Impacted

Tooth
by:
drg. Surijana Mappangara, M.Kes, Sp. Perio
Definition
(IMPACTED TEETH)
ARCHER
A tooth that is entirely or partially
unerupted is positioned opposite of another
tooth, bone or soft tissue.
FIELDMAN
An abnormally erupted tooth that did not
follow its normal eruption pattern in the dental
arch
DORLAND’S DICTIONARY
Tooth that is within the alveolar in which its
eruption and position is locked within the
bone
 Definition and Morphological Limitation
Definition:
Impacted teeth are teeth that
have difficulty/failed to
erupt, caused by
malposition, lack of space or
obstruction by other teeth,
covered with thick bone
and/or surrounding soft
tissue.
Morphological
Limitation:
Complaints or
complications that can be
caused by impacted teeth,
including: inflammation,
pain, cyst formation,
pericoronal infection,
abscess, osteomyelitis,
etc.
 Terminologies
IMPACTED

MALPOSED

UNERUPTED

ERUPTIO DIFFICILIS

IMPACTED TEETH = RETAINED TEETH

 Frequency
• Mandibular third molar
• Maxillary third molar
• Maxillary canines
• Mandibular premolars
• Mandibular canine
• Maxillary premolars
• Maxillary central incisor
• Maxillary lateral incisor
• Maxillary and mandibular first molars are rarely
impacted.
 Etiology
BERGER
 Local Etiology
Crowded teeth
Bone Density
Chronic Inflammation

Premature extraction
Retained deciduous tooth
Change in bone structure due to childhood systemic condition

Infection or Abscess
13256_2014_Article_2965_Fig1_HTML.webp

Impacted canine on child with cretinism

Systemic Etiology
- Heredity
- Miscegenation

- Rickets
- Anemia
- Congenital syphilis
- Tuberculosis
- Endocrine dysfunction
- Malnutrition
Oral manifestations of children with rickets
 ORAL IMPLICATION OF ANEMIA. Dr. Priya Verma (Professor),
Department of Pedodontics and Preventive Dentistry, K.D. Dental
College & Hospital Mathura, U.P. India

Clinical manifestations of patients with sickle cell anemia

Clinical manifestations of patients with congenital syphilis
 Other Berger Etiology
Other rare circumstances:
- Cleidocranial dysostosis
- Oxycephalis = Steeple head
- Progeria
- Achondroplasia
- Palatal cleft
Clinical manifestations of patients with
Cleidocranial dysostosis/ cleidocranial
dysplasia
 Other Etiology
Gradual evolutionary reduction of the size of the
mandible and maxilla in humans, so that the
jawbone is reduced to accommodate the third
molars.

This can be caused by:

•- Congenital agenesis of the third molar
•- Rudimentary third molars
•- Other dental malformations.
 Other Etiology

NODINE DEWEL

Stimulus for The bone in the

hard palate is The length of the
bone growth distance that must
is reduced more resistant
than the alveolar be traveled by the
due to bone, so the upper tooth from its
nutrition canines tend to place of growth
erupt palatally. to normal
occlusion
 Impaction Classification
LOWER THIRD MOLARS

George B. Winter, G.J. Pell

Archer (1975)
& G. Gregor
Lower M3 relation to
mandibular ramus and Impacted tooth curvature
Lower M2
Depth of M3 in the jaw
The relation of the impacted
tooth to the occlusal surface
Pell & Gregory (1993)

The apex/root of the tooth is

Long axis/lower M3 & lower impacted on the mandibular
M2 axis canal
MANDIBULAR ANATOMY
MANDIBULAR ANATOMY
 LOWER M3 CLASSIFICATION
Classification According to George B. Winter, G.J.
Pell & G. Gregor:
MANDIBULARY THIRD MOLARS
A. Based on the relationship of the lower third
molars with the mandibular ramus and lower second
molars:
Class I, the distance between the distal second lower
molar and mandibular ramus is quite wide
mesiodistal lower third molar
Mandibular Mandibu Mandibular
2nd Molar Ramus lar 2nd Ramus Ramus
2nd Molar
Molar
 LOWER M3 CLASSIFICATION
Classification According to George B. Winter, G.J.
Pell & G. Gregor:
MANDIBULARY THIRD MOLARS
B. Based on the relationship of the lower third
molars with the mandibular ramus and lower second
molars:
Class II: The distance between the distal second
lower molar and mandibular ramus is less than the
mesiodistal width of the lower third molar

