tooth
- Delivery of sectioned tooth
- Removal of follicle, granulation tissue, debris
- Closure
Flap elevation
– Full thickness mucoperiosteal flap
– Envelope (sulcular) flap
– Triangular/trapezoid flaps (utilizing vertical releases)
– Vital structures
* Lingual nerve
envelope flap
triangular flap
triangular flap
three corner flap w vertical release
incision for man thrid molars anatomical consdierations
Incision should stay Buccal to Prevent injury to Lingual Nerve.
Surgical Removal of Impacted Mandibular Third Molars
Bone removal
– tool?
– bone areas removed?
* Lingual nerve?
– Expose?
– Surgical drill (NOT high-speed handpiece!)
– Occlusal bone removal
– Buccal trough
– Distal bone removal
* Lingual nerve
– Expose CEJ
Sectioning of Impacted Tooth
– Case?
– Sectioning of?
– Facilitates?
– Creates?
– Minimizes?
– distance?
– Vital Structures?
– Rarely needed for?
– Case selection (Tooth angulation)
– Section Crown and/or roots
– Facilitates procedure
– Creates space
– Minimizes bone removal
– 2/3rd to ¾ of distance – complete with elevator
– Vital Structures
– Rarely needed for maxillary teeth
Delivery of Tooth – Important considerations
– Following appropriate exposure and sectioning
– Unimpeded pathway
– Controlled, light forces
– Elevators, forceps, root picks, crane picks, cryers, etc.
Wound Debridement and Closure
* Debride wound of?
* Smooth?
* Remove remnants of?
* Irrigate?
* Closure?
- Debride wound of bone/tooth particles
- Smooth rough, sharp edges of bone
- Remove remnants of the dental follicle
- Irrigate socket and beneath flap with sterile saline
- Closure of the incision
– Resorbable sutures-chromic
Surgical removal of Impacted Upper Third Molar steps
- Raise a Mucoperiosteal flap
- Flap design (envelop flap, Two sided flap
- Bone removal
- Rule out establishment of OAF
- Closure of wound
Surgical removal of Palatally Impacted Canine anatomy
what can be done for non-erupted canines?
Surgical Exposure and Orthodontic Guided Eruption
Surgical Exposure with Orthodontic Guided Eruption
* Most commonly involves?
* Treatment involves what phases?
Surgical Exposure with Orthodontic Guided Eruption
* Most commonly involves the maxillary canines, and mandibular 2nd molars.
* Treatment involves both a surgical and an orthodontic phase.
Impacted Maxillary Canines
* commonality?
* % of general population
* About % are located palatally
* Upon recognition, prompt referral to?
- Second most common tooth impaction
- 1-3.5 % of general population
- About 80% are located palatally
- Upon recognition, prompt referral to an orthodontist is prudent.
Impacted Maxillary Canines
* Treatment involves:
* Creation or maintenance of?
* Identification of?
* Surgical?
* Orthodontic?
- Treatment involves:
- Creation or maintenance of space by orthodontist.
- Identification of location of impacted canine (clinical exam,
SLOB, CBCT Scan). - Surgical exposure and orthodontic bonding.
- Orthodontic activation to facilitate proper positioning.
impacted max canines with ortho chain
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
