Home » Principles of Management of Impacted Teeth
PERIOPERATIVE PATIENT MANAGEMENT
The removal of Impacted third molars is a surgical procedure that is associated with a large amount ‘of patient anxiety. In .addition, this surgical procedure can involve-unpleasant noises and sensations. As a result, surgeons who routinely perform surgical removal of impacted
third molars com monly recommend to their patientssome type of profound anxiety control such as a
SURGICAL PROCEDURE
The principles andsteps for removing impacted teeth are the same as for other surgical extractions. Five basic steps make up the technique: The first’ step is to have adequate exposure of the area of the impacted tooth. This means that the reflected soft tissue flap must be of an adequate dimension to allow the surgeon to retract the soft tissue and perform the necessary surgery. The
DIFFICULTY OF REMOVAL OF OTHER IMPACTED TEETH
most commonly impacted tooth is the maxillary canine. If the patient seeks orthodontic care, the orthodontist will frequently request that the maxillary canine simply have the overlying soft and hard tissue removed so that the tooth can be manipulated into its proper position byorthodontic appliances. When the tooth is positioned in such a way that orthodontic
MODIFICATION OF CLASSI FICATION SYSTEMS FOR MAXILLARY IMPACTED TEETH
The classification systems for the maxillary impacted third molar are essentially the same as for the impacted mandibular third molar, However, several distinctionsand additions must be made to assess more accurately the difficulty of removal during the treatment-planningphase of the procedure. oncerning, angulation, the three types of ma
Nature of Overlying Tissue
The preceding-systems all classify factors that make third molar extraction easier or more difficult. The classification system discussed in this section does not fit into this category. However, it is the system used by most dental
insurance ‘companies and the one by which the surgeon charges for his
f-I~. ? 35 A, Radioqrephic view of mandibuiar th!rd molar suggests that It IS
Relationship to Inferior Alveolar Nerve
Impacted mandibular third molars frequently have roots that are superimposed on the inferior alveolar canal on radiographs. Although the canal is usually on the buccal aspect of the tooth, it is in close proximity to the tooth. Therefore one of the potential sequelae of impacted thirdmolar removal is damage to or bruising of the inferior alveolar nerve. This usually res
Contact with Mandibular Second Molar
If space exists between the second molar and the impacted third molar, the extraction will be easier, However, if the tooth is a mesioangular or horizontal impaction, it is frequently in direct contact with the adjacent second molar. To
remove the third molar sa fely without injuring the second• molar, the surgeon must be cautious with pressure from elevators or with the
Density of Surrounding Bone
The density of the bone surrounding the tooth plays a role in determining the difficulty of the extraction. Although some clues can be seen on the radiographs,variations in radiograph density and angulation render interpretations based on radio graphs unreliable. Bone densityis best
who are 18 years of age or younger have bone densities favorable for tooth removal. The bone is
Size of Follicular Sac
The size of the follicle around the impacted tooth can help determine the difficulty of the extraction. If the follicular sac is wide (almost cystic in size), much less bone must be removed, which makes the tooth easier to extract
(Fig. 9-34). (Yo ung patients are more likely to have. large follicles, which is another factor that makes extractions easier in younger patients.) However,
ROOT MORPHOLOG Y
.’Just as the root morphology of the erupted tooth has a major influence on the degree of difficulty of a closed extraction, root morphology plays a major role in determining the degree of difficulty of the impacted tooth’s removaL Several factors must be considered when assessing the morphologic structure of the root The first consideration is the length of the root. As discussed