Mandibular Mandibular
2nd Molar Ramus Mandibular Ramus Ramus
2nd Molar 2nd Molar
 LOWER M3 CLASSIFICATION
Classification According to George B. Winter, G.J.
Pell & G. Gregor:
MANDIBULARY THIRD MOLARS
C. Based on the relationship of the lower third
molars with the mandibular ramus and lower second
molars:
Class III Lower third molars are located within the
mandibular ramus

Mandibular Ramus Mandibular Ramus Mandibula Ramus

2nd Molar 2nd Molar r 2nd Molar
 LOWER M3 CLASSIFICATION
B. Based on the depth of the
impacted lower third molar in Mandibular
2nd Molar
Ramus

the jaw:
Position A: The highest part of
the impacted lower third
Mandibular Ramus
molar is the same as the 2nd Molar

occlusal plane of the second

lower molar.
Mandibular Ramus
2nd Molar
 LOWER M3 CLASSIFICATION
B. Based on the depth of the
Mandibular
impacted lower third molar in 2nd Molar
Ramus

the jaw:
Position B: The highest part of the
impacted lower third molar is Mandibular Ramus

located below the occlusal 2nd Molar

plane of the second lower

molar, and above the cervical
line of the second lower molar. Mandibular Ramus
2nd Molar
 LOWER M3 CLASSIFICATION
B. Based on the depth of the
impacted lower third molar in Mandibular
2nd Molar
Ramus

the jaw:
Position C: The impacted lower
third molar is below the Mandibular Ramus

cervical line of the second 2nd Molar

lower molar

Mandibular Ramus
2nd Molar
 LOWER M3 CLASSIFICATION
Gambar 2 : Klasifikasi dari impaksi molar ketiga mandibula menurut Pell dan
Gregory (1933):
Mandibular 2nd Molar Mandibular 2nd Molar Mandibular 2nd Molar

Based on impaction depth and relationship to the mandibular second molar;

Ramus Ramus Ramus

The position of the mandibular third molars was based on the distance between the
mandibular second molars and the anterior border of the mandibular ramus
 LOWER M3 CLASSIFICATION
C. Based on the long axis of the lower third molar impaction with
the long axis of the lower second molar:
1. Vertical position: Impacted teeth are normal/upright/vertical
2. Horizontal position: Impacted teeth are flat/asleep/horizontal
3. Inverted position: Impacted teeth are reversed
4. Mesioangular position: Leaning/tilted mesially
5. Distoangular position: Leaning/tilted distally
6. Buccoangular position: Leaning / tilted to the buccal
7. Linguoangular position : Leaning/tilted to the lingual
8. Unnusual position: Horizontal and located far to the distal from
where it should be
9. Besides that, it can also occur: Buccal version, Lingual version,
Torso version.
 LOWER M3 CLASSIFICATION

Figure 3: Classification of mandibular third molars based on Archer (1975) and

Kruger (1984): (1) Mesioangular, (2) distoangular, (3) vertical, (4) horizontal,
(5) buccoangular, (6) linguoangular, (7) ) inverted.
 LOWER M3 CLASSIFICATION
D. Based on the curvature of the impacted tooth
- Roots of impacted teeth are straight but separated/fused
- Roots of impacted teeth are straight and gather together
- Impacted tooth roots are bent/curved (distally / mesially)
E. Based on the relation of the impacted tooth to its occlusal
surface:
- High Level: The highest part of the impacted tooth close to
the occlusal surface (eg partially erupted teeth)
- Low Level: Highest part of the impacted tooth away from
the occlusal surface (eg deeply erupted teeth)
 LOWER M3 CLASSIFICATION
F. Based on the root/apex relation of the
impacted tooth to the mandibular canal:
1. The root apex of the impacted tooth is above
the mandibular canal.
2. The root apex of the impacted tooth encircles
the mandibular canal.
3. The root apex of the impacted tooth on the
lingual side of the mandibular canal
 Upper M3

