Category Archives: 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

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

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

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

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

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