management of impacted teeth

Principles of management of impacted teeth

Dr.Mohamed Rahil (( Maxillofacial surgeon ))

Tikrit dentistry college 2015 – 2016

impaction An impacted tooth is any tooth that is prevented from reaching its normal position in the mouth by tissue, bone, or another tooth.

Indications for Extraction

• Localized or Generalized Neuralgias • Pericoronitis• Production of Caries• Destruction of Adjacent Teeth Due to

Resorption of Roots• Participation in the Development of

Various Pathological condition• Restrict the Placement of a Partial or

Complete Denture. • Restrict the Normal Eruption of

Permanent Teeth• Provoking or Aggravating

Orthodontic Problems

Timing

most suitable time is when the patient is young due to :

younger patients generally well tolerate surgical procedure and stress .

faster postsurgical wound healing compared with older patients.

Bone removal more easy in young than older patient.

Steps of Surgical Procedure1. Incision and reflection of the mucoperiosteal flap

2. Removal of bone to expose the impacted tooth

3. Luxation of the tooth

4. Care of the postsurgical socket and suturing of the wound

Impacted Third Molar Classifications• Mesioangular• Distoangular• Vertical• Horizontal• Buccoangular• linguoangular• Inverted

• Class A: The occlusal surface of the impacted tooth is at the same level as, or a little below that of, the second molar

• Class B: The occlusal surface of the impacted tooth is at the middle of the crown of the second molar or at the same level as the cervical line

• Class C: The occlusal surface of the impacted tooth is below the cervical line of the second molar

Class 1: The distance between the second molar and the anterior border of the ramus is greater than themesiodistal diameter of the crown of the impacted tooth

Class 2: The distance is less and the existing space is less than the mesiodistal diameter of the crown of the impacted tooth

Class 3: There is no room between the second molar and the anterior border of

the ramus, so that the entire impacted tooth or part of it is embedded in the ramus

Types of Flaps

Triangular flap:• The incision for this type of flap

begins at the anterior border of the ramus (external oblique ridge) with special care for the lingual nerve and extends as far as the distal aspect of the second molar,

• while the vertical releasing incision is made obliquely downwards and forward, ending in the vestibular fold .

Types of Flaps

Horizontal (envelope) flap:• The incision for the flap also

begins at the anterior border of the ramus and extends as far as the distal aspect of the second molar, continuing along the cervical lines of the last two teeth, and ending at the mesial aspect of the first molar.

• This type of flap is usually used in cases where impaction is relatively superficial.

Types of Flaps

Removal of Bud of Impacted Mandibular Third Molar

Extraction of Impacted Third Molarin Horizontal Position

Extraction of Third Molar with Mesioangular Impaction

Extraction of Third Molarwith Distoangular Impaction

Extraction of Impacted Third Molarin Edentulous Patient

Impacted Premolar

Impacted Canine

Extraction of Impacted Maxillary Teeth

Impacted Third Molar

Impacted Canines

Extraction Using Labial Approach

Extraction Using Palatal Approach

Ectopic Impacted Canine

Exposure of Impacted Teethfor Orthodontic Treatment

Impacted Mandibular Caninewith Labial Position

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