Management, Indication, Contraindication

1. Management for mandibular 3rd molar impaction

2. 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

3. distoangular impaction PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY 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

4. 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 PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY Second Edition

5. Vertically impacted PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY 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.

6. Mandibular 3rd molar removal!

7. Impaction of teeth other than 3rd molar

8. Impaction of teeth other than 3rd molar Etiology

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

10. Management for impacted tooth other than 3rd molar

11. 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

12. Palatally impacted canines PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY Second Edition Labially impacted canine exposed important part of this surgical procedure using an apically repositioned flap

14. 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

15. Third molar in path of second molar eruption

16. 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) PETERSON‘S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY Second Edition

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

18. * Molar tooth  similar to 3rd molar!

19. Indication for removal of impacted tooth

21. Usually mandibular – partially erupt

22. Microbes :Peptostreptococcus, Fusobacterium, and Bacteroides(Porphyromonas)

23. 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

24. 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!

25. iii. OrthodonticConsiderations

28. Most cases - adjacent tooth recalcified (deposition of a cementumover the resorbedarea) & formation of 2odentin.

31. An impacted third molar -  resistance to fracture in mandible  common site for fracture

33. the surgeon must make sure that all other sources of pain are ruled out before suggesting surgical removal of the third molar.