Depth of Upper M3 Impaction

Archers (1975)
Based on the depth of the
impaction of M3 on the upper M2

Relation of the longitudinal axis of

impacted Upper M3 & Upper M2

Upper M3 impaction & maxillary

sinus relation
 UPPER M3 CLASSIFICATION
MAXILLARY THIRD MOLARS
A. Based on the depth of the impacted upper third
molar:
Class A: The lowest part of the crown of an impacted
upper third molar lies on/or above the occlusal line of
the upper second molar.
Class B: The lowest part of the crown of the impacted
upper third molar between the occlusal and cervical
lines of the upper second molar.
Class C: The lowest part of the crown of the impacted
upper third molar lies at/above the cervical line of the
upper second molar.
 UPPER M3 CLASSIFICATION
Figure 5: Classification of impacted maxillary third molars according to
Archer (1975), based on the depth of impaction of the maxillary third
molars on the maxillary second molars
 UPPER M3 CLASSIFICATION
B. Based on the longitudinal axis of the impacted
upper third molar in relation to the axis of the upper
second molar:
• vertical Impaction,
• horizontal,
• mesioangular,
• distoangular,
• inversion,
• buccoangular,
• linguoangular,
• besides that buccoversion, linguoversion and
torsoversion can occur
 UPPER M3 CLASSIFICATION

Figure 4: Classification of impacted maxillary third molars according to

Archer (1975): (1) mesioangular, (2) distoangular, (3) vertical, (4)
horizontal, (5) buccoangular, (6) linguoangular, (7) inverted
 UPPER M3 CLASSIFICATION
C.Based on the relationship between the impacted
upper third molar and the maxillary sinus:
1. Sinus approximation (SA): No bone or a thin layer
of bone between the impacted tooth and the
maxillary sinus
2. No sinus approximation (NSA): there is 2 mm or
more of bone between the impacted tooth and the
maxillary sinus
Figure 6 :
Sinus approximation, there
is no bone or there is a thin
layer of bone between the
impacted tooth and the
maxillary sinus

Figure 7: No sinus
approximation, there is
bone 2 mm thick or more
between the impacted teeth
and the maxillary sinus
 Classification

Upper C Lower C

Class 1
Labial Position

Class 2 Abnormal
Position

Class 3

Class 4
 UPPER C CLASSFICATION
• Class I • Class II
Located on the palatal Located in the labial /
position horizontal, buccal position
vertical and semi-vertical horizontal, vertical and
semivertical

Figure 9: Class II canine impaction

Figure 8: Class I canine impaction

 UPPER C CLASSFICATION
• Class III • Class IV
The crown is located in the Located on the alveolar
labial/buccal position and process, vertically
the root is palatinal or vice between the upper
versa = incisors and the upper
interlocking/intermediate first premolars
position

Gambar 11 : Impaksi kaninus kelas IV

Gambar 10: Impaksi kaninus kelas III
 LOWER C CLASSFICATION
LOWER CANINUS
Labial position: - Impacted teeth are vertical
- Impacted tooth lies oblique
- Impacted teeth are horizontal
Unusual positions:
- Impacted teeth are located on the lower edge
of the mandibular body
- Impacted teeth are located on the mental
protuberant
- Impacted teeth are located on the opposite
side / contralateral
 Management
of

