Management of impacted mandibular third molar /certified fixed orthodontic courses by Indian dental academy

MANAGEMENT OF IMPACTED
MANDIBULAR THIRD MOLAR

www.indiandentalacademy.com

INDIAN DENTAL ACADEMY
Leader in continuing dental education


• IMPACTED TOOTH – DEFINITION
• CLASSIFICATIONS

• CLINICAL EVALUATION
• RADIOLOGICAL ASSESSMENT
– WHARF’S ASSESSMENT
– “WAR” LINES
– PEDERSON’S INDEX
• SURGICAL MANAGEMENT


IMPACTED TOOTH – DEFINITION
• Impacted tooth is one that fails to erupt & will
not eventually assume its anatomical arch
relationship beyond the chronological
eruption date.


PELL & GREGROY’S CLASSIFICATION
• Relationship of teeth to Ramus
• Relative depth
• Long axis of the tooth


PELL & GREGROY’S CLASSIFICATION


Archer (1975) and Kruger (1984).


Quek et al. (2003)
•
•
•
•
•

Vertical impaction (10° to -10°),
Mesioangular impaction (11° to 79°),
Horizontal impaction (80° to 100°),
Distoangular impaction ( -11° to -79°),
Others (111° to -80°)


Int. J. Oral Maxillofac.

Surg. 2003; 32: 548–552

CLINICAL EVALUATION
•
•
•
•
•

Restricted mouth opening
Retrusive mandible
Small oral commissure
Pericoronitis
Adjacent teeth


CLINICAL EVALUATION


RADIOLOGICAL ASSESSMENT
– WHARF’S ASSESSMENT
– “WAR” LINES
– PEDERSON’S INDEX


WHARF’S ASSESSMENT
S. No

Criteria

Category

Score

1

Winter’s

Horizontal

2

classification

Distoangular

2

Mesioangular

1

Vertical

0

1-30mm

0

31-34mm

1

35-39mm

2

Angulation of third

1-50

0

molar

60-69

1

70-79

2

80-89

3

90+

4

2

3

4

Height of mandible

3

Normal

0
1

Enlarged

2

Space available

0

Distal cusps covered

1

Mesial cusps covered

2

Both covered

Path of exit

2

Possibly enlarged

6

1

Unfavorable curvature
Follicles

Complex
Favorable curvature

5

Root shape

3


WAR LINES


PEDERSON’S INDEX


INFERIOR ALVEOLAR NERVE RELATION


SURGICAL MANAGEMENT
•
•
•
•
•
•
•

Anesthesia
Incision & Mucoperiosteal flap
Removal of Bone
Tooth Removal
Wound Debridement
Arrest of hemorrhage
Wound closure

incisions


HORIZONTAL


MESIO ANGULAR


TOOTH DIVISION


WOUND DEBRIDEMENT & SUTURING


BONE & TOOTH REMOVAL
TECHNIQUES
•
•
•
•

Bur technique
Chisel Technique
Split Bone Technique
Lateral Trephination Technique


CHISEL vs BUR
CRITERIA
Chances of fracture of bone

CHISEL & MALLET
Relatively High

BUR
Less Possibility

Healing of Bone

Good

Delayed

Post op Edema

Less

More

Dry Socket
Post op Infection
Deeply buried tooth

Incidence is less

High

Less

More

Difficult to Remove


Relatively Easy

Split Bone Technique
VERTICAL ‘STOP CUT’
AT ANTERIOR END

HORIZONTAL CUT
JUST ABOVE LOWER
END OF ‘STOP CUT’

DISTO LINGUAL BONE
FRACTURED WITH CHISEL
AT AN ANGLE OF 45◦
PARALLEL TO E.O.R

LINGUAL PLATE GRASPED
BY HEMOSTAT

TOOTH ELEVATED


Lateral Trephination Technique
• S shaped incision from retromolar fossa across
external oblique ridge
• Bur used to trephine buccal cortical plate over
3rd molar crypt
• Vertical cut anteriorly & posteriorly


Thank you
Leader in continuing dental education


Management of impacted mandibular third molar /certified fixed orthodontic courses by Indian dental academy

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