Impacted Mandibular 3rd Molar & other teeth than 3rd molar

Management for mandibular 3rd molar impaction

Vertically impacted
Mesio - angularly impacted
A. buccal and distal bone are removed to expose crown of tooth to its cervical line.
B. The distal aspect of the crown is then sectioned from tooth. Occasionally it is necessary to section the entire tooth into two portions rather than to section the distal portion of crown only.
C . A small straight elevator is inserted into the purchase point on mesial aspect of 3rd molar, & the tooth is delivered with a rotational and level motion of elevator.
PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY
Second Edition

distoangular impaction
Second Edition
C, The purchase point is put into the remaining root portion of the tooth, and the roots are delivered by a Cryer elevator with a wheel and-axle
motion. If the roots diverge, it may be necessary in some cases to split them into independent portions
A. Removal of mesial & distal boen. It is important to remember that more distal bone must be taken off than for a vertical or mesioangular impaction.
B. The crown of the tooth is sectioned off with a bur and is delivered with straight
elevator

A. Removal of distal and buccal underlying bone
B. The crown is sectioned
from the roots of the tooth and is delivered from socket.
C, The roots are delivered together or independently with a Cryer elevator used with a rotational motion. Saperation of root into 2 parts - occasionally the purchase point is made in the root to allow the Cryer elevator to engage it.
Horizontally impacted
D, The mesial root of the tooth is elevated in similar fashion
Second Edition

Vertically impacted
Second Edition
A. When removing a vertical impaction, the bone on the occlusal, buccal, and distal aspects of the crown is removed, and the tooth is sectioned into
mesial and distal portions.
B. The posterior aspect of the crown is elevated first with a Cryer elevator inserted into a small purchase point in the distal portion of the tooth.
C. A small straight no. 301 elevator is then used to lift the mesial aspect of the tooth with a rotary and levering motion.

Mandibular 3rd molar removal!

Impaction of teeth other than 3rd molar

Impaction of teeth other than 3rd molar
Etiology

Clinical problem : malocclusion, loss of arch length, migration/ loss of adjacent tooth, periodontal disease, root resorption (internal & external) of impacted tooth, dentigerouscsyt & pericoronitis.

Management for impacted tooth other than 3rd molar

a) Exposure (with/ without ortho band)
Allow natural eruption of impacted teeth
Most appropriate technique
Most common : bonded orthodontic bracket to
Conserve exposure of the tooth
Remove only enough soft tissue + bone to place bracket
Avoid exposure of CEJ

Palatally impacted canines
Second Edition
Labially impacted canine exposed important part of this surgical procedure using an apically repositioned flap

b) Uprighting
Commonly for impacted MOLARS
Remove 3rd molar for 2nd molar to erupt normally
Normal time for uprighting molar teeth : 2/3 of the root has formed
If root fully formed  poor prognosis
If  3rd molar : Remove bone to ensure  occlusal force, antibiotic
Molar uprighting is frequently needed to treat a malocclusion bad bite that occurs years after the extraction of the lower first molar tooth

Third molar in path of second molar eruption

c) Transplantation
For adult :  undergo conventional ortho movement of canine / premolar
how?
Expose the impacted tooth
Move into position + stabilize with ortho app.
Endo treatment : calcium hydroxide paste (antimicrobial effect & bone-regeneration stimulant) 6-8 weeks after surgical procedure
Conventional root canal filing at 1 year following surgery
Extraction possible : transalveolar transplantation (max. canines)
Second Edition

iv. Removal
Last choice! : canines / premolar / molar
Surgical + Radiographic assessment
Conservation of bone through conservative exposure + removal with sectioning

* Molar tooth  similar to 3rd molar!

Indication for removal of impacted tooth

i. PericoronitisPrevention or Treatment
The most cases for removal of impacted tooth!
Usually mandibular – partially erupt
Microbes :Peptostreptococcus, Fusobacterium, and Bacteroides(Porphyromonas)
Initial treatment :
i.Débridement
ii. Disinfection with irrigation solution (hydrogen
peroxide or chlorhexidine)
iii.surgical management – extract opposing max 3rd
molar.
iv. Severe cases with systemic effect – antibiotic
Recurrent – Removal of involved tooth

ii. Preventionof DentalDisease
Caries! – At mand 3rd molar / adjacent tooth
(mostly at cervical line)
unable to clean effectively & inaccessible to the restorative dentist  advanced periodontal disease : Extract!

iii. OrthodonticConsiderations

iv. Preventionof OdontogenicCystsand Tumors
Follicular sac (formation of the crown)  cystic degeneration dentigerouscyst --> odontogenictumor (rare)
Reason for removal of asymptomatic teeth because pathology occurs, it may pose a serious health threat!

v. Root Resorptionof Adjacent Teeth
Misaligned erupting teeth may resorb the roots of adjacent teeth just like succedaneousteeth resorb the roots of primary teeth during normal eruption.
Most cases - adjacent tooth recalcified (deposition of a cementumover the resorbedarea) & formation of 2odentin.
If severe resorption & the mandibular 3omolar displaces significantly into the roots of the second molar REMOVE.

vi. Teeth underDental Prostheses
Removable tissueborne prosthesis – is constructed on a ridge where an impacted tooth is covered by only soft tissue or 1 or 2 mm of bone  overlying bone resorbed, mucosa perforate & the area become painful and inflamed. So ----> Extract!
In older patients with tooth- or implant-borne fixed prostheses asymptomatic deeply impacted teeth can be safely left in place.

vii. Prevention of Jaw Fracture
Patients engage in contact sports(football, rugby, martial arts) & noncontact sports (basketball)  remove to prevent jaw fracture
An impacted third molar -  resistance to fracture in mandible  common site for fracture
increased complications in the treatment of the fracture.

viii. Management ofUnexplained Pain
Jaw pain in the area of an impacted third molar but  clinical or radiographic signs of pathology.
the surgeon must make sure that all other sources of pain are ruled out before suggesting surgical removal of the third molar.
Patient must be informed that removal of the third molar may not relieve the pain completely

Contraindication for removal of impacted tooth

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Impacted Mandibular 3rd Molar & other teeth than 3rd molar

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