Impacted
Tooth

by:
drg. Surijana Mappangara, M.Kes, Sp. Perio
 Management of Impacted Tooth
The management of impacted teeth is divided into:
1. Surgical Management
Operculectomy, which is the removal of the operculum using a
cautery that covers the teeth that are predicted to emerge from
the gingival surface.
Odontectomy is the removal of impacted teeth by surgery (open
method).
2. Non-surgical management, namely not doing or delaying
odontectomy, provided that:
Partial impaction: clean teeth, asymptomatic. The emphasis is on
maintaining good dental and oral hygiene, as well as carrying
out routine dental checkups.
Totalis impaction: be aware of the possibility of dentigerous
cysts control impacted teeth once every 1-2 years
 Management of Impacted Tooth
Surgical management is intended to:
1. Bring the impacted tooth so that it can erupt into its
normal dental arch so that the tooth can function as a good
chewing tool, for example by:
- Surgical eruption and positioning of teeth both
with/without orthodontic treatment
- Transplantation and replantation of teeth where in this case
the impacted tooth can function as a chewing tool
2. Taking impacted teeth from their sockets because these
teeth are considered detrimental if they are not removed
from their sockets (especially partially impacted teeth).
 Odontectomy
DEFINITIONS:
• Removal of teeth that are unerupted/partially erupted
and cannot be removed with forceps and must be
removed by surgical excision.
Odontectomy is the same as the open extraction
method, it only requires the accuracy and skill of the
operator.
 Odontectomy Indications
Odontectomy

Caries Pain

Periodontal Disease Disturbing

Orthodontic
Treatment

Internal and
External Resorption Mandibular
Fracture

Odontogenic Cyst and

Tumour PERICORONITIS
 Odontectomy Indications
1. Caries

A B
Figure 12: (A) Radiographic appearance of caries in an impacted
third molar. (B) Carious radiographic appearance of an existing
second molar due to impacted third molar.
 Odontectomy Indications
2. Periodontal Disease

Figure 13. Radiograph showing severe bone loss around second

molar due to periodontal disease caused by impacted third molar
 Odontectomy Indications
3. Internal and External Resorption

Figure 14 : Radiographic appearance of impacted mandibular

third molars damaging the second molars
 Odontectomy Indications
4. Odontogenic Cyst and Tumour

Figure 15 : A, Dental follicle surrounding the crown of an

impacted third molar. B, Cyst that appears due to the development
of dental follicles that produce fluid.
 Odontectomy Indications
5. Pain

Figure 16: Pain resulting from an impacted third

molar.
 Odontectomy Indications
6. Disturbing Orthodontic Treatment

Figure 17 : Movement of the incisors anteriorly as a result of

impacted third molars movement
 Odontectomy Indications
7. Mandibular Fracture

Figure 18 : Mandibular fracture due to impacted third molar

 Odontectomy Indications
8. Pericoronitis

Figure 19 : Pericoronitis showing swelling and inflammation around the

crown of an impacted tooth, recurring
 Odontectomy Indications

A. Infe B. Damaging Neighbouring C. Cyst

Teeth
Figure 20 : Complications that can arise from
partially impacted teeth (images A and B) and
totally impacted teeth (images C)
 Odontectomy Contradications
1. Extreme Age

A. 12 Years B. 14 years C. 17 years D. 25 years

Gambar 21 : Perkembangan gigi impaksi menurut umur pasien

2. Health status at risk

- Cardiovascular dysfunction
- Respiratory dysfunction
- Body endurance
3. Damage to adjacent structures
 Impacted Tooth Diagnosis
• The diagnosis of impacted teeth is based on:
History, clinical examination, radiographic
examination and classification.
- For partially impacted teeth (Partially eruption
teeth) detected by clinical examination.
- For full/total impacted teeth (Deeply embedded
teeth) detected by radiographic examination.
• Radiographic examination of impacted teeth
should be done from two projection directions that
are perpendicular to each other to see clearly their
location and position relative to the surrounding
tissue.
Figure 22: Panoramic radiograph showing
impacted third molar.
 FACTORS THAT MUST BE CONSIDERED IN
TREATMENT OF IMPACTED TEETH:
1. X-ray: morphology and relationship of neighboring teeth
impacted teeth
2. Classification of impacted teeth
3. The position of the teeth is buccal/lingual
4. Relationship of the impacted tooth root to the mandibular canal
for lower impacted teeth, maxillary sinus for upper impacted teeth
5. Out line flap to be made
6. How to take impacted teeth; splitting, intoto or a combination
7. Estimated number of bones to be removed
8. Selection of bone extraction instruments, chisels, burs or
combination
9. Choose the best way: satisfactory results
10. What is the state of the tooth, whether it is caries/internal resorption
11. Tissue around impacted teeth: inflammation/infection
12. Hard/soft tissue around impacted teeth: dense/thick,
radiolucent/radiopaque
 ODONTECTOMIC COMPLICATION FACTORS

