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BDS4 CDS Oral Surgery > Third Molars 2 > Flashcards

Third Molars 2 Flashcards

1
Q

3 parts of wisdom tooth assessment

A

history
clinical
radiographic

Also eval pt ability to the consequences of each tx option

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2
Q

history aspects for 3rd molar assessment

A

General Appearance
* Swelling, asymmetry, anxiety, difficulty swallowing/speaking

Presenting complaint eg recurrent pericoronitis

History of Presenting Complaint –how long, how many episodes, how often, severity, requirement for antibiotics?

Medical History – systemic enquiry, Medications, Allergies, Previous hospitalisations inc surgery

Dental History – history of extractions, dental anxiety, dental experience, regular oral hygiene

Social History – smoking, alcohol, occupation, carer, support

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3
Q

extra oral clinical assessment for 3rd molars

A

TMJ’s – assess if any TMD, similar pain as pericoronitis

Limited mouth opening (surgical access)

Lymphadenopathy – enlarged, tender

Facial asymmetry

Muscles of Mastication

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4
Q

intra oral clinical assessment for 3rd molars

A

Soft Tissue examination

Dentition

M2M – prognosis, working space – distance from M2M to ascending ramus of mandible

Eruption and status of the M3Ms – any communication, how erupted (1 cusp, 2/3 occlusal surface), operculum

Condition of the remaining dentition

Occlusion

Oral hygiene

Caries status

Periodontal status

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5
Q

radiographic assessment for 3rd molars

when

A

only if surgical intervention is being considered

use OPT

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6
Q

OPT of 3rd molars to determine

A

Presence or absence of disease (in 3M or elsewhere)

Anatomy of 3M (crown size, shape, condition, root formation)
* Crown root ratio – large crown, small roots = harder to extract, not enough access to get tooth to pop out of socket (need surgical)

Depth of impaction

Orientation of impaction

Working distance

Follicular width

Periodontal status

The relationship or proximity of upper third molars to the maxillary antrum (sinus) and of lower third molars to the inferior dental canal (bony cavity)

Any other assoc pathology/abnormalities

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7
Q

depth of impaction options

A
  • Superficial – crown of 8 is sitting at same heigh at adj 7
  • Moderate – crown of 8 is sitting somewhere between roots and crown of 7
  • Deeply – crown of 8 is sitting at root height of adj 7
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8
Q

orientation of impaction options

A
  • Vertical – up and down
  • Mesial
  • Distally
  • Horizontal
  • Transverse
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9
Q

3rd molar working distance

A

distal of lower 7 to ramus of mandible

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10
Q

follicular width is

A

Tissue that surrounds the crown on developing tooth
* Usually lost on eruption

Unerupted tooth – this will appear as a radiolucency, if it gets large some evidence suggest indicative of pathology so keep an eye on them (2.5mm+)

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11
Q

OPT what to assess for IDB canal

A
  • interruption of the white lines/lamina dura of the canal
  • darkening of the root where crossed by the canal
  • diversion/deflection of the inferior dental canal
  • deflection of root
  • narrowing of inferior dental canal
  • Narrowing of the root
  • Dark and bifid root
  • juxta apical area?
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12
Q

3 signs that have been shown to have significantly increased risk fo nerve injury during 3rd molar surgery

A

diversion of the inferior dental canal

darkening of the root where crossed by the canal

interruption of the white lines of the canal

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13
Q

what is this

A

diversion/deflection of the inferior dental canal

IDB canal shapes round the outline of the 8 apices

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14
Q

what is this

A

darkening of the root where crossed by the canal

Dark band is IDB canal - apices at same level as IDB canal

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15
Q

what is this

A

interruption of the white lines/lamina dura of the canal

can usually see both upper and lower borders of IDB canal

but either upper or upper and lower borders of tramline lost

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16
Q

what is this

A

deflection of roots

IDB canal caused curvey roots

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17
Q

what is this

A

narrowing of inferior dental canal

narrower as it spasses apices of 8

18
Q

what is this

A

narrowing of roots of 8

19
Q

what is this

A

dark and bifid roots

roots splits or divides over canal

20
Q

what is this

A

Well circumscribed radiolucent lateral to root of molar not just at apex

Well defined area, can be corticated

Lamina dura still in tact

Appearance is not pathological – must check (tooth vitality and infection status)

21
Q

further imaging for 8s when

A

“Where conventional imaging has shown a close relationship between the third molar and the inferior dental canal, cone beam computed tomography (CBCT) may be of benefit. “

22
Q

further imaging for 8s when

A

“Where conventional imaging has shown a close relationship between the third molar and the inferior dental canal, cone beam computed tomography (CBCT) may be of benefit. “

if suspect close relationship, consider CBCT (IDB canal and M3M)

if CBCT not available, CT can be used but limited field of view

23
Q

radiological assessment used to confirm what

A

angulation

  • Vertical – around 30 - 38% of impacted lower 8’s
  • Mesial – around 40%
  • Distal – around 6 - 15%
  • Horizontal – around 3 - 15%
  • Transverse (less common) crown buccally placed and roots lingually placed or vice versa
  • or aberrant – not where expect to find e.g midway up ramus of mandible or at lower border of mandible
24
Q

radiological angulation of 8s measured against

A

curve of Spee

natural curve following the cusps of a natural dentition

25
Q

how to assess impaction

A

ne through 8 and 7, where 8 lies in relation to 7

26
Q

impaction of 8s?

A

LR8 - mesially impacted

LL8 - horizontally impacted

27
Q

impaction of 8s?

A

LR8 - horizontally impacted

LL8 - distoangular impacted

28
Q

hardest impaction to extract?

A

distally impacted 8s

need to remove distal bone

29
Q

impaction of 8s?

A

LR8 - true vertical impaction

LL8 - distal impaction

30
Q

impaction of 8?

A

transverse impaction

31
Q

impaction of 8?

A

LL8 aberrant position

32
Q

depth of impaction indicates

A

amount of bone removal required

33
Q

how to measure depth of impaction

A

measure crown 8 against adj 7 crown

superficial
moderate
deep

34
Q

superficial impaction

A

crown of 8 related to crown of 7

35
Q

moderate impaction

A

crown of 8 related to crown and root of 7

36
Q

deep impaction

A

crown of 8 related to root of 7

37
Q

impaction of 8s depth?

A

LL8 - superifical distoangular

LR8 - moderate mesioangular

38
Q

impaction of 8 depth?

A

superficial mesial LL8

39
Q

impaction of 8 depth?

A

moderate vertical

40
Q

what other radiographic finding would need to warm pt of here?(not 8)

A

LR7 – overhang amalgam

risk of restoration damage due to proximity, temporise tooth and work on later

BDS4 CDS Oral Surgery (19 decks)

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