IMPACTION

CONTENTS
• INTRODUCTION

• DEFINITIONS

• ORDER OF FREQUENCY OF IMPACTED TEETH

• ETIOLOGY

• PROBLEMS DUE TO RETAINED IMPACTED TEETH

• INDICATIONS FOR REMOVAL

• CONTRAINDICATIONS FOR REMOVAL

 CONTENTS
• IMPACTED 3RD MOLARS
- CLASSIFICATION
- PRE-OP ASSESSMENT
- PRE-OP MANAGEMENT OF IMPACTED TEETH
- SURGICAL TECHNIQUES
- PERIOPERATIVE CARE

• OTHER IMPACTED TEETH

- CANINES
- PREMOLARS
- INCISORS
- 1ST AND 2ND MOLARS

• SURGICAL SIDE-EFFECTS AND COMPLICATIONS

• CONCLUSION

• REFERENCES
INTRODUCTIO
N
 DEFINITIONS
• IMPACTED TOOTH : A tooth which is completely or
partially unerupted and is positioned against another
tooth, bone or soft tissue so that its further eruption is
unlikely, described according to its anatomic position.

• MALPOSED TOOTH : A tooth, unerupted or erupted,

which is in an abnormal position in the maxilla or
mandible.

• UNERUPTED TOOTH : A tooth not having perforated

the oral mucosa.
American society of oral surgeons 1971
ORDER OF FREQUENCY OF
IMPACTED TEETH
• Mandibular 3rd Ms
• Maxillary 3rd Ms
• Maxillary cuspids
• Mandibular bicuspids
• Mandibular cuspids
• Maxillary bicuspids
• Maxillary central incisors
• Maxillary lateral incisors

According to Archer
ETIOLOGY
 THEORIES OF IMPACTION
According to DURBECK, causes can be
discussed under 3 separate theories:

• Orthodontic theory
• Phylogenic theory
• Mendelian theory
• LOCAL CAUSES

Berger lists the following local causes of

impaction :

• Irregularity in the position and presence of

an adjacent tooth.

• Density of the overlying or surrounding

bone.

• Long – continued chronic inflammation with

resultant increase in density of the overlying
mucous membrane.
• Lack of space due to underdeveloped jaws.

• Unduly long retention of the primary teeth.

• Premature loss of the primary teeth.

• Acquired diseases, such as necrosis due to

infection or abscesses and inflammatory
changes in the bone due to exanthematous
diseases in children.
• SYSTEMIC CAUSES
• Prenatal causes
– Heredity
• Postnatal causes
– Rickets
– Anemia
– Congenital syphilis
– T.B
– Endocrine dysfunctions
– Malnutrition
• Rare conditions
– Cleidocranial dysostosis
– Oxycephaly
– Achondroplasia
– Cleft palate
 PROBLEMS DUE TO RETAINED
IMPACTED TEETH

• INFECTION

• Buccinator
• Mylohyoid
• Masseter
• Medial pterygoid
• RISK OF CYST & TUMOR DEVELOPMENT
• Most common age : 20- 25 years.
• Incidence of dentigerous cyst- 1.6% (KEITH,1973)
• Incidence of cyst formation-2.31%(Guven et al,2000)
• Incidence of ameloblastoma – 0.14- 2 %(Shear,1978)
• Risk of surgical morbidity increases with age.

• PAIN
• Risk of mandibular fracture:

• Weak areas : angle,condyle & parasymphysis

region.
• Mechanism: occupy osseous space-decreased
cross-sectional area of bone.
• Frequency of occurrence of mand. angle # is
higher in pts. with ILTMs & that of condylar # is
higher in pts. without it.(Iida & colleagues,2004)
• Absence of unerupted 3rd molars is significantly
associated with higher incidence of condylar
#.More symphysis & condyle combination # in
cases without ILTM.(Zhu et al , 2005)
• Trismus.
• Chronic cheek biting.
• Resorption of adjacent tooth.
• Other complications :
• Ears - Ringing, singing or buzzing sound
• Eye - dimness of vision, blindness, iritis, pain
simulating that of glaucoma
COMMON REASONS FOR 3rd
MOLAR SURGERY
• Pericoronitis(NICE-England,March2000)
• Caries
• Periodontal disease
• Difficult to clean
• To improve access
 MANDIBULAR SAGITTAL SPLIT OSTEOTOMIES:
• Prior to orthognathic surgery :fully formed complete bony
vertical impactions and those who are scheduled for rigid
fixation without maxillomandibular fixation.
1 year prior to the planned orthognathic surgery.
• Simultaneous with orthognathic surgery: teeth whose intra-
operative removal is facilitated by the planned osteotomies
and whose surgical flap design does not compromise the
vascular supply to adjacent dentoalveolar structures may be
extracted intraoperatively.
• Following orthognathic surgery : rarely planned following
SSRO
 Less common reasons
• Associated pathology

