Category Archives: Principles of Management of Impacted Teeth


Summary  The three classification systems discussed so far are used in conjunction to determine the difficulty of an extraction. For example, a mesioangular impaction with a class 1 ramus and a class A depth is easy to remove and is essentially the extraction of an erupted tooth (Fig. 9-26): . However, as the ramus relationship changes to a class 2 and the depth of the impaction increases to a class B, the d

Relationship to Anterior Border of Ramus

Relationship to Anterior Border of Ramus Another method for classifying. impacted mandibular third molars is based on the amount of impacted tooth that is covered with the bone of the mandibular ramus .• This classification is known as the Pell and GregQIJ’classification and is sometimes referred to as the Pell and Gregory classes 1, 2, and 3. For this classification it is important that till surgeon ca


Angulation The first classification system employs a description of the angulation of the long axis of the impacted third molar _vith respect to the 19n9 axis of the second molar. Because teeth at certain inclinations have ready-made pathways for withdrawal, whereas pathways for teeth of other inclinations require the removal of substantial amounts of bone, this classification system provides an initial evalu


CLASSIFICATION SYSTEM OF IMPATED TEETH Removal of impacted teeth can be either extremely difficult or relatively straightforward and easy. To determine the degree of difficulty preoperatively, the surgeon should examine the patient methodically. The primary factor determining the difficulty of the removal is accessibility. Accessibility is determined by the case of exposing the tooth, of preparing a pathway to


Summary The preceding discussion of indications and contraindications for the removal of impacted third molars has been designed to point out that there are various risks and benefits for removing impacted teeth in patients. Patients who have one or more pathologic symptoms or problems should have their impacted teeth removed. Most of the symptomatic, pathologic problems that result from impacted third molars occur

Probable Excessive Damage to Adjacent Structures

Probable Excessive Damage to Adjacent Structures If the impacted tooth lies in an area in which its removal may seriously jeopardize adjacent nerves, teeth, or previously constructed bridges, it may be prudent to leave the tooth in place. When the dentist makes the decision not to remove a tooth, the reasons must be weighed against potential future cornpllcations. For younger patients who may suffer the seque

Compromised Medical Status

Compromised Medical Status Similar to extremes of age, compromised medical status may contraindicate the removal of an impacted tooth, Frequently, compromised medical status and advancing age go hand-in-hand. If the impacted tooth is  symptomatic, its surgical removal must be viewed as elective. If the patient’s cardiovascular or respiratory function or host defenses for combating in ection ‘are

Extremes of Age

Extremes of Age The third molar tooth bud can be radiographically visualized by age 6. Some surgeons think that removal of the tooth bud at age 7 to 9 can be accomplished with minimal surgical morbidity and therefore should be per- ‘formed at this age. However, most surgeons believe that it is ot possible to predict accurately if the forming third molar will be impacted. The consensus is that very early


CONTRAINDICATIONS FOR REMOVAL OF IMPACTED TEETH All impacted teeth should be removed unless specific contraindications justify leaving them in position, Whenthe potential benefits outweigh the potential complications and risks, the procedure should be performed, Similarly, when the risks are great er than the potential. benefits, the procedure should be deferred. Contraindications for the removal of impacted t

Optimal Periodontal Heaiing

 Optimal Periodontal Heaiing As noted earlier, one of the most important indications for .removal of impacted third _ars is to preserve the, f:~nodontal healtl •. A great deal of attennon has been given to the two primary parameters of periodontal FIG.9-10 FIG.9-10 Impaction in atrophic mandible, which may result in jaw fracture during extraction. health after third molar surgery; that is, bone height on the