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Definition
is a tooth that fails to erupt into its normal
functioning position in the dental arch within
the expected time
The term Unerupted includes both
impacted teeth and teeth that are
in the process of erupting.
Causes of impaction
Systemic Causes
Local Factors
A.
B.
C.
D.
frequency of impaction
1.
2.
3.
4.
5.
6.
7.
Complication of
impacted teeth
(indication for removal):
A. Pericoronitis
Definition of pericoronitis
is an infection of the soft
tissue around the crown of
partially impacted tooth and
is caused by the normal
oral flora.
Causes
1. If the patient experience a mild transient
decrease in host defense, pericoronitis may
result.
2. pericronitis may arise secondary to minor
trauma from maxillary third molar. The soft tissue
that covers the occlusal surface of the partially
erupted mandibular third molar known as the
operculum can be traumatized and become
swollen this can be treated by removal of
maxillary third molar.
3.
4.
antibiotic of choice).
B. Dental Caries
When third molar is
impacted or partially
impacted ,the bacteria
that cause dental
caries can be
exposed to the distal
aspect of the 2nd
molar, as well as to
third molar
C. Periodontal Disease
Erupted teeth adjacent to
impacted teeth are
predisposed to periodontal
disease.
As it decrease amount of
bone on the distal aspect of
adjacent 2nd molar, with
deep periodontal pocket on
the distal aspect of the 2nd
molar.
D. Root Resorption
Impacted teeth cause
sufficient pressure on
the root of an adjacent
tooth to cause root
resorption.
E. Pain of unexplained
origin:
Pain in the retro
molar region with
no obvious reason.
I. Facilitation of orthodontic
treatment
to relief crowding
of mandibular
anterior teeth.
Contraindication for
removal of impacted
teeth:
1. extreme of age:
- as the bone become highly calcified, less
flexible, less likely to bend under force of
tooth extraction
the result ,bone more surgically removed to
displace tooth from its socket and less post
operative sequla
Classification system
of impacted teeth
- this is done to help dentist in evaluation of
the extent of the surgical procedure and in
the planning of this procedure.
1-Classification of impacted
mandibular third molar:
Class1
the space between
the anterior part of the
ascending ramus and
the distal surface of
the 2nd molar is
sufficient to
accommodate the
mesiodistal diameter
of the crown of the
third molar.
Class2
the space between
the anterior part of the
ascending ramus and
distal surface of the
2nd molar is less than
the mesiodistal
diameter of the crown
of the third molar (part
of the tooth located
within the ramus)
Class3
all the third molar is
located within the
ascending ramus of
the mandible.
Position A:
the highest portion of the tooth is on level
with or above the occlusal plane.
Position B:
the highest portion is below the occlusal
plane but above the cervical margin of the
2nd molar
Position C:
the highest point of the tooth is below the
cervical margins of the 2nd molar (deep
impaction)
a - lingual deflection.
b - buccal deflection.
5-inverted impaction
2 -Classification of impacted
maxillary third molar:
1.
3-Classification of impacted
maxillary cuspids:
Class1:
palatally impacted cuspids ,these could be in vertical,
horizontal, semivertical position.
Class2:
labialy impacted cuspide which could be in vertical,
horizontal, semivertical.
Class3:
impacted cuspid located both in the palatal and labial
surfaces.
Class4:
impacted cuspid that are present in an edentulous
maxilla and may assume any of the previous three
classes.
Surgical removal of
impacted teeth:
Envelope Incision
and reflection
When more
accessibility is
needed , a releasing
incision is made.
2- bone removal
This is done for :A- exposure of impaction
B- reduction of resistance
C- making a point for application of the elevator
3- tooth delivery
1- total delivery by application of force using elevators:
a- mesial application of force :straight elevators and pot's
elevators.
b- buccal application of force :winter elevator
4- fracture of tuberosity:
this occurs with erupted rather than unerupted tooth
due to improper use of force
pain.
infection
heamoraghe
anesthesia or parenthesis of the lingual or inferior
alveolar nerve
trismus,limitation of jaw movement
osteomylitis
pain at tmj
pain on swallowing due to edema of pharynx and
hematoma formation.
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