Exam 1 - Removal of impacted Teeth 1 and 2

Question 1

Impacted teeth definition

Answer 1

one that fails to erupt into the dental arch within the expected time. Eruption has been impeded by adjacent teeth, dense bone, or excessive soft tissue.

Question 2

Top 3 incidence of impacted teeth

Answer 2

1. Maxillary and Mand 3rd molars
2. Max canines are next most comon
3. Mandibular premolars

Question 3

Why Maxillary canine

Answer 3

erupts after the max lateral incisor and after the max first olar

Question 4

Why mand premolars

Answer 4

erupts after the mand 1st molar and after the mandibular canine

Question 5

Should all impacted teeth be removed?

Answer 5

yes unless it is contraindicated

Question 6

Normal development for the lower 3rd molar?

Answer 6

Begins in a horizontal angulation that changes to mesioangular and then to vertical

Question 7

ideal time for removal of 3rd molars?

Answer 7

when roots of teeth are at least 1/3rd formed but before they are 2/3rd

Question 8

Indications for removal of impacted teeth

Answer 8

prevention of

1. periodontal disease
2. dental caries
3. periocornitis
4. root resorption
5. impacted teeth under a dental prosthesis
6. prevention of cysts

Question 9

The retention of third molars is associated with increased risk of second molar pathology in middle-aged and older adult men

Answer 9

true

Question 10

What is pericornitis

Answer 10

infection of the soft tissue around the crown of a tooth.

Caused by normal oral flora

Question 11

What is pericornitis caused by:

Answer 11

streptococci and anaerobic bacteria

Mild tx is irrigation
Moderate Tx is abx
Severe would be hospital admit/referral

Question 12

Do we need to remove the offending mandibular third molar once the infection has resolved?

Answer 12

YES

Question 13

Diagnosis of a dentigerous cyst

Answer 13

if follicular space around the crown of a tooth is greater than 3mm

Question 14

Most common odontogenic tumor in the third molar region

Answer 14

Ameloblastoma

Question 15

Contraindications to taking out 3rd molars

Answer 15

1. Age > 40
2. Medical Status
3. Probable damage to adjacent structures
4. long standing asymptomatic impacted tooth

Question 16

Classification of Impacted teeth: Angulation

Answer 16

1. Mesioangular
2. Horizontal
3. Vertical
4. Distoangular

Question 17

Mesioangular impaction

Answer 17

least difficult to remove in mandible
tilted toward the second molar in a MESIAL direction
43% of all impacted mandibular third molars

Question 18

Horizontal angulation

Answer 18

Approx. 3% of mandibular impaction

second most easiest to remove on mandible

Question 19

Vertical Angulation

Answer 19

Long axis of the impacted tooth runs in the same direction as the long axis of the second molar
38% of impactions
3rd most difficult to remove in mandible

Question 20

Distoangular

Answer 20

MOST difficult to remove
long axis of the third molar is distally or posteriorly angled away from the second molar
6% of impacted mandibular 3rd molars

Question 21

Classification of impacted teeth (Pell and Gregory)

Answer 21

1. Relationship to the anterior border of the ramus (1,2, and 3)
2. Relationship to the occlusal plane (A, B and C)

Question 22

Classification 1

Answer 22

The mesiodistal diameter of the crown is completely anterior to the anterior border of the ramus

Question 23

Classification 2

Answer 23

Approximately half of the crown is covered by the anterior border of the ramus

Question 24

Classification 3

Answer 24

The crown is covered entirely by the anterior border of the ramus

Question 25

Classification A

Answer 25

The occlusal plane of the impacted tooth is at the same level as the occlusal plane of the second molar

Question 26

Classification B

Answer 26

The occlusal plane of the impacted tooth is between the occlusal plane and the cervical line of the second molar

Question 27

Classification C

Answer 27

The occlusal plane of the impacted tooth is below the cervical line of the second molar

Question 28

Classifications can be combinations

Answer 28

ex. Distoangular, Class 3, C

Question 29

Classification | -Nature of overlying tissue

Answer 29

``` Soft tissue -Full -Partial Bone -Full -Partial ```

Question 30

Root Morphology

Answer 30

``` Length Single or fused curvature width PDL space ```

Question 31

Density of surrounding bone is:

Answer 31

Age dependent young (18) - less dense Older >35 - more dense

Question 32

Maxillary Classification

Answer 32

Vertical (63%) Distoangular (25%) Mesioangular (12%) PG classification A, B, and C

Question 33

What makes impaction surgery less difficult

Answer 33

- mesioangular position in the mandible - class 1 ramus - class A depth - roots one third to two thirds formed - large follicle - wide periodontal ligament - separated for IAN - soft tissue impaction

Question 34

What makes impaction surgery more difficult

Answer 34

- distoangular in mandible - class III ramus - Class C depth - Long, thin roots - Narrow periodontal ligament - Thin follicle - Close to IAN - Contact with the second molar

Question 35

Is increased age associated with a higher complication rate for M3 extractions?

Answer 35

Yes, age >25

Question 36

What about impacted max. Canine?

Answer 36

May expose and ligate tooth and through ortho can aid in eruption of the tooth

Question 37

Impacted Maxillary Teeth

Answer 37

Rarely section Mostly bone removal Concern with max sinus Do not use chisel to section a maxillary tooth

Question 38

Perioperative patient management

Answer 38

``` Anxiety control: IV sedation or GA Long acting local anesthetics IV steroids to prevent/decrease swelling Ice packs on the face Possible use of antibiotics ```

Question 39

What is normal postoperative experience?

Answer 39

Swelling Discomfort Mild/moderate trismus All of symptoms are less intense in a young, healthy patient

Question 40

Can routine use of CT for extraction of third molars be recommended? LISTEN TO LECTURE AT THIS SLIDE 41

Answer 40

NO, data obtained form the CT had MINIMAL effect on surgical outcome

Question 41

Can cone-beam technology improve presurgical planning?

Answer 41

Yes

Question 42

Alveolar Osteitis

Answer 42

The development moderate to severe throbbing pain usually occurring around the third to fifth day after surgery and is often confused with an earache, headache, or pain from another tooth with no evidence of pathologic condition Halitosis usually present

Question 43

Alveolar osteitis clinical examination

Answer 43

extraction socket is partially or completely devoid of a clot or is often filled with debris and shows evidence of poor healing Exposed bone is source of pain Area of socket has a bad odor NO USUAL SIGNS or symptoms of infection present

Question 44

Alveolar osteitis incidence

Answer 44

0.3% - 26% Occurs more frequently in the mandible