• Lone standing molar in edentulous jaw

• Tooth in the line of #:In 1988, Alling stated that

“teeth in the line of fracture may aid in the
stabilization of the fragments, for eg, maintenance
of a tooth or portion of a tooth may prevent
dislocation of a proximal fragment and obviate the
need for open reduction”. He concluded, “--- if,
however, the oral and maxillofacial surgeon judges
a tooth in or near a line of fracture likely to cause a
complication, the tooth should be removed.”
• PROPHYLACTIC REMOVAL
• Controversy
• ‘Asymptomatic’ does not mean ‘risk free’
• Decision should be individualized rather than
generalized.
• Extraction of impacted 3rd molars should be
limited to those teeth with well- defined
medical,surgical or pathologic indications.

• Obscure facial pain

• Resorption of adjacent tooth
INDICATIONS FOR REMOVAL

• Any symptomatic wisdom tooth

• Grossly decayed 3rd molars
• Periodontal disease
• Dentigerous cyst formation or other related
oral pathology
• External resorption of 3rd molar or of 2nd
molar
US national institutes for health (NIH) consensus(published in
1980)
• Orthodontic abnormalities.
The erupting 3rd molar transmits an anterior component
of force down the dental arch that results in a breakdown
in the continuity of contact areas of the incisors and
canines (Weinstein)
3rd molar does not contribute to any irregularity in
malalignment or malocclusion (Stemm)

• Removal of 3rd molar prior to orthognathic

surgery
• Surgery of mandible in the 3rd molar
region

US national institutes for health (NIH) consensus(published in

1980)
According to AAOMS, 1989, indications for
removal of impacted teeth are :

• Infection.
• Non restorable dental caries.
• Compromise of periodontal status of
adjacent teeth.
• Cyst formation.
• Interference with orthodontic treatment.
• Presence of impacted tooth in the line of
jaw fracture.
• Persistent pain of unknown origin.
• Pre-irradiation.
• Resorption of adjacent teeth.
• Proceeding fabrication of adjacent
restorative crowns and dentures.
CONTRAINDICATIONS FOR REMOVAL

According to USNIH, removable is not advisable :

• For patients whose unerupted or impacted 3rd molars

would be expected to erupt successfully and have a
functional role in dentition.

• For those with no history or evidence of pertinent local or

systemic pathology

• Where the medical history makes the removal of 3rd

molars a greater risk to the overall health of the patient
than the benefits world justify
• Where there is an increased risk of
significant complications e.g. a high risk of
permanent inferior alveolar nerve damage
or fracture of the mandible.
• There is no strong indication to extract
symptomatic contralateral or unerupted
maxillary teeth simultaneously if they are
disease free.
II. According to Larry J. Peterson the general
contraindications for removal of impacted
teeth can be grouped into 3 primary
areas :

• Patients age – extremes of age.

• Poor health.
• Surgical damage to adjacent structures.
Local factors
• Radiotherapy
• Teeth in close proximity to tumour
• Acute gingivitis

Systemic factors
• Uncontrolled diabetes
• Pregnancy
• Underlying bleeding disorders
• Acute blood dyscrasias
• Cardiac conditions
• Patients on anticoagulants,steroids,etc.
ABSOLUTE CONTRAINDICATIONS

Acute pericoronitis.

Acute necrotising ulcerative gingivitis.

Haemangioma.

Thyrotoxicosis.
IMPACTED MANDIBULAR 3rd MOLARS
Classification suggested by Pell &
Gregory(1933), which includes portion
of George B Winter’s
classification(1926):
A. Availability of space between 2nd molar and
ramus of the mandible (horizontal plane): 
Class I
There is sufficient space between the ramus of
the mandible & the distal side of the second
molar for the accommodation of the mesiodistal
diameter of the crown of the third molar.
Class II
The space between the ramus of the mandible &
the distal side of the second molar is less than
the mesiodistal diameter of the crown of the third
molar.
Class III
Complete or most of the third molar is located
within the ramus.
• B. Relative depth of the 3rd molar in bone
(vertical plane):
Position A
The highest portion of the tooth is on a level with or above the
occlusal plane.
 
