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OS 3 > Management of Impacted Teeth - II > Flashcards

Management of Impacted Teeth - II Flashcards

1
Q

Surgical Management of Impacted Teeth
(3)

A
  • Surgical removal of the Impacted tooth(Third Molars).
  • Surgical exposure and orthodontic assisted eruption
    (canines and 2nd molars)
  • Surgical repositioning and transplantation
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2
Q

Surgical Removal of Impacted Mandibular Third Molars
Important Considerations
(6)

A
  • History
  • Clinical exam
  • Adequate Radiographic Imaging
  • Anesthesia plan
  • Surgery plan
  • Preoperative, operative and postoperative instructions
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3
Q

Anesthesia Options
(4)

A
  • Local Anesthesia
  • Local Anesthesia with nitrous oxide
  • Local Anesthesia with intravenous sedation
  • General anesthesia
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4
Q
  • Local Anesthesia with intravenous sedation
    (2)
A

– Light Sedation
– Deep Sedation

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5
Q

Day of Surgery Instructions
(5)

A
  • Responsible guardian available
  • Time off work/school
  • Clothing, Make-up, Contact Lens
  • Medications
  • I.V. Sedation / Anesthesia
    – NPO
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6
Q

Postoperative Care
(4)

A
  • Diet
  • Wound care
  • Medications
  • Postoperative follow up visit
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7
Q
  • Medications
    (3)
A

– Analgesics
– Antibiotics
– Anti-inflammatory

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8
Q

Surgical Removal of Impacted Mandibular Third
Molars
Predictors of difficulty
(10)

A
  • Tooth angulation (Distoangular Impaction- Lower Third Molars)
  • Tooth position (Pell & Gregory - Class 3 ramus & Class C depth
    (More difficult)
  • Complete bony impaction
  • Narrow PDL
    – Degree of root development (ideally ½ - 2/3rd)
    – Root morphology (conical vs. dilacerated)
    – Contact with second molar (separation preferred)
    – Relation to Inferior alveolar neurovascular bundle (separation
    preferred)
    – Dense, inelastic bone
    – PATIENT AGE
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9
Q

Surgical Removal of Impacted Mandibular Third Molars
(6)

A
  • Flap elevation (Adequate exposure-soft tissue incision/flap
    reflection)
  • Bone removal (Assess need for bone removal/removal of
    sufficient bone)
  • Sectioning of tooth
  • Delivery of sectioned tooth
  • Removal of follicle, granulation tissue, debris
  • Closure
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10
Q

Surgical Removal of Impacted Mandibular Third Molars
Flap elevation
(4)

A

– Full thickness mucoperiosteal flap
– Envelope (sulcular) flap
– Triangular/trapezoid flaps (utilizing vertical releases)
– Vital structures

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11
Q

MAnd vital structures (1)

A
  • Lingual nerve
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12
Q

Surgical Removal of Impacted Mandibular Third Molars
Bone removal
(5)

A

– Surgical drill (NOT high-speed handpiece!)
– Occlusal bone removal
– Buccal trough
– Distal bone removal
* Lingual nerve
– Expose CEJ

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13
Q

Sectioning of Impacted Tooth
(8)

A

– Case selection (Tooth angulation)
– Section Crown and/or roots
– Facilitates procedure
– Creates space
– Minimizes bone removal
– 2/3rd to ¾ of distance – complete with elevator
– Vital Structures
– Rarely needed for maxillary teeth

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14
Q

Delivery of Tooth – Important considerations
(4)

A

– Following appropriate exposure and sectioning
– Unimpeded pathway
– Controlled, light forces
– Elevators, forceps, root picks, crane picks, cryers, etc.

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15
Q

Wound Debridement and Closure
(6)

A
  • Debride wound of bone/tooth particles
  • Smooth rough, sharp edges of bone
  • Remove remnants of the dental follicle
  • Irrigate socket and beneath flap with sterile saline
  • Closure of the incision
    – Resorbable sutures-chromic
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16
Q

Surgical removal of Impacted Upper Third Molar
(5)

A
  • Raise a Mucoperiosteal flap
  • Flap design (envelop flap, Two sided flap
  • Bone removal
  • Rule out establishment of OAF
  • Closure of wound
17
Q

Surgical Exposure with Orthodontic Guided Eruption
(2)

A
  • Most commonly involves the maxillary canines, and
    mandibular 2nd molars.
  • Treatment involves both a surgical and an orthodontic phase.
18
Q

Surgical Exposure with Orthodontic Guided Eruption
Impacted Maxillary Canines
(4)

A
  • Second most common tooth impaction
  • 1-3.5 % of general population
  • About 80% are located palatally
  • Upon recognition, prompt referral to an orthodontist is
    prudent.
19
Q

Surgical Exposure with Orthodontic Guided Eruption
Impacted Maxillary Canines
* Treatment involves:
(4)

A
  • Creation or maintenance of space by orthodontist.
  • Identification of location of impacted canine (clinical exam,
    SLOB, CBCT Scan).
  • Surgical exposure and orthodontic bonding.
  • Orthodontic activation to facilitate proper positioning
20
Q

Complications Associated With Impacted Teeth
Surgery
(7)

A

Hemorrhage
Fractured root
Damage to adjacent tooth, tooth displacement
Oro-antral or Oro-nasal communication
Fracture mandible / Maxillary tuberosity
Nerve injury(Paresthesia)
Infection

OS 3 (14 decks)

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