Impacted Teeth Part b

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IMPACTED 3RD MOLARREMOVAL

PRE OPERATIVE ASSESSMENT

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WHO IS GOING TO DO IT

• General dental surgeon / Referral

• Oral surgeon

who has the;1. experience or trained in.

2. facilities

3. know possible complications –

intraoperative & post operative

4. Choice of anesthesia i.e. L.A or G.A

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Pre operative assessment

CLINICAL ASSESSMENT

• General factors (Hx )

• Local factors1. Acute inflammation

2. Mouth opening (clinical access Poor

Good - External oblique ridge –

guide for access

3. Second molar

4. Missing 1st molar

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Pre operative assessment cont1.

Radiographic Assessment

• Peri apical view

•

Bite wing• Occlusial view.

• Lateral oblique.

• OPG.

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Pre operative assessment cont2. 

Interpretation of standardized intra oral radiograph

1. Access:

2. Position & depth:

3. Root pattern:

4. Shape of crown:

5. Texture of the investing bone:

6. Position & root pattern of the 2nd molar:

7. Inferior dental canal

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Classification

A. Relation ship of tooth to the ramus & 2nd molar.

Class I.

Class II.

Class III.

B. Relationship of 3rd molar in bone.

Position A.

Position B.

Position C.

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WINTERS CLASSIFICATION

• Long axis of 3rd molar in relation to longaxis of 2nd molar.

• Describes 3rd molar impactions as – vertical, Mesio-angular, Disto-angular &Horizontal.

• Howe modified it using the Winter Lines – importance of the vertical depth of 3rd molar.

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PELL & GERGORY

• Similar to winter but uses the three tilts oflong axis of 3rd molar;

• Uses relationship to;

Ramus (Class I, II & III)

Relative depth (Position I, II, III)

2nd molar (Angulations- horizontal

mesioangular, distoangular etc.)

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MESIO & DISTO-ANGULAR IMPACTIONS

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HORIZONTAL IMPACTIONS

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ACCESS

•Radio-opaque linecast by externaloblique ridge

Vertical-poor.

Horizontal- excellent

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POSITION & DEPTH

• Winter lines.

White-axial inclination& depth of imp. tooth.

Amber- margins of alv.bone enclosing imp.tooth

Red-depth of the tooth

in side the mandible.Longer the line deeperthe imp.

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ROOT PATTERN

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SHAPE OF CROWN

• Large square &prominent cusps – more difficult.

• Small conical crowns& flat cusps- easy.

• Tooth impaction 

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TEXTURE OF THE INVESTING BONE

• Large cancellousspaces & fine bonestructure- bone

elastic.• Small cancellous

spaces & boneshadow- bone is

sclerotic.

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POSITION & ROOT PATTERN OF 2ND MOLAR

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RELATIONSHIP TO INFERIORDENTAL CANAL