Position B
The highest portion of the tooth is below the occlusal plane, but
above the cervical line of the second molar.
 
Position C
The highest portion of the tooth is below the cervical line of the
second molar.
• C. Long axis of the impacted tooth in relation to the
long axis of the 2nd molar (angulation ; Winter’s
classification):
1.      Vertical.
2.      Horizontal.
3.      Inverted.
4.      Mesioangular.
5.      Distoangular.
6.      Buccoangular.
7.      Linguoangular.
• a>b : mesioangular

• a=b: vertical

• a<b: distoangular
Class I position A Horizontal Class I position B Vertical

Class II position A Vertical Class II position B Distoangular

Class III position C Class III position C horizontal
Mesioangular
SUPERIOR-INFERIOR POSITION OF THE
3RD MOLAR:

• Crown to crown

• Crown to cervix

• Crown to root
.
AAOMS classsification of procedural
terminology :

• Based on the operation performed to

remove an impacted tooth.
• It relates directly to abnormal physical
findings of other classifications.
ADA code on procedures and
nomenclature:
• The American Dental Association (ADA)
Code describes the amount of soft and hard
tissues over the coronal surface of an
impacted tooth.
• These are described as: soft tissue
impactions, partial bony impactions,
completely bony impactions, and completely
bony impactions with unusual surgical
complications.
Combined ADA and AAOMS classifications :
The AAOMS published the ADA coding with
explanations from the AAOMS procedural
terminology, in parentheses, as follows:
• 07220 : Removal of impacted tooth – (overlying)
soft tissue (Impaction that requires incision of
overlying soft tissue and the removal of the tooth).
• 07230 : Removal of impacted tooth – partially bony
impacted (Impaction that requires incision of
overlying soft tissue, elevation of a flap, and either
removal of bone and tooth or sectioning and
removal of tooth.
• 07240 : Removal of impacted tooth – completely
bony (Impaction that requires incision of overlying
soft tissue, elevation of a flap, removal of bone,
and sectioning of tooth for removal).

• 07241 : Removal of impacted tooth – completely

bony, with unusual surgical complications
(Impaction that requires incision of overlying soft
tissue, elevation of a flap, removal of bone,
sectioning of the tooth for removal, and/or
presents unusual difficulties and circumstances.
PRE-OP ASSESSMENT
• HISTORY
chief complaint
history of presenting complaint
medical history
social history

• EXAMINATION
clinical
radiographs

• DECISION
diagnosis
treatment planning
• HISTORY
– Pain and infection associated with partially
erupted teeth.
– Many impacted or displaced teeth are
unerupted and asymptomatic - incidental
finding following radiographic examination.
– Occasionally, unerupted wisdom teeth, in the
absence of any obvious infection, can give
rise to discomfort .
• It is important to exclude other possible
causes such as TMJ pain and pulpitis /
periapical abscess from another tooth
CLINICAL EXAMINATION

• Compliant : Pain, exclude other causes

such as TMJ disorder, pulpitis/abscess of
other teeth.
• Previous medical history.
• Dental history.
• Extraoral features.
• Intraoral features.
HOWES TECHNIQUE TO PREVENT
INFERIOR ALVEOLAR NERVE DAMAGE
• RADIOGRAPHIC EVALUATION

1. To study the relation with adjoining tooth.

2. To study the configuration of the roots &
status of the crown.
3. To know the buccoversion or
linguoversion of Impacted tooth.
4. Shadow of the external oblique ridge.
• If vertical & anterior to the Impacted
tooth – Poor access.
• If oblique & posterior to the Impacted
tooth—Good access.
• PERIAPICAL X-RAYS
FRANK’S TUBE SHIFT TECHNIQUE
 RELATIONSHIP OF INFERIOR ALVEOLAR NERVE TO
THE ROOTS OF THE THIRD MOLAR.

