Documente Academic
Documente Profesional
Documente Cultură
Outlines
1 2 3 4 Indications for Surgical Extraction Contraindication for Surgical Extraction Multiple Extractions Classification of Impacted Teeth
5
6
Surgical Procedure
Postoperative Management
3) Orthodontic Considerations
Crowding of mandibular Incisors (controversial) Interference of orthodontic treatment/orthognathic surgery
Extremes of age
Removal of tooth bud at early stage is unnecessary Healing response with ageImpacted teeth fully impacted, no communication with oral cavity, no signs of pathology, > age 40
Multiple Extraction
1. Preextraction treatment planning
Dentures, soft tissue surgery, implants
2. Extraction Sequencing:
Maxillary teeth first
Infiltration anesthetic: more rapid Debris may fall into the empty sockets With mainly buccal force more effective use of dental elevators
Multiple Extraction
Summary
1) 2) 3) 4) 5) 6) 7) 8) Upper posterior teeth, leaving the 1st molar Upper anterior teeth, leaving the canine Upper 1st molar Upper canine Lower posterior teeth, leaving the 1st molar Lower anterior teeth, leaving the canine Lower 1st molar Lower canine
Angulation
2
3
Angulation Lower
43% Least difficult 3% More difficult than mesioangular ones 38% Third in difficulty 6% Most difficult
Angulation Upper
63%
25%
12%
Surgical Procedure
1. Gain adequate access through a properly designed soft tissue flap 2. Remove bone as little as possible
A. The bone overlying the O surface of tooth is removed with a fissure bur. B. Bone on the B and D sides of impacted tooth is then removed.
Mesioangular impaction A. B and D bone are removed B. D of the crown is sectioned. Occasionally the entire tooth. C. Small straight elevator into M side, and the tooth is delivered with a rotational and level motion of elevator.
Horizontal impaction A. B and D bone are removed B. Crown is sectioned from the roots. C. Roots are delivered together or independently with a Cryer. D. M root is elevated in similar fashion
Vertical impaction
A. Bone on O, B, D of crown is removed, and the tooth is sectioned into M and D. If fused single rootD of the crown is sectioned off. B. The posterior aspect of the crown is elevated first with a Cryer. C. Small straight no. 301 elevator ito lift M of the tooth with a rotary and levering motion.
Distoangular impaction A. O,B,D bone is removed with more D bone. B. Crown is sectioned off. C. Roots are delivered by a Cryer with a wheel-and-axle motion. If the roots diverge, it may be necessary in some cases to split them into independent portions.
Impacted maxillary third molar A. B bone is removed with a bur or a hand chisel. B. Tooth is then delivered by a small straight elevator with rotational and lever types of motion in DB and O direction.
Postoperative Management
Analgesics
During the first 24 hours, analgesics are prescribed routinely; after this time, they are used only when required. Combination of codeine and aspirin/acetaminophen or NSAID might be suggested.
Antibiotics
Preexisting pericoronitis antibiotics for a few days No preexisting infection antibiotics is not indicated
Anti-inflammatory medication
Steroid or aspirin might be considered.
Post-OP Complications
Trismus
Reaches its peak on the second day and resolves by the end of the first week.
Bleeding
Moist gauze pack ing with pressure Socket packed with oxidized cellulose
Swelling/edema
Corticosteroids Ice packing has no effect on edema Reaches its peak by the end of the second day
Infection (1.7~2.7%)
Debris left under the mucoperiosteal flap
Post-OP Complications
Fracture
Broken root displaced into submandibular space, IAN canal, or maxillary sinus Radiographic follow-up