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Impaction of Third Molar
Impaction of Third Molar
IMPACTED TEETH
Definition
A tooth which is completely or partially
unerupted & is positioned against
another tooth, bone or soft tissue, so that
further eruption is unlikely, described
according to its anatomic position.
Etiological theories
1. PHYLOGENIC THEORY --
Civilization has eliminated the human
need for large & powerful jaws which
leads to decreases the size of jaws. Due
to this IIIrd molar occupies an abnormal
position & may be consider a vestigial
organ( with out purpose or function).
. 2. MENDELIAN THEORY
HERIDIETRY OR GENETIC INFLUNCE LEADS TO SMALL
JAWS & RESULTING IMPACTED TEETH.
3.ENDOCRINE THEORY
Due to lack of function of anterior lobe of pituitary gland,
leads to hampering the growth of jaws.
4. PATHOLOGICAL THEORY
As a result of early diseases of adjacent molars leads to
existence of osteosclerosis in IIIrd molar area.
4. ORTHODONTIC THEORY
• Supported by constricted & narrowed
dental arches of early mouth breathers
• Depend on Position & alignment of
permanent teeth.
Causes of Impaction
LOCAL CAUSES --
1.Irregularity in position & pressure of an
adjacent tooth.
2. Density of overlying or surrounding
bone.
3.Long continued chronic inflammation
with resultant increase in density of
overlying mucous membrane.
4. Premature loss of primary teeth.
Systemic causes
• Prenatal Cause :-
Heredity
• Post Natal Cause – Rickets, Anemia
• Congenital Syphilis ,Tuberculosis, Malnutrition,
endocrine dysfunction.
• RARE CONDITION –
Cleidocranial dysostosis
Oxycephaly (Steeple head-pointed head)
Progeria - Premature old age
Achondroplasia (Cartilage fails to develop)
Cleft Palate
INDICATIONS
1 Recurrent pericoronitis – 70 – 80% of
patients are adults with impacted teeth.
2 Root resorption – It may occur due to
pressure effect from 3rd molar to 2nd
molar.
3.Caries or periodontal
problems-It occurs in impacted
teeth
4 Recurrent infection around pericoronal flap may lead
to TMJ problems
impacted teeth
– Dense bone
– Last to erupt
CLASSIFICATION
• Angulation
age group.
3. Facial form:
1. swelling
3. submandibular lymphadenopathy
parasthesia
5. Intraoral:
1. mouth opening
appearance.
should be visible.
Occlusal films:
plate
• Lateral oblique projection
ASSESSEMENT
1. TECHNIQUE
2. TYPES OF IMPACTION
2. Periodontal disturbances
Contd-
6. POSITION AND DEPTH – George Winter
1. WHITE LINE: - represents the occlusal plane
a) Joining the white enamel caps of the erupted
molars it is extended posteriorly over the 3rd molar.
b) The maximum contour of the impacted tooth and its
relation to the white line will indicate the relative
depth of its location.
2. AMBER LINE: - represents the bone level, distal to the 3rd
molar and extended anteriorly along the crests of
intrdental septum between the molars. Represents the
amount of bone covering the impacted tooth which will
have to be removed
Red line
6. BUCCOVERSION AND LINGUOVERSION:
2. Number of roots
hypercementosis
1. Individuals
2. Age
3. Sex
4. Systemic constitution
9. RELATIONSHIP WITH INFERIOR ALVEOLAR
CANAL: if root apices closely related to the canal
then warn patient about possible impairment of
labial sensations, and better to use tooth division
technique.
RELATIONSHIP OF THE ROOT TO THE CANAL
i. Seperated
ii. Adjacent
iii. Superimposed
b) Related to changes in the roots
c) Diverted canal
DARKENING OF
ROOT
DARK AND BIFID
APEX OF ROOT
NARROWING OF
ROOT
DEFLECTION OF
ROOT
INTERRUPTION
OF WHITE LINE
OF CANAL
NARROWING OF
THE CANAL
DIVERSION OF
THE CANAL
10. OTHER RADIOGRAPHIC TECHNIQUES:
OCCLUSAL VIEW
MODIFIED WARD’S
L – SHAPED INCISION
BONE REMOAVAL
• CHISEL MALLET
• Tooth lock
adjacent tooth)
ROTARY CUTTING INSTRUMENTS
• 1000 – 30, 000 RPM
• Straight hand piece – optimal control
• Plentiful irrigation- to prevent rise in temperature
as, as little as 10 degrees – lethal to osteocytes
• round burs –
• versatile and efficient
• difficult to control lateral cuts
• once bur head is inside bone difficult to gauge
depth
• fissure burs:
• cut neatly and precisely in lateral direction
• less good at cutting than round bur
• greater feel than round bur
• burs can be used to:
• drilling bone around the tooth or tooth root on
the buccal side – buccal guttering – to make
space for elevator
• bone is shaved off or block of bone outlined
and removed, then tooth or tooth root is
removed (postage stamp method).
BUCCAL GUTTERING
CHISEL AND MALLET
6. Parasthesia / anaesthesia
7. Trismus
9. Infection
11.Emphysema