Darkening of root Deflection of root Narrowing of root Dark & Bifid ape
Interruption of white Narrowing of canal Diversion of canal
line of canal
• Radiological signs significantly
related to inferior alveolar nerve
injury are:

1.darkening of the tooth root

2.narrowing of the tooth root
3.diversion of the canal
4.interruption of the white line

JOMS 63:3-7,2005
ARCHER’S MODIFICATION TO PREVENT
INFERIOR ALVEOLAR NERVE DAMAGE
WINTER’S LINES OR WAR
LINES.
• WHITE LINE
• It corresponds to the occlusal plane.
• It indicates the difference in occlusal level of second & third
molars.
• AMBER LINE.
• Crest of the interdental septum
• This line denotes the alveolar bone covering
the impacted tooth & the portion of the tooth
not covered by the bone.
• RED LINE.
• It indicates the amount of bone that will have
to be removed before elevation i.e. the depth
of tooth in bone & the difficulty encountered
in removing the tooth.
• Length more than 5mm - extraction is
difficult.
• Every additional millimeter renders the
removal of the Impacted tooth 3 times more
difficult.
• OPG-existence of a positive radiographic
sign may indicate a true relationship b/w
ILTM & mand. canal(Diaz- Torrez et al
1990 & Felez- Gutierrez et al 1997)

• Conventional tomography- technique of

choice for verifying existence of a close
relationship b/w ILTM & mand.
Canal(Miller et al,1990 & Kaeppler,2000)
• Facial x-rays
lateral oblique views
• CT-gold standard
• Other imaging techniques
xeroradiography
dentascans
intra-oral cameras
magnetic resonance imaging
FACTORS RESPONSIBLE FOR INCREASING
THE DIFFICULTY SCORE FOR REMOVAL OF
IMPACTED 3rd MOLARS
1. Difficult access to the operative field:
a. Small orbicularis oris muscle.
b. Inability to open mouth wide enough.
c. Trismus.
d. OSMF.
e. Macroglossia.
2. As per the angulation.
3. As per the depth.
4. As per the space available for the eruption.
5. Dilacerated roots.
6. Hypercementosis.
7. Extremely dense bone.
8. Proximity to mandibular canal.
9. Ankylosed impacted tooth.
10. Large bulbous crown.
11. Long slender roots.
DIFFICULTY INDEX FOR REMOVAL
OF IMPACTED LOWER 3rd MOLARS
• Class I – 1
• Class II – 2
• Class III- 3

 
• Mesioangular - 1
• Horizontal – 2
• Vertical - 3
• Distoangular - 4
 
  Position A - 1
 Position B - 2
 Position C - 3

INTERPRETATION:

• Relatively difficult: 3-4

• Moderately difficult: 5-7
• Very Difficult : 7-10
WHARFE’S ASSESSMENT
1. Winter's classification
Horizontal 2
Distoangular 2
Mesioangular 1
Vertical 0
2. Height of mandible
1-30mm 0
31-34mm 1
35-39mm 2
3.Angulation of 3rd molar
1- 59° 0
60 -69° 1
70 -79° 2
80 -89° 3
90° & above 4

4. Root shape- Root development

a) Less than 1/3 complete 2
b) 1/3 to 2/3 complete 1
c) More than 2/3 complete:
Favourable curve 1
Unfavourable curve 2
Complex 3
5.Follicle
Normal 0
Possibly enlarged -1(NEGATIVE)
Enlarged -2(NEGATIVE)
Impaction relieved -3(NEGATIVE)
6. Path of exit
Space available 0
Distal cusp covered 1
Mesial cusp covered 2
Both covered 3

TOTAL SCORE 33
 PRE-OP MANAGEMENT
• First visit – consultation
– Thorough review of medical history.
– Good quality diagnostic x-rays (OPG is
preferred).
– Review all risks of procedures.
– Review all post surgical home care
instructions.
– Review surgical procedure utilizing
teaching aids.
– Discuss and evaluate need for sedation.
• Give patient prescriptions for analgesics and antibiotics
• Surgical visit
– Have patient sign consent form.
– Surgical equipment should be readily
available.
– Suture material available and on surgical tray.
Basic instruments