1. Abnormal tooth root curvature

2. Hypercementosis
3. Proximity of the root of the lower third molar to the
mandibular canal
4. Density of bone around impacted teeth
5. Ankylosis
6. The operating field is inadequate
7. Proximity of the impacted upper third molars and upper
canines to the maxillary sinus
8. The impacted upper third molar is located above the root
of the second upper molar
9. The upper third molar fuses with the root of the second
upper molar
10. The upper third molar close to the proc. zygomaticus.
 ODONTECTOMY METHOD
1. In toto: the bone around the impacted tooth is excised
to remove the impacted tooth completely
2. Splitting/inseparation/sectioning of the tooth: The
impacted tooth is divided so that it can be removed in
parts easily.
In toto removal requires tools such as bone burs, chisels
and rongeurs and bone removal depends on:
- Location of impacted teeth
- The amount of bone around the impacted tooth
- Size and shape of the impacted tooth
 ODONTECTOMY METHOD
Figure 23 : Removal of impacted teeth in toto

a b c

e f
d
 ODONTECTOMY METHOD

a b c

d e f

Figure 24 : Extraction of teeth by splitting/inseparation/sectioning of the tooth

 Proper Period to do Odontectomy

1. When the patient is still young:

New/already formed tooth roots ½ - ¾ part,
crowns are formed up to the cervical third
which is round in shape. Golden period:
before the age of 18
2. In conditions where there is no acute infection.
Operations performed in acute conditions can
cause more severe complications.
 ODONTECTOMIC INSTRUMENTS
1. Disposable sterile scalpel

Figure 25 :
Several types of scalpels are used in oral surgery
 ODONTECTOMIC INSTRUMENTS

Figure 26 : How to insert the blade into the handle

 ODONTECTOMIC INSTRUMENTS

Figure 27 : The correct way to hold a scalpel

 ODONTECTOMIC INSTRUMENTS
2. Periosteal elevator

Figure 28 : Several types of periosteal elevators.

a Seldin. b Freers. c No. 9 Molts
 ODONTECTOMIC INSTRUMENTS
3. Retractor

Figure 30 : Kocher–Langenbeck
retractor, has the same function as
Farabeuf retractor
Figure 29 : Farabeuf retractor to retract the
cheek and mucoperiosteal flap

Figure 32 : Weider retractor to

Figure 31 : Minnesota retractors to retract retract the tongue during a surgical
the cheeks and tongue procedure
 ODONTECTOMIC INSTRUMENTS
4. Bone Burs 5. Suction

Gambar 34 : a Fergusson suction tip with wire stylet

used as a cleaning instrument. b Disposable suction tip

6. Irrigation device Figure 35 :

a. Special irrigation system to
irrigate the operating area
with a steady stream of
saline solution.
Figure 33 : Several b. Regular plastic syringe used
types of bone burs for the same thing.
 ODONTECTOMIC INSTRUMENTS
7. Extraction Forceps 8. Elevator

Figure 37 : Straight elevator

Figure 38 : A straight elevator with

a slightly concave blade used in the
Lower molar Upper molar extraction of maxillary posterior
extraction forceps extraction forceps teeth
 ODONTECTOMIC INSTRUMENTS
9. Desmotome

Figure 39 : A pair of elevators

with crossbar or T-shaped Figure 41 : Desmotomes. A Straight. B Curved
handles
10. Bone File

Figure 40 : A pair of double Figure 44 : Double-ended bone file with

angle elevators small and large ends
 SUTURING INSTRUMENT
1. Needle holder

Figure 46 : The tip of the needle holder

holds the sewing needle. The ends of the
needle holder interlock to stabilize the
needle during tissue penetration

Figure 45 : Needle holders.

a Mayo–Hegar needle holder.
b Mathieu needle holder
Figure 47 : Correct finger position when
holding the needle holder
 SUTURING INSTRUMENT
4. Sutures
3. Tissue Cutter

