management of impacted teeth pt. 2

Question 1

Surgical Management of Impacted Teeth
- Surgical removal of?
- exposure and orthodontic assisted eruption?
- Surgical repositioning and transplantation?

Answer 1

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.

Question 2

Surgical Removal of Impacted Mandibular Third Molars Important Considerations

Answer 2

• History
• Clinical exam
• Adequate Radiographic Imaging
• Anesthesia plan
• Surgery plan
• Preoperative, operative and postoperative instructions

Question 3

Anesthesia Options

Answer 3

• Local Anesthesia
• Local Anesthesia with nitrous oxide
• Local Anesthesia with intravenous sedation
  – Light Sedation
  – Deep Sedation
• General anesthesia

Question 4

Day of Surgery Instructions

Answer 4

• Responsible guardian available
• Time off work/school
• Clothing, Make-up, Contact Lens
• Medications
• I.V. Sedation / Anesthesia
  – NPO

Question 5

Postoperative Care

Answer 5

• Soft Diet
• Wound care
• Medications
  – Analgesics, Antibiotics, Anti-inflammatory
• Postoperative follow up visit

Question 6

Surgical Removal of Impacted Mandibular Third Molars
* Tooth angulation?
* Tooth position?
* impaction?
* PDL?

Answer 6

• Tooth angulation (Distoangular Impaction- Lower Third Molars)
• Tooth position (Pell & Gregory - Class 3 ramus & Class C depth (More difficult)
• Complete bony impaction
• Narrow PDL

Question 7

Surgical Removal of Impacted Mandibular Third Molars
Predictors of difficulty
– root?
– morph?
– Contact with?
– Relation to?
– bone?
– age?

Answer 7

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

Question 8

Surgical Removal of Impacted Mandibular Third Molars steps

Answer 8

• 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

Question 9

Flap elevation

Answer 9

– Full thickness mucoperiosteal flap
– Envelope (sulcular) flap
– Triangular/trapezoid flaps (utilizing vertical releases)
– Vital structures
* Lingual nerve

Question 10

Answer 10

envelope flap

Question 11

Answer 11

triangular flap

Question 12

Answer 12

triangular flap

Question 13

Answer 13

three corner flap w vertical release

Question 14

incision for man thrid molars anatomical consdierations

Answer 14

Incision should stay Buccal to Prevent injury to Lingual Nerve.

Question 15

Surgical Removal of Impacted Mandibular Third Molars
Bone removal
– tool?
– bone areas removed?
* Lingual nerve?
– Expose?

Answer 15

– Surgical drill (NOT high-speed handpiece!)
– Occlusal bone removal
– Buccal trough
– Distal bone removal
* Lingual nerve
– Expose CEJ

Question 16

Sectioning of Impacted Tooth
– Case?
– Sectioning of?
– Facilitates?
– Creates?
– Minimizes?
– distance?
– Vital Structures?
– Rarely needed for?

Answer 16

– 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

Question 17

Delivery of Tooth – Important considerations

Answer 17

– Following appropriate exposure and sectioning
– Unimpeded pathway
– Controlled, light forces
– Elevators, forceps, root picks, crane picks, cryers, etc.

Question 18

Wound Debridement and Closure
* Debride wound of?
* Smooth?
* Remove remnants of?
* Irrigate?
* Closure?

Answer 18

• 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

Question 19

Surgical removal of Impacted Upper Third Molar steps

Answer 19

• Raise a Mucoperiosteal flap
• Flap design (envelop flap, Two sided flap
• Bone removal
• Rule out establishment of OAF
• Closure of wound

Question 20

Surgical removal of Palatally Impacted Canine anatomy

Answer 20

Question 21

what can be done for non-erupted canines?

Answer 21

Surgical Exposure and Orthodontic Guided Eruption

Question 22

Surgical Exposure with Orthodontic Guided Eruption
* Most commonly involves?
* Treatment involves what phases?

Answer 22

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.

Question 23

Impacted Maxillary Canines
* commonality?
* % of general population
* About % are located palatally
* Upon recognition, prompt referral to?

Answer 23

• 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.

Question 24

Impacted Maxillary Canines
* Treatment involves:
* Creation or maintenance of?
* Identification of?
* Surgical?
* Orthodontic?

Answer 24

• 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.

Question 25

Answer 25

impacted max canines with ortho chain

Question 26

Complications Associated With Impacted Teeth Surgery

Answer 26

Hemorrhage
Fractured root
Damage to adjacent tooth, tooth displacement
Oro-antral or Oro-nasal communication
Fracture mandible / Maxillary tuberosity
Nerve injury(Paresthesia)
Infection