• For cheek retraction and visualization of

surgical site  mouth mirror, wide
retractor.
• For incisions – scalped handle with no. 15
blade.
• Flap development and reflection – no. 9
periosteal elevator, Woodson, Molt.
• Flap retraction – wide retractors.
• Bone removal – handpiece, burs – cross-
cut tapered fissure, nontapered crosscut
fissure, round.
• Luxation and sectioning – straight
elevators, cryer’s.
• Tooth removal – forceps.
• Suture cutting, distal wedge excision,
severing fibrotic tissue – Deans scissors.
• Tying sutures, traction on follicle
removing pieces of tooth – Mayo-hegar
needle holder.
• Suturing material – 4-0 or 3-0 or chromic
gut suture with 3/8 circle reverse cutting
needle.
• Curetting follicle or infection – surgical
spoon curette.
• Suctioning – surgical suction tip,
preferably tapered.
• Irrigation – handpiece, syringe. Medium
– sterile saline or sterile water.
 SURGICAL TECHNIQUE
• GENERAL PRINCIPLES FOR SURGICAL TECHNIQUE OF
IMPACTION REMOVAL
.
• Reflect mucoperiosteal flap to obtain good visual
access.
• Remove labial bone with high speed surgical drill
using round or cross-cut but.
• Expose crown of impaction upto CEJ and make room
to allow for elevator placement.
• Attempt to gently evaluate for motility with elevator.
• Section crown with high-speed surgical handpiece.
Care should be taken to protect the lingual soft tissue
and depth of surgical cut should not be too much.
» Straight elevator should be used to separate
crown from tooth.
» Deliver roots with root tip elevators or crane pick.
» Inspect bony crypt for loose debris and any
bleeding problems and smooth bone margins with
bone file.
» Carefully remove follicular soft tissue and tease it
out from surrounding mucosa.
» Copious irrigation of socket and beneath soft
tissue
» Reapproximate soft tissue flap and close with 3-0 or
4-0 chromic or black silk sutures.
» Consider intraoral injection of steroids if extensive
bone surgery has been performed. 4mg of
dexamethasone can be injected into masseter
muscle on each side
» Evaluate for post surgical bleeding prior to discharge.
flap prior to closure.
 BUCCAL VS LINGUAL APPROACH
Criteria Buccal Lingual

Access Relatively easy in the conscious patient Relatively difficult in the conscious patient

Instruments Chisel and mallet or bur Only chisel and mallet

Procedure Tedious Easy

Operating time Time consuming Less time consuming

Technique Easy to perform, hence traditionally popular Technically difficult, hence not popular among
all dental surgeons

Bone removal Thick buccal plate Thin lingual plate

Postoperative pain Less More due to the damage of lingual periosteum

Postoperative edema Obviously more Less

Dry socket Incidence is high due to the damage of external Incidence is negligible since socket is
oblique ridge eliminated.
INCISIONS AND FLAP DESIGNS
• Distal relieving incision

• Envelop flap

• Buccal extension flap

• Triangular flap
WARDS INCISION MODIFIED WARDS INCISION
MAJOR COMPONENTS OF INCISIONS
 BONE REMOVAL
Aim:
1.      To expose the crown by removing the bone
overlying it.
2.      To remove the bone obstructing the pathway for
removal of the impacted tooth.
Types:1. By consecutive sweeping action of bur(in
layers).
2. By chisel or osteotomy cut(in sections).
How much bone has to be removed?
1. Bone should be removed till we reach below the
height of contour, where we can apply the elevator.
2. Extensive bone removal can be minimized by tooth
sectioning.
 CHISEL VS BUR
Sl.No Criteria. Chisel&Mallet Bur

1. Technique Difficult Easy.

2. Controll over bone cutting Uncontrolled Controlled.

3. Patient acceptance. Not tolerated in Well tolerated in

L.A. L.A.

4. Healing of bone. Good Delayed Healing

5. Postoperative edema Less More.

6. Dry socket. Less. More.

7. Postoperative Infection. Less. More.

       
TECHNIQUES FOR REMOVAL OF
DIFFERENT TYPES OF MANDIBULAR
3rd MOLAR IMPACTIONS
 MOORE/GILLBE COLLAR
TECHNIQUE
– A mucoperiosted flap of standard
design is elevated exposing the
underlying bone.
– A rose-head bur (no.3) is used to
create a ‘gutter’ along the buccal side
and distal surface of the tooth.
– The lingual soft tissue s/b protected
with a periosteal elevator during the
removal of the distolingual spur of
bone
– A mesial point of application is created with
the bur, and a straight elevator is used to
deliver the tooth.
– After delivery of the tooth has been effected,
the sharp bone edges are smoothed with a
vulcanite bur, and the cavity is irrigated.
– The wound is closed with sutures or the
buccal flap is tucked into the cavity and held
against the bone with a pom-pom soaked in
Whitehead’s varnish.
Mesioangular impaction
Horizontal impaction
Vertical impaction
Distoangular impaction
 Split bone technique-Sir William
Kelsey Fry(1933)
INCISION
VERTICAL STOP
CUT

HORIZONTAL
CUT DISTAL CUT

REMOVAL OF
ELEVATION
DISTAL
& BUCCAL BONE

REMOVAL OF
LINGUAL BONE CLOSURE
 ADVANTAGES:

Faster tooth removal.

