| INDICATIONS FOR REMOVAL OF IMPACTED TEETH | Prevention of: periodontal disease, dental caries, pericoronitis, root resorption, odontogenic cysts and tumors, fracture of the jaw |
| CONTRAINDICATIONS OF REMOVAL OF IMPACTED TEETH | extremes of age, compromised medical status, robable excessive damage to adjacent structures |
| causes of pericoronitis | Compromised host defenses; minor trauma from maxillary third molar; food entrapment under the operculum |
| treatment of pericoronitis: | Mechanically debriding the large periodontal pocket that exists under the operculum |
| what solutions to debride pericoronitis | hydrogen peroxide, saline, chlorhexidine |
| classification of pericoronitis: Localized tissue swelling and soreness | Mild pericoronitis |
| classification of pericoronitis: Mild facial swelling; Low-grade fever | Local swelling and Pain |
| classification of pericoronitis: Mild trismus resulting from inflammation extendeing into the muscles of mastication | Local swelling and Pain |
| classification of pericoronitis: Large amount of local soft tissue swelling being traumatized by a maxillary third molar | Slight to Severe infection |
| classification of pericoronitis: trismus and fever | Serious Fascial space infection |
| classification of pericoronitis: facial swelling, pain, malaise | Serious Fascial space infection |
| classification of pericoronitis(treatment): Mild facial swelling | Irrigation and curettage by the dentist |
| classification of pericoronitis(treatment): Local swelling and Pain | Antibiotic (Clindamycin); Irrigation delivered under pressure and Extraction |
| classification of pericoronitis(treatment): Slight to Severe infection | Local irrigation, Extraction of the maxillary third molar |
| classification of pericoronitis(treatment): Serious Fascial space infection | refer, hospitalization, Parenteral antibiotic administration and careful monitoring |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):generally acknowledged as the least difficult impaction to remove | Mesioangular |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):the most commonly seen and comprises approximately 43% of all impacted teeth | Mesioangular |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):usually considered more difficult to remove than the mesioangular impaction (3rd in difficulty) | Horizontal |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):occur less frequently and are only seen in approximately 3'%1 of all mandibular impactions | Horizontal |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation): occurs with the second greatest frequency, accounts for approximately 38% of all impactions | Vertical |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):Second most common impaction | Vertical |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):Second most difficult to remove | Vertical |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):most difficult to remove because the tooth has a withdrawal pathway that runs into the mandibular ramus, and its removal requires greater surgical intervention | Distoangular |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):occur uncommonly and account for only approximately 6% of all impacted third molars | Distoangular |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(angulation):Uncommon and most difficult of the four types to remove | Distoangular |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO ANTERIOR BORDER OF RAMUS):mandibular third molar has sufficient anteroposterior room to erupt. | Pell and Gregory class 1 impaction |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO ANTERIOR BORDER OF RAMUS):approximately half is covered by anterior portion of ramus of mandible. | Pell and Gregory class 2 impaction |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO ANTERIOR BORDER OF RAMUS):impacted third molar is completely embedded in bone of ramus of mandible | Pell and Gregory class 3 impaction |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO OCCLUSAL PLANE):occlusal plane of impacted tooth is at same level as occlusal plane of second molar | Pell and Gregory class A impaction |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO OCCLUSAL PLANE):occlusal plane of impacted tooth is between occlusal plane and cervical line of second molar | Pell and Gregory class B impaction |
| CLASSIFICATION SYSTEMS OF IMPACTED TEETH(RELATIONSHIP TO OCCLUSAL PLANE):tooth is below cervical line of second molar | Pell and Gregory class C impaction |
| PRINCIPLES OF REMOVING IMPACTED TOOTH | 1. The operation should be performed under direct vision;
2. Careful technique should not be sacrificed for speed;
3. The operation should be planned so that the dislodgement of the teeth requires as little lever force as possible;
4. The 2nd molar and its periodontal structures should remain uninjured |
| FACTORS THAT AFFECT THE DIFFICULTY OF REMOVING TOOTH/ROOTS | Abnormal root curvature
Hypercementosis
Proximity to the 2nd molar and mandibular canal
The follicular space has been filled with bone,
Extreme bone density |
| FACTORS THAT MAKE IMPACTION SURGERY LESS DIFFICULT | Mesioangular position
Class 1 ramus
Class A depth
large follicule
elastic bone |
| FACTORS THAT MAKE IMPACTION SURGERY MORE DIFFICULT | Distoangular
Class 3 ramus
Class C depth
thin follicule
dense inelastic bone |
| STEPS OF SURGICAL PROCEDURE | 1. Obtained adequate anesthesia.
2. Incision and reflection of the mucoperiosteal flap,
3. Removal of bone to expose the impacted tooth,
4. Luxation of the tooth.
5. Tooth sectioning,
6. Care of the post-surgical socket
7. suturing of the wound |
