By Mohammad Hussein Zaki Lecturer Oral & Maxillofacial Surgery Faculty of Dentistry – Minia University
. Impacted tooth.
Failure of the tooth to fully erupt into the oral cavity within its expected developmental time period and can no longer reasonably be expected to do so.
A tooth that can not, or will not, erupt into its normal functioning positions.
. Impacted tooth.
An impacted tooth is one that is erupted, partially erupted or unerupted and will not eventually assume a normal arch relationship with the other teeth and tissues.
. Unerupted tooth.
Includes impacted teeth and teeth that are in the process of erupting.
. Impacted teeth seen in the following order of frequency: 1. Mandibular third molars.
2. Maxillary third molars.
3. Maxillary canine.
4. Mandibular premolar.
5. Maxillary premolar.
6. Mandibular canine.
7. Maxillary central incisors.
8. Maxillary lateral incisors.
. Systemic factors:
• Syndromes.
Cleidocranial dysplasia.
• Endocrine deficiencies.
Hypothyroidism.
• Irradiation.
. Local factors: • Obstruction for eruption.
Irregularity in position of an adjacent tooth.
Density of the overlying soft tissue or bone.
Prolonged deciduous tooth retention.
Supernumerary teeth.
• Tooth ankylosis.
• Dilaceration of roots.
• Malposed tooth germs.
. Local factors:
• Pathological lesions.
• Arch-length deficiency.
Phylogenic theory.
Mendelian theory.
. Clinical.
. Radiographic.
• Periapical.
. Radiographic.
• Periapical.
. Radiographic.
• Occlusal.
. Radiographic.
• Panorama.
. Radiographic.
• Panorama.
. Radiographic.
• CT.
. Radiographic.
• CBCT.
Impacted teeth other than third molars.
Exposure.
• A procedure that allows natural eruption of impacted teeth.
• It should be done as soon as it is determined that the tooth is not going to erupt spontaneously.
• Spontaneous eruption versus orthodontic assistance.
Impacted teeth other than third molars.
Exposure.
Impacted teeth other than third molars.
Exposure.
Impacted teeth other than third molars.
Exposure.
Impacted teeth other than third molars.
Uprighting.
• Applied most commonly to impacted molars.
• Rationale.
Providing occlusion with opposing teeth and proximal contacts with adjacent teeth.
Minimizing the risk of caries and periodontal disease.
Assisting in orthodontic treatment.
Impacted teeth other than third molars.
Uprighting.
• The optimal time for uprighting a molar tooth is when two-thirds of the root has formed.
Impacted teeth other than third molars.
Uprighting.
• Technique.
Impacted teeth other than third molars.
Uprighting.
• An endodontic evaluation should be performed 3 weeks following the uprighting of the tooth.
• Radiographs should be taken at 6-month intervals for 2 years to evaluate the postoperative course.
Impacted teeth other than third molars.
Transplantation.
• The surgical movement of a tooth from one location in the mouth to another in the same individual.
• It may be appropriate for the adult patient who cannot undergo conventional orthodontic movement of a canine or premolars.
Impacted teeth other than third molars.
Transplantation.
• The advocated technique.
Careful wide exposure of the impacted tooth..
The tooth is then moved into its position within the dental arch .
Stabilization with a segmental orthodontic appliance.
Endodontic treatment begins with calcium hydroxide paste 6 to 8 weeks after the surgical procedure.
Conventional root canal filling is performed at 1 year following surgery.
Impacted teeth other than third molars.
Transplantation.
Impacted teeth other than third molars.
Transplantation.
Impacted teeth other than third molars.
Transplantation.
Impacted teeth other than third molars.
Removal.
• Performed when other methods of treatment are unavailable.
• Impacted teeth should be approached from the surface of the bone with which they are most closely associated.
Impacted teeth other than third molars.
Removal.
• When a large palatal flap has been reflected, maintaining a palatal splint to support the soft tissues for several days prevents hematoma formation.
Impacted teeth other than third molars.
Removal.
Impacted third molars.
Classification.
• Classified radiographically by:
Angulation
Depth
Arch length
Impacted third molars.
Classification.
• Angulation
Mesioangular.
Horizontal.
Vertical.
Distoangular.
Impacted third molars.
• Angulation
Impacted third molars.
• Maxillary sinus
Impacted third molars.
Classification.
• Depth.
Position A.
Position B.
Position C.
Impacted third molars.
Classification.
• Arch length.
Class I.
Class II.
Class III.
Impacted third molars.
Classification.
• Helpful for:
Describes the general position of the impacted third molar.
Aids in estimating the difficulty in removing the Tooth.
o Difficulty index
Impacted third molars.
Classification.
• Difficulty index.
Impacted third molars.
Classification.
• Difficulty index.
Minimally difficult : 3 to 4.
Moderately difficult: 5 to 7.
Very difficult: 7 to 10.
Impacted third molars.
Indications for removal.
• Pericoronitis prevention or treatment.
Impacted third molars.
Indications for removal.
• Prevention of periodontal disease.
Impacted third molars.
Indications for removal.
• Prevention of dental caries.
Impacted third molars.
Indications for removal.
• Prevention of root resorption.
Impacted third molars.
Indications for removal.
• Impacted teeth under a dental prosthesis.
Impacted third molars.
Indications for removal.
• Prevention of odontogenic cysts and tumors.
Impacted third molars.
Indications for removal.
• Prevention of jaw fracture.
Impacted third molars.
Indications for removal.
• Orthodontic considerations.
Crowding of mandibular incisors.
Obstruction of orthodontic treatment.
Interference with orthognathic surgery
Impacted third molars.
Indications for removal.
• Treatment of pain of unexplained origin.
Impacted third molars.
Contraindications for removal.
• Extreme age.
Very young age.
Elderly patients.
• Compromised medical status.
Impacted third molars.
Contraindications for removal.
• Surgical damage to adjacent structures.
Impacted third molars.
Perioperative assessment.
• Determining surgical difficulty. • Classification.
• Roots.
• Follicular sac.
• Age.
Impacted third molars.
Technique.
Adequate exposure of the area of the impacted tooth.
Impacted third molars.
Technique.
Adequate exposure of the area of the impacted tooth.
Impacted third molars.
Technique.
Adequate exposure of the area of the impacted tooth.
Impacted third molars.
Technique.
Adequate exposure of the area of the impacted tooth.
Impacted third molars.
Technique.
Removal of overlying bone.
Impacted third molars.
Technique.
Sectioning the tooth.
Impacted third molars.
Technique.
Sectioning the tooth.
Impacted third molars.
Technique.
Sectioning the tooth.
Impacted third molars.
Technique.
Sectioning the tooth.
Impacted third molars.
Technique.
Delivery of the tooth with elevator.
Cross bar.
Warwick James or Millar.
Impacted third molars.
Technique.
Preparing the wound for closure.
Mechanical debridement.
Smoothening rough sharp edges of the bone.
Socket and wound irrigation.
Hemostasis.
Impacted third molars.
Technique.
Wound closure.
The flap is returned to its original position.