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aa BDS M6 - Oral surgery > Impacted teeth - incisors and premolars > Flashcards

Impacted teeth - incisors and premolars Flashcards

1
Q

What is the third most commonly impacted tooth?

A

maxillary incisors

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2
Q

For what reasons would delayed eruption require monitoring or investigations?

A
  • if contralateral teeth erupted 6/12 previously or in the case when both upper centrals missing one year after eruption of lower incisors
  • deviation from normal sequence of eruption i.e. laterals before centrals
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3
Q

What are the hereditary causes for delayed incisor eruption?

A
  • supernumeraries
  • cleft lip/palate
  • cleidocranial dysostosis
  • odontomes
  • abnormal tooth /tissue ratio
  • gingival fibromatosis
  • generalised retarded eruption
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4
Q

What are the environmental causes for delayed incisor eruption?

A
  • trauma= root dilaceration
  • early loss or extraction of deciduous tooth
  • retained deciduous tooth
  • cyst formation
  • endocrine abnormalities
  • bone disease
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5
Q

If a patient presents with delayed incisor eruption, what should you do?

A
  • history and examination
  • look for:
    • retained deciduous teeth (if not mobile indicates lack of root resorption)
    • palpable buccal/palatal mass
    • lack of space
    • erupted mesiodens/supernumeraries
  • radiography - parallax
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6
Q

What are the 3 most common ways of managing an incisor impaction?

A

interceptive, exposure, or removal

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7
Q

What would interceptive management of incisor impaction involve?

A

removal of retained deciduous teeth if they are impeding eruption of the permanent incisor

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8
Q

When would an impacted incisor be managed by removal?

A

if severely dilacerated

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9
Q

If an incisor was impacted and the deciduous tooth was removed, what would need to be done after its removal?

A

create and maintain space - 75% erupt spontaneously, 55% align spontaneously

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10
Q

If a supernumerary tooth was impeding eruption of an incisor, what would be done?

A

remove other obstructions and expose the incisors surgically, 50-75% erupt in 16 months, may require brackets to align

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11
Q

Where are impacted incisors typically positioned?

A

labially

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12
Q

What is the open technique of incisor exposure?

A

flap raised taking as much attached gingivae as possible and repositioned apically and packed

involves removal of bone/fibrous tissue to exposure maximum convexity of tooth

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13
Q

What is the closed technique of incisor exposure?

A

raising a flap, removing bone/fibrous tissue to expose maximum convexity of tooth, and attaching bracket and gold chain before suturing the flap back over

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14
Q

What can be seen here?

A

conical supernumerary which is delaying the eruption of the central incisor

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15
Q

What does this show?

A

conical inverted supernumerary tooth which has caused rotation of the central incisor which can’t be corrected orthodontically until the supernumerary is removed

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16
Q

What is this showing?

A

open technique - apically repositioned flap for incisor exposure, 3 sided flap

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17
Q

When may the open technique for incisor exposure be advocated?

A

when the impacted incisor is very superficial/close to where it should be

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18
Q

What technique of impacted tooth exposure leads to better gingival aesthetics?

A

closed technique

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19
Q

What is this showing?

A

closed technique - 3 sided flap, overlying bone etc removed, orthodontic brackets and gold chains applied

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20
Q

What is the 4th most commonly impacted tooth?

A

mandibular premolars

21
Q

What are the potential causes of mandibular premolar impaction?

A

crowding, pathology, ankylosed deciduous tooth, supernumeraries, genetic disorders

22
Q

Where are mandibular premolars usually displaced?

A

usually lingual displacement palpable clinically

23
Q

What is the incidence of mandibular premolar impaction?

A

0.2-0.3%

24
Q

What is involved in the removal of mandibular premolars?

A

removal required buccal flap, avoiding damage to mental bundle, elevate or section tooth to remove as a traumatically as possible

removal of adjacent premolar may be preferred

25
Q

What can be seen here?

A

an impacted premolar (supplemental)

26
Q

What may this situation lead to in the long term?

A
  • caries of the impacted tooth via a gingival communication
  • caries of the erupted teeth due to difficulty cleaning
  • cystic change of the impacted tooth leading to problems such as root resorption of other teeth
27
Q

Describe the impacted tooth seen in this DPT

A

impacted mandibular premolar, ectopically placed, intra-osseous

28
Q

What would the treatment be for the impacted premolar shown here?

A

free of pathology so would follow conservative management

29
Q

What would the treatment options for these impacted premolars be?

A

if hygiene an issue - removal

if hygiene not an issue - conservative

30
Q

What kind of flap is being shown here?

A

2-sided flap

31
Q

What anatomical feature must be carefully thought about when cutting a flap in the premolar region?

A

mental nerve bundle

32
Q

Where are supplemental supernumerary teeth commonly found?

A

palatal in maxilla or premolar/third molar

33
Q

What are the 3 types of supernumerary teeth?

A

supplemental, conical, tuberculate

34
Q

Where do conical supernumeraries commonly erupt?

A

between central incisors, called mesiodens

35
Q

What issues may tuberculate supernumeraries cause?

A

tend not to erupt but prevent eruption of adjacent teeth therefore removal warranted and often performed during incisor exposure

36
Q

What is this?

A

mesiodens

37
Q

What kind of supernumerary teeth can be seen here?

A

supplemental teeth

38
Q

What condition can be seen here?

A

hyperdontia

39
Q

What are odontomes?

A

hamartomas, genetic malformations sometimes referred to odontogenic tumours which are entirely benign

40
Q

What are the 2 forms of odontomes?

A

complex or compound

41
Q

What are complex odontomes thought to be formed by?

A

invaginations of tooth germs therefore disordered dental tissues found in mandibular molar region

42
Q

Where are compound odontomes more common?

A

anteriorly

43
Q

Where are complex odontomes more common?

A

posteriorly

44
Q

What % of all odontogenic tumours do odontomes account for?

A

22%

45
Q

What do compound odontomes result from?

A

exuberant proliferation of the dental lamina therefore consists of a number of denticles (look like a bag of small teeth)

46
Q

What’s the difference between complex and compound odontomes?

A

complex are disordered formations of dental tissues eg dentine, cementum etc., whereas compound look more like formed teeth

47
Q

What issues may odontomes cause?

A

may impede eruption or result in associated pathology, so may require surgical removal

48
Q

What kind of odontomes are these?

A

very large complex odontomes, impeding eruption of other teeth

49
Q

What kind of odontome is this?

A

compound odontome - can see lots of small calcified structures

aa BDS M6 - Oral surgery (10 decks)

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