Gambar 49 :
Resorbable suture
Figure 48 : The correct way to
hold tissue cutter

Figure 50 : Non-resorbable suture

made of silk
 SUTURING INSTRUMENT
2. Needle

Figure 50 : (A) Cross-section of needle (1), oval tapered, (2) cutting (3)
triangular with sharp edges on inner bend (4) triangular with two sharp edges
on inner bend).
(B) Size of needle in one circle (1) quarter circle (2) three-eighths circle (3)
half circle (4) three-quarters circle
 ODONTECTOMY PROCEDURE
1. Preparation before surgery
- Diagnosis of impacted teeth → Ro photo
- Preoperative information
- Instrumentation, divided into:
a. Equipment for surgery
b. Equipment for sewing
Disinfection of the operating area
2. Inferior alveolar and lingual nerve block anesthesia and buccal
nerve infiltration anesthesia
3. Creation of soft tissue flaps
The types of flaps commonly used are:
• Envelope design
• Triangular flap, an envelope design with vertical incisions
 FLAP DESIGN
Figure 51 :
A. The envelope incision is most
commonly used for soft tissue
reflection to remove impacted third
molars. An extended posterior
incision should spread laterally to
avoid lingual nerve injury.
B. Envelope incision is reflected
laterally to expose the bone covering
the impacted tooth.
C. When a three-cornered flap is
created, a release incision is made on
the mesial aspect of the second
molar.
D. When the soft tissue flap is
reflected with the intention of freeing
the incision, a greater view may be
obtained, particularly of the surgical
base on the apical aspect
 FLAP DESIGN
Figure 52 :
A. The Envelope Flap is
most commonly used to
remove maxillary impacted
teeth.
B. When the soft tissue is
reflected, the bone covering
the third molar is easily seen.

C. If the tooth is deeply

impacted, a waiver of the
incision can be used to
gain wider access.
D. When the three-
cornered flap is reflected,
the more apical portion of
the bone becomes more
visible.
Flap Incision
Lift the Flap using the Rasparatorium
 ODONTECTOMY PROCEDURE
5. Open the crown of the impacted tooth up to the CEJ and
provide a place for the elevator
6. Crown cutting (horizontal or vertical depending on the
slope of the impacted tooth) using a dental speed
surgical handpiece. Be careful of the lingual soft tissue
and the depth of the surgical cut
7. Separating the crown from the tooth with straight
elevator
8. Take out the superior and labial bones that surround the
teeth
9. Removal of impacted teeth
 ODONTECTOMY PROCEDURE

Figure 53 : A. After the soft tissue is reflected, the bone covering the occlusal
surface of the tooth is removed with a fissure bur. B. Bone on the buccodistal
aspect of an impacted tooth, then removed with a bur.
 MESIOANGULAR IMPACTION

Figure 54 :
1.When removing the mesioangular impaction, the bucodistal bone is lifted to
expose the tooth crown to the cervical line.
2.The distal aspect of the crown is then separated from the tooth.
3.After the distal portion of the crown is removed, a small straight elevator is
inserted into the mesial aspect of the third molar, and the tooth is removed by a
rotational motion and the elevator is leveraged.
 DISTOANGULAR IMPACTION

Figure 55 :
1.For distoangular impaction, the occlusal, buccal, and distal bones are removed
with a bur. It is important to remember that more distal bone must be removed
than vertical or mesioangular impaction.
2.The crown of the tooth is cut with a bur, and the crown is removed with a
straight elevator.
3.The root is released using a Cryer elevator with a wheel and axle movement
type.
 HORIZONTAL IMPACTION

A, During horizontal impaction removal, the bone covering

the tooth (bone on the distal and buccal aspects of the tooth)
is removed with a bur.
B, The crown is then cut from the root of the tooth and
removed from the socket.
C, The roots are then released by an elevator cryer which is
used in a rotational motion. Roots may require division into
two parts; Sometimes, a hook point is made at the root to
allow the cryer elevator to pull up the root.
Figure 56 : D, The mesial root of the tooth is removed in the same
motion
 VERTICAL IMPACTION

