White Paper - 3rd molars Flashcards
(41 cards)
what factors do we look at to more accuratley predict or answer the question - can the course of an unerupted third molar be predicted?
- tooth angulation
- degree of root development
- depth relative to the occlusal plane
- size of tooth
- available space for eruption
when say ‘ available space for eruption’ what are we more closely looking at?
generally described as the mandibular ramus (xi point) and the distal of the second molar
one thing that is def. necessary for 3rd molar to errupt
SPACE - needs to be adequate space between the anterior border of the mandible and the distal of the mandibular second molar – to then allow a successful eruption to the occlusal plane
*eruption to the occlusal plane does not imply a good state of health, particularly with respect to soft tissue support
T/F - position of 3rd molar can change in position into the 3rd decade?
true - unerupted teeth can change position past 25 yo and into the 3rd decade of life.
resorption of the distal of the second molar is more associated with what type of impacted third molar angulation?
mesioangular and horizontal impactions
from a periodontal perspective - how does the presence of an impacted third molar impact?
presence of a third molar adversely affects the periodontium of adjacent 2nd molars in
- DISRUPTION OF PDL
- ROOT RESORPTION
- AND POCKET DEPTH ASSOCIATED WITH LOSS OF ATTACHMENT
disto-angular
mesio- angular
horizontal
where are roots and crown in relation to the second molar crown
disto-angular - the roots are closer to second molar with the crown tilted back
mesio angular – roots are tilted back and crown is closer to second molar
horizontal - roots are closer back and crown is closer to the crown of second molar
T/F when a visible third molar is present - there is a greater chance of periodontal findings / pocket depth
true – white paper quotes
- greater probability of probing pocket depth greater or equal to 5 mm on distal of second molar when a visible 3rd molar is present
*in similar clinical scenario –> pocket depth of over 5mm has shown to be assoc. with loss of attachment
does the removal of impacted third molar negatively impact the periodontium of the adjacent second molar?
- obviously not a strict answer –> describe
it CAN.
pre-operative environment is important to consider
1. was there an intra-bony defect prior to removal?
- what is the size of the second / third molar contact area
2. what is the age of the patient –> research has shown that earlier removal (20 years vs over 30 years) – older adults more likely to have adverse outcomes
3. level of plaque control that is present –> does the patient have good / bad home care, etc.
*imp to recognize there are studies that show little to no deleterious effects vs some that do show and these aspects are ones that are imp to know.
a way to mitigate a reduction in post-op loss of PDL attachment?
ex) surgical approach? guided tissue regen? using DBP? - demineralized bone powder?
NO one surgical approach in the removal of 3rd molars that will minimize loss of PDL attachment was identified
GTR / DBP MAY be beneficial in instances where there is evidence of significant PRE EXISTING attachment loss
scaling and root planning, and plaque control have the potential to reduce post-op loss of attachment
advantages seen in using DBP in thirds extractions?
does not seem to offer too much of an advantage other than….!!!!
- those who are HIGH risk going into the procedure –> older than 26, pre-existing attachment loss (over 3mm) and having mesio-angular or horizontal impaction
*scaling and RP in addition to plaque control measures at time of ext could have influenced no significant benefits seen with using GTR.
presence of a third molar negatively impact the progression and/ or severity of periodontitis in adjacent teeth?
there are FOUR type of info that could help support this and they are…
- an association of third molars with greater periodontal disease severity
- an association between the presence of 3rd molars and progressive loss of attachment on NON- third molars (w/ more emphasis on second molars)
- the influence of 3rd molars on the periodontal micro-flora, esp the putative pathogens, and on the molecular markers of inflammation
- and what the effect of removing the 3rd molar is on factors 2 and 3 above
major perio disease severity aspect to note
patients with VISIBLE third are more likely to have INCREASED SEVERITY of perio whether mild, moderate, severe (just greater overall)
- based on pocket depth ad BOP
is perio progressive in adjacent teeth with visible 3rd molars?
in presence of visible 3rd molars, periodontitis involving adjacent teeth is progressive and only partially responsive to therapy.
when evaluating a visible 3rd molar - what should the assessment include?
assess the perio associated with 3rd molar AND the second molar
- include the anatomical AND MECHANICAL LIMITTIONS TO REOMVAL OF PLAQUE
- presence of pocket depth 4-5 mm or above and/or bleeding on probing should be recognized as possible predictors of future progression of periodontitis
The association of overall increased disease severity in the presence of visible third molars, the progressive nature of periodontitis involving non-third molars when third molars are present, the relationship between visible third molars and bacteria associated with severe and refractory periodontitis, and the negative impact of visible third molars on treatment outcomes all lend support to the hypothesis that third molars should be considered as a possible predictor of periodontitis.
take it out if visible with pockets essentially
basic definition of pericoronitis and tx?
pericoronitis –> an acute infection of enveloping mucosa and gingiva associated with eruption of third molars , clinical symptoms include pain, swelling, erythema, and purulence
majority of cases the flora of anaerobic bacteria predominate
TX–> antibiotic therapy coupled with surgical intervention (surgical removal of the tooth associated with the infection is curative)
***ABSENCE OF CLINICAL SYMPTOMS DOES NOT INDICATE ABSENCE OF DISEASE OR PATHOLOGY.
data on microflora and asymptomatic disease in the thrird molar region show what 5 things
- absence of symptoms does NOT indicate absence of disease
- pathogenic bacteria (red and orange complexes) in clinically sig. numbers exist in and around asymptomatic 3rd molars
- perio disease as indicated by probing depths over 4 mm exist in and around asymptomatic third molars
- indicators of chronic inflammation exist in perio pockets in and around asymptomatic third molars
- perio disease progresses in the absence of symptoms
postoperative risks of pocketing and age association?
**ALL risks associated with third molar removal increases with increasing age
papers define over 25 years
in addition to things like fractures, sinus involvments, etc
germectomy? aka
lateral trepanation –> germectomy is defined as the removal of a tooth that has one third or less of root formation and also has a radiographically discernible periodontal ligaments
role of germectomy and impact on post op complications like nerve incolvement , osteotits, or perio
It does appear that early third molar removal mayt be associated with a lower incidence of morbidity and also less economic hardhship from time off
orthodontic and prosthodontic considerations in removal of third molars
most studies focus on the crowding associated with lower mandibular incisors –> but little attention has been paid to changes in arch width, form or length
**ETIOLOGY OF DENTAL CROWDING IS COMPLEX AND MULTIFACTORIAL
some studies show evidence for both for and against thirds contributing to crowding –> most accept play some sort of role in crowding — but role may not be clinically significant
no cause and effect relationship / study has been performed and therefor determined
should asymptomatic 3rds under an existing or planned removable prosthesis be removed?
Many clinicians recommend removal of impacted third molars under planned or existing removable prosthesis (full or partial dentures) - limited data
this topic is dynamic and unpredictable – management of these teeth are best determined from multifactorial approach - like age of patient, position of tooth, anticipated difficulty of removal, type of overlying prosthesis and risks associated with removal
is a CT scan associated with a decreased incidence of IAN nerve involvement?
CT permits localization of the IAN canal in the superior-inferior and medio-lateral positions; detection of an intra-radicular path; determination of the distance between the tooth and IAN canal, and
root angulation.
in the setting of high risk findings on PANO imagine and a clinical situation dictating operative management (meaning -surg. ext. required) then CT can provide valuable info
the EXACT role and indications for CT imaging for managment of impacted thirds is unclear and evolving