Less risk of inferior alveolar nerve damage.
Reduces the size of residual blood clot by
means of saucerization of the socket .
Decreased risk of damage to the
periodontium of the second molar.
Decreased risk of socket healing problems.
 • DRAWBACKS OF THIS TECHNIQUE ARE:
Risk of damage to the lingual nerve.

Increased risk of postoperative infection and greater danger of

spread.

Patient discomfort due to the use of a chisel and mallet for lingual
bone removal or fracturing.

Only suitable for young patients with elastic bone in which grain is
prominent
 MODIFIED LINGUAL SPLIT TECHNIQUE
FOR REMOVAL OF MANDIBULAR
THIRD MOLAR (Dr.DAVIS 1979)

INCISION VERTICAL STOP CUT DISTAL CUT

TOOTH ELEVATION CLOSURE
 LATERAL TREPANATION
TECHNIQUE (BOWDLER HENRY).

Flap design Bone removal Tooth sectioning

ADVANTAGE
• Partially formed unerupted 3rd molar can
be removed.
• Can be preformed under general or
regional anesthesia with sedation.
• Post-op pain is minimal.
• Bone healing is excellent and there is no
loss of alveolar bone around the 2nd
molar.
DISADVANTAGE
• Virtually every patient has some post
operative buccal swelling for 2-3 days after
surgery
SURGICAL CLOSURE
1) Wedge removal
2) Debridement
3) Intra-alveolar
dressings
4)Closure of soft
tissue flap
5) Intraoral
dressings
• SOFT TISSUE IMPACTIONS
OTHER IMPACTED TEETH
MANDIBULAR CANINES
• CLASSIFICATION-

1.LABIAL
• Vertical 2.ABERRANT
• At inferior border
• Oblique
• On the opposite
• Horizontal
side
Vertically impacted canine
PREMOLARS
• Vertically impacted 2nd premolar
• Horizontally impacted 2nd premolar
• Unerupted 2nd premolar with dentigerous
cyst
• Impacted 1st premolar
1 AND 2 MOLARS
st nd

• Rarely impacted
• Raise a buccal flap, remove bone and
carry out vertical section of the tooth in
order to facilitate its extraction.
• 1st molars are sometimes found vertically
placed near the lower border of the
mandible.
 SURGICAL SIDE-EFFECTS AND
COMPLICATIONS
Intra operative complications:

1. During incision
a.Injury to facial artery.
b.Injury to lingual nerve.
 
2. During bone removal
a. Damage to second molar.
b. Slipping of bur into soft tissue & causing
injury.
c. Fracture of the mandible when using chisel &
mallet.
 3.DURING ELEVATION OR TOOTH REMOVAL

a. Luxation of neighbouring tooth.

b. Soft tissue injury due to Slipping of elevator.
c.  Injury to inferior alveolar neurovascular
bundle.
d. Fracture of mandible.
e. Forcing tooth root into submandibular space
or inferior alveolar canal.
f. Breakage of instruments.
g. TMJ Dislocation.
POST OPERATIVE
COMPLICATIONS:

a. Dry socket.
Incidence-3%(Heasman,1987)
Predisposing factors-smoking,pre-
existing infection,birth control
medication,extensive bone removal.
b. Pain.

c. Trismus.

d. Infection

e. Swelling.
f. Paresthesia of Lingual or Inferior
alveolar nerve.
-Over 96% of pts with IAN injury & 87%
of those with lingual n. injuries recover
spontaneously (Alling)
-Spontaneous recovery-
9months(Mozsary,1987)
CONCLUSION
REFERENCES
– Impacted teeth – Charles C. Alling
– Handbook of 3rd molar surgery- George
Dimitroulis
– Peterson’s Principles of oral and maxillofacial
surgery, 2nd edition, vol. 1.
– Textbook of oral and maxillofacial surgery, vol.
2, Laskin.
– Textbook of oral and maxillofacial surgery-
Kruger
– Oral and maxillofacial surgery-Archer
– Surgery of the mouth and jaws-Moore
• Journals :

• JOMS 1995;53:1178-1181.
• JOMS 2006;64:94-99
• JOMS 2005;63:1443-1446
• OOO 2001;92:377-83
• OOO 2006;102:448-52
• OOO 2006;102:300-6
• JOMS 2006;64:1371-1376
• OOO 2006;102:154-8
• JOMS 2005;63:3-7