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Definition
is a tooth that fails to erupt into its normal functioning position in the dental arch within the expected time.
Etiology
A-Systemic Causes :
(B)Local Causes
(1) prolonged deciduous tooth retention (2) malposed tooth germ (3) arch length deficiency (4) odontoginic tumors abnormal eruption path (5) cleft lip and palate(rarly) . (6) special for upper canine(Palatal barrier,narrow M-D length )
Frequency of impaction
1. mandibular 3rd molar 2. maxillary 3rd molar 3. maxillary cuspid Theteeth is as follow:4. mandibular cuspid 5. Mandibular premolar 6. maxillary premolars 7. maxillary central and lateral incisors
Evaluation
1.
2.
Include clinical inspection to disclose tooth not in position or absent in place and radiographic assessment Showing the unerupted position of the tooth. Standard radiographic techs used to localize the unerupted teeth, these include:
The tube shift method Periapical & occlusal films Panoramic view CT
(1)Pericoronitis
D. Ro(3) Resorption
Ameloblastoma
2. 3.
A - Relation of the tooth to the ascending ramus of the mandible and to the distal surface of the 2nd molar: (Pell &Gregory) this show the anterioposterior relationship of the tooth to the arch and the amount of resistance offered by the bone of the ascending ramus that may influence the tooth removal
Class I
the space between the anterior part of the ascending ramus and the distal surface of the 2nd molar is sufficient to accommodate the mesiodistal diameter of the crown of the third molar.
Class II
the space between the anterior part of the ascending ramus and distal surface of the 2nd molar is less than the mesiodistal diameter of the crown of the third molar (part of the tooth located within the ramus)
Class III
all the third molar is located within the ascending ramus of the mandible.
C - the position of the long axis of the impacted tooth in relation to the long axis of the 2nd molar (winter's classification): 1-vertical: the long axis of the third molar is parallel to that of the 2nd molar. 2-horizontal: the long axis of the third molar is at right angle to that of the 2nd molar . 3-mesioangular impaction. 4-destoangular impaction:
all the previous four classes can come in:
5-inverted impaction
1- Proper radiographic and clinical evaluation of the condition: A- periapical radiograph B- occlusal radiograph C- panoramic radiograph 2- Classification of impaction to help in planning the surgical procedure: 3- Selection of the time for surgical procedure:
surgical removal of impacted third molar is not as a surgical emergency, it is an elective procedure which shouldn't be postponed for along period of time until several complication arises.
4- The condition should be explained to patient in a simple easy way directing his attention to possible complication that may arise from leaving tooth in position 5- Surgical removal can be made under local anesthesia as well as general anesthesia the choice of the anesthetic technique depends on:
a- general condition of the patient and his ability psychologically and physically take the procedure. in very apprehensive patient, general anesthesia is preferred. b- position of impaction and extent of surgical procedure c- patient co-operation d- number of impaction that will be removed in the setting
with palatally impacted maxillary cuspid - exposure of the field of surgery can be done by gingival incision extending from the palatal side of premolar in one side to other side all around the palatal gingiva of the present teeth.
2- bone removal
This is done for :A- exposure of impaction B- reduction of resistance C- making a point for application of the elevator
3- tooth delivery
1- total delivery by application of force using elevators:
a- mesial application of force :straight elevators and pot's elevators. b- buccal application of force :winter elevator
Bone is removed with the surgical bur to expose the whole crown
A purchase point is prepared in the root, which is then removed with an elevator
4- fracture of tuberosity:
this occurs with erupted rather than unerupted tooth due to improper use of force
d- pushing of impacted tooth into maxillary sinus: e- pushing of impacted maxillary molar into pterigopalatine fossa:
- uncontrolled mesial application of force in deep impaction
post operativecomplication:
1. 2. 3. 4. pain. infection heamoraghe anesthesia or parenthesis of the lingual or inferior alveolar nerve trismus,limitation of jaw movement osteomylitis pain at tmj pain on swallowing due to edema of pharynx and hematoma formation.
5. 6. 7. 8.
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