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Pembimbing : Herman

Hambali, drg Sp.BM

Vera
Mohan

Anatomy
Vascularisation
Inervation
Embriology
Etiology
Clasification
Operation Technik
Complication
Treatment Post Operation

Anatomy

Introduction
An impacted tooth is one that is
partially erupted or unerupted, beyond
the chronological date of eruption, and
will not eventually assume a normal
relationship with the other teeth and
tissues

Vascularization

Innervation

Embriology

E
(a) 9 (b) 11 (c) 14 (d) 16 (e) 24

Etiology
Systemic
Cleidocranial dysplasia
hypothyroidism
hypopituitarism

Local Factors
arch-length deficiency
supernumerary teeth
Odontogenic tumors

Classification

According Archer (1975) and Kruger (1984)

According Pell Gregory

Radiographic evaluation
The ultimate goal :
to determine the location of the
impacted tooth
its relation to the anatomic structure
identification of potential pathologic
findings in that area

Radiographic evaluation

Indications for
third molar removal
recurrent or severe pericoronitis
periodontal disease with a pocket depth of 5 mm or
more
non-restorable caries in the third molar
resorption of the third molar or adjacent tooth
caries in the second molar
apical periodontitis
cysts or tumors associated with the third molar
when required for orthognatic surgery
removal of third molar in a fracture line

Contraindications for third molar


removal
Third molar buds in young people
Asymptomatic and pathology-free
third molars totally covered by
bone/tissue
Patients whose medical history or
conditions expose the patient to an
unacceptable risk to their overall
health.

Ideal requirements of the


flap
Should provide adequate exposure of
the operative site
The base of the flap should be wide
Should not be extended too far
distally
The insision should be design so that
the flap can be closed over solid
bone
The incision should not damage any
of the vital anatomic structures

Technic Operations
Type of incisions
Envelop
L-shaped
Bayonet
Triangular

Envelop flap

Advantages
Easy reapproximation to original
position
Wound heals quickly

L-shaped

Suits only the buccal approach

Triangular flap

Indicated in case where the impacted


tooth is deeply embedded in the bone and
requires extensive bone removal

Bayonet flap

Disadvantage
Overextension of the incision into the
sulcus may cause brisk oozing of the
blood

Bone removal

Tooth sectioning

Complications
Paraesthesia
Pain
Haemorrhage
Hematoma
Dry socket
Facture or luxation of adjacent tooth
Infection
Surgical damage to adjacent structure
Fractured mandible
Retained foreign body
Nerve injury

Medications

Successful outcome
Symptoms and signs have been
eliminated
Tissues have fully healed with no
residual functional deficit

Thank you