Hani Al Sheikh Radhi Al Mustansiria University Impacted Wisdom Teeth Aims To enable diagnosis assessment and management of impacted teeth Objectives Learn causes of impaction List clinical and radiographic features taken into ID: 779133
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Impacted and ectopic teeth
Hani Al Sheikh Radhi
Al Mustansiria University
Slide2Impacted Wisdom Teeth
Aims: To enable diagnosis, assessment and management of impacted teeth.Objectives: Learn causes of impaction List clinical and radiographic features taken into account in assessing unerupted teethTo be able to design flaps for removal of teeth, taking into account the anatomy of the regionTo be able to describe postoperative careList common complications of surgical removal
Slide3Failure of tooth eruption
- General - Local
Slide4Slide5Slide6Failure of tooth eruption
- General - Local • Loss of space • Abnormal position of crypt • Overcrowding • Supernummary • Local pathological lesion
Slide7Theories of Impaction1) Orthodontic theory : Jaws develop in downward and forward direction. Growth of the jaw and movement of teeth occurs in forward direction,so any thing that interfere with such moment will cause an impaction (small jaw-decreased space). A dense bone decreases the movement of the teeth in forward direction.
Slide82) Phylogenic theory: Nature tries to eliminate the disused organs i.e., use makes the organ develop better, disuse causes slow regression of organ. [More-functional masticatory force – better the development of the jaw] Due to changing nutritional habits of our civilization, use of large powerful jaws have been practically eliminated. Thus, over centuries the mandible and maxilla decreased in size leaving insufficient room for third molars.
Slide93) Mendelian theory: Heredity is most common cause. The hereditary transmission of small jaws and large teeth from parents to siblings. This may be important etiological factor in the occurrence of impaction. 4) Pathological theory: Chronic infections affecting an individual may bring the condensation of osseous tissue further preventing the growth and development of the jaws.
5) Endocrinal theory: Increase or decrease in growth hormone secretion may affect the size of the jaws
Slide10Slide11Slide12Slide13Assesment (History)
Presenting complaintHistory of the presenting complaintMedical HistoryRelevant dental historySocial History
Slide14Assessment (Impacted teeth)
Clinical examination • Access - mouth opening - operating space •B •C •D
Slide15A
ccess
Slide16Assessment (Impacted teeth)
Clinical examination • Access - mouth opening - operating space • Bone quality – age,ethnicity • Caries and pathology • Degree of eruption
Slide17Assessment (Impacted teeth)
Radiographic examination• OPG (Orthopantomagraph)• Periapical views• Parallax views• Occlusal views
Slide18Mandibular third molar assessment
Type of impactionDepth of impactionRoot patternCrown formBone densityRelationship to ID nerveCariesPosition and root pattern of 2nd molarAssociated pathologyAccess
Slide19(1) Type of impaction
Slide20Slide21Slide22Types of impaction
• Vertical• Mesioangular• Distoangular• Horizontal• Transverse
Slide23Lines parallel-
vertical
Slide24Slide25Slide26Slide27Slide28Slide29Slide30Slide31Slide32(2) Depth of impaction
Slide33Slide34Slide35Slide36Pell & Gregory ClassificationBased on the amount of tooth covered by the anterior border of the ramusThe depth of the impaction relative to the adjacent tooth
Slide37Pell & GregoryRelation to the Ramus
Class I
Class II
Class III
Slide38Pell & GregoryDepth of ImpactionMandibular
Class A
Class B
Class C
Slide39Pell & Gregory
Slide40Slide41Slide42