Surgical Removal of Impacted Teeth

Question 1

Definition of Impacted teeth

Answer 1

an impacted tooth is one that fails to erupt into the dental arch within the expected time.

the eruption has been impeded by adjacent teeth, dense bone, or excessive soft tissue

Question 2

most common impacted? why?

Answer 2

3rd molars – becauwe lase to erupt

then canine – maxillary - because later in eruption as well

Question 3

general rule about impacted teeth

Answer 3

should be removed unless removal is contra-indicated

Question 4

ideal time for 3rd molar removal

Answer 4

when the roots of the teeth are on-third formed and before they are 2/3 formed

usually between the ages of 17 and 20

Question 5

indications for removal of impacted teeth (long list)

Answer 5

1. prevention of perio disease
2. prevent caries
3. prevent pericornitis
4. prevention of root resorption
5. impacted teeth under a dental prosthesis
6. prevention of odontogenic cysts and tumors
7. tx of pain of unexplained origin
8. prevention of jaw fracture
9. facilitation of orthodontic treatment
10. optimal periodontal healing

Question 6

main reason to remove the 3rd molars

Answer 6

Periodontal disease prevention

Question 7

study regarding the dominant hand *

Answer 7

no difference

Question 8

pericorinitis

definition and describe

Answer 8

seen in partially erupted teeth with large amounts of soft tissue over the occlusal surface

it is an infection of the soft tissue around the crown

caused by noraml oral flora

host defense maintain balance

Question 9

pericorinitis secondary to

Answer 9

to minor trauma from the maxillary third molar - traumatizes the operculum over the partially erupted mandibular 3rd molar

Question 10

take out opposing third molar to diminish pericorinitis

Answer 10

yes – could be harmful to the tooth having pericorinitis

Question 11

pericorinitis caused by

Answer 11

streptococci and anaerobic bacteria

can be mild to severe

Question 12

tx for periorintis

mild?
moderate?
severe?

Answer 12

mild – irrigation

moderate – tx with antibiotics

severe – facial space infections - trismus, temp greater than 101 F, mailaise, facial swelling, pain – need referral and possible hospital admit.

Question 13

tx for periorintis

mild?
moderate?
severe?

Answer 13

mild – irrigation

moderate – tx with antibiotics

severe – facial space infections - trismus, temp greater than 101 F, mailaise, facial swelling, pain – need referral and possible hospital admit.

Question 14

operculectomy?

Answer 14

usually does not work to cure the pericoriniits – tends to recur

Question 15

risk factors for external root resoprtion of second molars associated with impacted third molars?

Answer 15

increased with age and with mesioangular and horizontal inclincations

Question 16

impacted tooth removal before other tx?

Answer 16

yes - should be removed before prosthesis is constructed - because if the impacted tooth must be removed after construction, the alveolar ridge may be so altered by the extraction that the prosthesis becomes unaatractive and less functional

Question 17

operculum is?

Answer 17

soft tissue covering an impacted / partially erupted tooth

Question 18

odontogenic cysts and tumors association

Answer 18

it is recommended that impacted teeth be removed to prevent the occurence of cysts and tumors

Question 19

diagnosis of a dentigerous cyst is reasonable when?

Answer 19

if the follicular space around the crown of the tooth is greater than 3mm, the diagnosis of a dentigerous cyst is reasonable

Question 20

most common odontgenic tumor

Answer 20

ameloblastoma in the third molar region

Question 21

relative contraindications for removal of impacted teeth

Answer 21

1. over age 40

2.

Question 22

over age 40 details

Answer 22

1. highly calcified brittle bone
2. prolonged healing time
3. anesthesia considerations

Question 23

impacted teeth classification

Answer 23

1. angulation

Question 24

impacted teeth classification

Answer 24

1. angulation

Question 25

impacted teeth classification in terms of angulation

Answer 25

1. angulation - mesio-angular - horizontal - vertical - distoangular

Question 26

mesioangular impaction details

Answer 26

*generally acknowledged as the least difficult to remove in the mandible tilted toward the second molar in a mesial direction approx. 43% of all impacted mandibular third molars

Question 27

horizontal impaction

Answer 27

approx 3% (based on info we have) of mandibular impactions second ' easiest

Question 28

classification (3 caegories)

Answer 28

1. angulation 2. relationship to the anterior border of the ramus 3. relationship to the occlusal plane

Question 29

relative contraindications to removal of impacted teeth

Answer 29

1. probable damaeg to adjacent structures - nerves - major blood vessels - teeth - prostheses 2. long standing asymptomatic tooth

Question 30

age when relative contraindications to removal of impacted teeth

Answer 30

over 40 - highly calcified brittle bone - prolonged healing time - anesthesia considerations Medical status - ASA classification

Question 31

vertical impaction

Answer 31

long axis of the tooth runs in the same direction as the long axis of the second molar approx. 38% the third most difficult to remove

Question 32

*distoangular impaction details

Answer 32

the MOST difficult angulation for removal of mandibular impacted tooth long axis of the third molar is distally or posteriorly angled AWAY from the second molar its path of withdrawl runs into the mandibular ramus * approx. 6% of mandibular third molars

Question 33

PG / Pell and Gregoy classsification

Answer 33

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

Question 34

PG classification 1

Answer 34

the mesiodistal diameter of the crown is completley anterior to the anterior border of the ramus

Question 35

PG classification 2

Answer 35

approx. half the crown is covered by the anterior border of the ramus

Question 36

PG classification 3

Answer 36

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

Question 37

normal development of the lower third molars sequence

Answer 37

starts at disto-angular -- changes to mesio-angular -- then to vertical

Question 38

usual time of eruption of the 3rd molars

Answer 38

20 -- can continue to erupt into the age of 25