Figure 57 :
1.When lifting the vertical impaction, the bone in the occlusal, buccal and distal aspects
of the crown is removed, and the tooth is cut into mesial and distal sections. If the tooth
has one fused root, the distal portions of the crown are separated in the manner described
for mesioangular impaction.
2.The posterior aspect of the crown is lifted first by an elevator Cryer that is inserted into
a small attachment point on the distal portion of the tooth.
3.Small straight elevator no. The 301 is then used to elevate the mesial aspect of the tooth
in a rotary-and-lever type motion
 UPPER M3 IMPACTION
Figure 58 :
A. After the soft tissue is reflected, the
bone in the buccal area is removed
slightly with a bur or hand chisel.

B. The tooth is removed by a small straight

elevator with rotation and leverage.
Teeth were removed in distobuccal and
occlusal directions.
 ODONTECTOMY PROCEDURE
10. Cleaning/debridement and wound closure
The flaps are repositioned and sutured with 3-0 or 4-0
chromic or black silk
11. Post-surgical care: antibiotics, analgesics, anti-
inflammatories and roburansia
Consider intraoral injection with steroids if extensive
orthopedic surgery is being performed.
Dexamethasone (Decadron 4 mg) can be injected
into m. masseter on each side
12. Evaluate bleeding after surgery before discharging
the patient
 ODONTECTOMY PROCEDURE

Cleaning the
extracted tooth
socket
followed by
irrigation with
0.9% saline
solution
(NaCl)
 ODONTECTOMY PROCEDURE

Return of the
flap and
suturing with
simple
interrupted
suture
technique
 Odontectomy Complications
1. Opening of the alv canal. inferior
2. Injure the alv nerves. Inferior/depressed: lip paresthesia
3. Trismus
4. Root fracture
5. Injure the blood vessels of the inferior alv
6. Fracture of most of the proc.alveolaris
7. Trauma to adjacent teeth
8. Discoloration of the soft tissue
9. Wounds on the lips, mucous membranes due to the use of tools
10. Opening of the maxillary sinuses
11. The teeth are pushed into the maxillary sinus
12. The upper M3 teeth are pressed into the pterygomaxillary fossa
13. Mandibular/maxillary fracture
14. Lacerations/soft tissue trauma
15. Pain, edema, infection etc.
 Odontectomy Complications

Mouth corner sores Oral mucosal sores Trismus

Alveolitis (Dry Socket) Mandibular Angulus fracture

 Post-Surgical Instructions
• Conditions that usually occur:
- Pain: take analgesics after eating
- Bleeding: usually occurs the first 24 hours, pressure with gauze
- Swelling: reaches its peak 24 hours after surgery one week, cold
compress

• Actions that should be taken:

1.Use the drug as prescribed
2.Place the gauze over the extraction area
3.Do cold compresses every 30 minutes compress 30 minutes released
4.Sleep with your head slightly elevated
5.Brush your teeth, as usual, and keep your mouth clean
6.Eat and drink as usual
7.Rest
 Medication
R/ Amoxycillin tab 500mg No.
XV
S 3 dd 1
R/ Asam Mefenamat tab 500 g
No XV
S 3 dd 1

Pro : Tn. X
Umur : 18 Tahun
 Post-Surgical Instructions
What to avoid:
1. Avoid hard / rough food (eat soft)
2. Do not suck on the former surgery area
3. Do not spit too often
4. Do not chew gum / smoke
5. Avoid the operating area from heat
6. Do not work hard the first 48 hours
7. Do not drink alcohol
8. Do not drive a vehicle etc.

If you experience the above problems contact the

dentist!
 Local Hemostasis
The following are some medicines used to stop bleeding after
odontectomy:

Figure 60 : Hemostatic Figure 61 : Absorbable Figure 62 : Gelatin

powder to stop capillary natural hemostatic collagen Sponge. Used for the
bleeding sponges. Indicated in cases of treatment of bleeding
bleeding after extraction after extraction
References
 Thank
You
by:
drg. Surijana Mappangara, M.Kes, Sp. Perio