Principles of management of Impacted teeth

Question 1

T/F As a general rule all impacted teeth should be removed unless removal is contraindicated

Answer 1

True

Question 2

How do you know if a person should keep their mandibular third molars?

Answer 2

-Enough room between the anterior boarder of the ramus and the second molar to all functional eruption

Question 3

Does age have an impact on the removal of impacted teeth?

Answer 3

-Yes advancing age makes it more difficult (over 30 or 35 years old)

Question 4

T/F Prevention of periodontal disease is not an indication for removal of impacted teeth

Answer 4

False

-It is an indication

Question 5

What are indications for removal of impacted teeth?

Answer 5

• Prevent periodontal disease
• Prevent dental caries
• Prevent pericoronitis
• Prevent root resorption
• Impacted teeth under dental prosthesis
• Prevention of odontogenic cysts
• Treatment of pain of unexplained origin
• Prevention of Jaw fractures
• Facilitation of Orthodontic treatment

Question 6

What are the symptoms of pericoronitis?

Answer 6

• Local and facial swelling
• Pain
• Limitation of opening (trismus)

Question 7

What is the initial treatment of pericoronitis?

Answer 7

• Antibiotics (penicillin (500 mg 4x per day for a week) and Cleocin (Clindamycin)
• Warm salt water rinses and irrigation
• Extraction of 3rd molar after infection resolved

Question 8

When should you refer a patient with pericoronitis to an OMS?

Answer 8

• Trismus opening less than 20 mm
• Increasing swelling and or pain
• Temp greater than 101 F
• Pt not responding to conservative measures and is getting sicker

Question 9

If a benign cyst gets out of control what can they become?

Answer 9

• Ameloblastoma

- Odontogenic keratocyst

Question 10

What are the contraindications for removal of impacted teeth?

Answer 10

• Extremes of Age
• Compromised medical status
• Probable excessive damage to adjacent structures

Question 11

What is the most often classification used for mandibular third molar impactions?

Answer 11

-Angulation

Question 12

What is the most common third molar impaction?

Answer 12

-Mesioangular

Question 13

What is the most difficult third molar impaction to take out?

Answer 13

-Distoangular

Question 14

When is the best time to take out 3rd molars?

Answer 14

-When roots are 1/3 to 2/3 rds formed

Question 15

What are factors that make impaction surgery less difficult?

Answer 15

• Mesioangular position
• Class 1 ramus with class A depth
• Roots 1/3 to 2/3 formed
• Fused conical roots
• Wide PDL
• Large follicle
• Elastic bone
• Separated from 2nd molar
• Separated from IAN
• Soft tissue impaction
• Young patient

Question 16

What are factors that make impaction surgery more difficult?

Answer 16

• Distoangular
• Glass 2-3 ramus with B or C depth
• Long thin roots
• Divergent curved roots
• Narrow PDL
• Dense inelastic bone
• Contact with 2nd molar
• Close to IAN
• Complete boney impaction
• Present in older patient

Question 17

What is the most common type of impaction found in the maxillary third molars?

Answer 17

-Vertical impaction

Question 18

What is the least common type of impaction found in the maxillary third molars?

Answer 18

-Mesioangular

Question 19

If the patient is asymptomatic does that mean you should just leave the third molars alone?

Answer 19

-No

Question 20

T/F It is ok to ignore retained third molars

Answer 20

False

-They need to be monitored

Question 21

What are radiographic signs associated with increased risk of IAN injury?

Answer 21

• Darkening of the root
• Deflection of root
• Narrowing of root
• Dark and bifid apex of root
• Interruption of white line of canal
• Diversion of canal
• Narrowing of canal