principles, indications and contraindications of removal of
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PRINCIPLES, INDICATIONS AND CONTRAINDICATIONS OF REMOVAL OF IMPACTED TEETHDr Ijaz Khan KCD Peshawar
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WHAT IS AN IMPACTED TOOTH?
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an impacted tooth is one that fails to erupt into the dental arch within the expected time.
they are retained for the patient's lifetime unless surgically removed..
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Possible causes
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» Irregularity in the position and pressure of an adjacent tooth.
» Density of the overlying or surrounding bone. » Chronic inflammation with resultant fibrosis of the
overlying mucosa. » Lack of space due to under developed jaws.
Unduly over retention of the deciduous teeth. » Inflammatory changes in the bone due to diseases
in children, like, Chicken pox, Parotitis.» Heredity» Malnutrition» Endocrine dysfunctions» Diseases of jaw and surrounding tissue
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Which teeth are most commonly impacted?
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Impaction In The Following Order Of Frequency» Mandibular third molars.» Maxillary thirds molars.» Maxillary cuspids.» Mandibular bicuspids.» Maxillary bicuspids.» Upper central incisors.» Upper lateral incisors
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Classification systems
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With careful classification of the impacted teeth using a variety of systems, the surgeon can approach the proposed surgery in an orderly fashion.
The majority of the classifying results from analysis of the radiograph.
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1.Angulation
Pro p o s e d by Arche r (1 9 7 5 ) a nd Krug e r (1 9 8 4). This classification system employs a
description of the angulation of the long axis of the impacted third molar with respect to the long axis of the second molar. This can be
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1 . Me s io a ng ula r, 2 . d is to a ng ula r, 3 . v e rtic a l, 4. ho riz o nta l, 5 . buc c o a ng ula r, 6 . ling uo a ng ula r, 7 . inve rte d
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2.Relationship of tooth to anterior border of ramus
This type of classification is based on the amount of impacted tooth that is covered with the mandibular ramus. It is known as the Pell and Gregory classification, classes 1,2 and 3
3.Relationship of tooth to occlusal plane The depth of the impacted tooth compared with
the adjacent second molar gives the basis for this type of classification. This was also given by Pell and Gregory and is called as Pell and Gregory A,B and C classification.
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What are indications for removal of impacted teeth?
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If impacted teeth are left in the alveolar process, it is highly probable that one or more of several following problems will result. To prevent this, impacted teeth should be removed
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Prevention of Periodontal Disease
Because the most difficult tooth surface to keep clean is the distal aspect of the last tooth in the arch, the patient may have gingivitis with apical migration of the gingival attachment leading to peridontitis and Presence of deep periodontal pockets as shown in figure
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Prevention of Dental Caries
When a third molar is impacted or partially impacted, the bacteria that cause dental caries can be exposed to the distal aspect of the second molar, as well as to the third molar
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Prevention of Pericoronitis
Pericoronitis is an infection of the soft tissue around the crown of a partially impacted tooth and is caused by the normal oral flora
It can be mild to very severe associated with trismus, high fever, pain, swelling, bad breath.
Prevention of pericoronitis can be achieved by removing the impacted third molars before they penetrate the oral mucosa and are visible.
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Prevention of Root Resorption Occasionally, an impacted tooth causes
sufficient pressure on the root of an adjacent tooth to cause root resorption
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Impacted Teeth under a Dental Prosthesis After teeth are extracted, the alveolar process
slowly undergoes resorption.The denture may compress the soft tissue on the impacted tooth, which is no longer covered with bone; the result is ulceration of the overlying soft tissue and initiation of an odontogenic infection
Removal of impacted tooth must occur before prosthesis construction,otherwise, the alveolar ridge may be so altered by the extraction that the prosthesis becomes unattractive and less functional
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Prevention of Odontogenic Cysts and Tumors
Although in most patients the retained dental follicle associated with impacted tooth maintains its original size, its cystic degeneration may occur and become a dentigerous cyst or keratocyst
odontogenic tumors can arise from the epithelium contained within the dental follicle e.g ameloblastoma.
Fig showing radiolucencies
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Prevention of Fracture of the Jaw
An impacted third molar in the mandible occupies space that is usually filled with bone. This may weaken the mandible and render the jaw more susceptible to fracture
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Facilitation of Orthodontic Treatment Lack of room in the arch is possibly the most
common indication for extraction, primarily of impacted and semi-impacted third molars of the maxilla and mandible.
It is recommended that impacted third molars be removed before orthodontic therapy is begun, since they may interfere with treatment..
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Obstruction of the Normal Eruption of Permanent Teeth. Impacted teeth and supernumerary teeth
often hinder the normal eruption of permanent teeth, creating functional and esthetic problem
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Prevention of pain of unexplained origin. Impacted teeth may be responsible for a
variety of symptoms related to headaches and various types of neuralgias
Symptoms may subside after the removal of the offending tooth, which basically involves ectopic impacted teeth, pressurizing the nerve endings.
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THANK YOU !!!