impaction assesment
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PREOPERATIVE ASSESSMENT PREOPERATIVE ASSESSMENT OF IMPACTED MANDIBULAR OF IMPACTED MANDIBULAR
AND MAXILLARY 3AND MAXILLARY 3rdrd MOLARS MOLARS
introductionintroduction
Minor oral surgeries can give a false impression that less skill and care are required.
A minor sugery should not produce a major morbidity
Proper assessment prevents or minimise complications
Introduction Introduction
ETIOLOGYETIOLOGY
THEORIES OF IMPACTION
STRONG INDICATIONS FOR REMOVAL
Den cl N A, V38, N2. Den cl N A, V38, N2.
CONTRAINDICATION
LOCAL ASSESSMENT
ASSESSMENT OF IMPACTED TEETH
LINGUAL NERVELINGUAL NERVE
Clinical and anatomical observations on the relationship of the lingual nerve to the mandibular third molar reg1ion. J Oral Maxillofac Surg 41:565,1984
2.28 mm + 1.9
RADIOGRAPHIC ASSESSMENT
Radiographs of third molars must Radiographs of third molars must show the show the
Sensitivity 24% to 38% ajomsSensitivity 24% to 38% ajoms
RADIOLOGICAL ASSESSMENT AIDS IN DETERMINING
CLASSIFICATION
◦ WINTER’S (1926) Based on angulation of long axis of 3rd molar to
long axis of 2nd molar
ajoms
According to the relation of the impacted tooth to the ramus of the mandible & the 2nd molar
PELL AND GREGORY CLASSIFICATION (1933)
Third-molar impaction classified according to the critieria of Pell and Gregory.
Sensitivity 15% onlySensitivity 15% only
ADA NOMENCLATURES
Combined ADA & AAOMS classification of procedural terminology
WHARFE ASSESSMENT
Difficulty Index for removal of impacted mand third molars
Difficulty index
◦ Very difficult : 7 to 10◦ Moderately difficult : 5 to 7◦ Minimally difficult : 3 to 4
Difficulty index for removal of impacted mand.Third molars
ding to J. P. Rood, B. A. A. Nooraldeen Shehab, Darkening of the root (Howe and Poyton,
Main).DeflectofMacgregor, Killey and Kay)
Radiological prediction of inferior alveolar nerve relation
Put jc
Darkening of the root
Loss of density of rootShows overlaping93.1% showed this sign
Deflected roots
Abrubt deviation
Roots may be hooked
Narrowing of roots
implies that the greatest diameter involved by cannal
Deep grooving or perforation may be their
Dark & bifid root
Nerve cross the apex
Double periodontal membrane of bifid apex
Interruption of white line
Diappeares as it reaches the tooth
Diversion of cannal
Change of direction due to displacement of cannalNerve may pass through root
Narrowing/ hour glass apperance
Downward displacement of cannel
ASSESSMENT OF DEPTH OF TOOTH ASSESSMENT OF DEPTH OF TOOTH IN ALVEOLAR BONEIN ALVEOLAR BONE
WHITE LINE
Amber line
Red line
Point of application of elevatorPoint of application of elevatorDepth -More than 5mm – GADepth -More than 5mm – GA
Distoangular impactions - red line-distal CEJ of impacted 3rd molarDistoangular impactions - red line-distal CEJ of impacted 3rd molar
Assesment of 2Assesment of 2ndnd molar molar
If 2nd molar roots are smaller in relation to the impacted tooth or if the roots of 2nd molarare fused & conical, surgeon must be carefulnot to luxate 2nd molar during elevation.
Absence of 1st molar leaves 2nd molar Unsupported
LOCALIZATION OF IMPACTED TEETH USING RADIOGRAPHS
Localization of impacted third molar using radiographs
TUBE SHIFT TECHNIQUE
If canal moves upwards then it is bucally placed .If it moves downwards then lies lingual to roots.
CLARK’S HORIZONTAL TUBE SHIFT
MAXILLARY THIRD MOLAR IMPACTION
ASSESSMENT OF IMPACTED MAX 3rd MOLAR
ARCHER’S ANATOMIC CLASSIFICATION
PELL & GREGORY – RELATIVE DEPTH IN RELATION TO 2ND MOLAR
DIFFICULTY FACTORS
ConclusionConclusion
• IMPACTED TEETH – ALLING , HELFRICK• CONTEMPORARY ORAL AND MAXILLOFACIAL
SURGERY,4TH EDITION-LARRY.J.PETERSON,JAMES.R.HUPP,MYRON.R.TUCKER
• MINOR ORAL SURGERY- GEOFRY L. HOW• TEXT BOOK OF ORAL AND MAXILLOFACIAL
SURGERY, BALAJI• TEXT BOOK OF ORAL AND MAXILLOFACIAL
SURGERY, SHRINIVASAN• BR JR OF ORAL AND MAXILLOFACIAL SURGERY
1990; 28: 20-25• J ORAL MAXILLOFAC SURG 2003; 61: 417- 421• J ORAL MAXILLOFAC SURG 2005; 63: 3-7• DENTAL CLINICS OF NORTH AMERICA – VOL
38.NO:2 APRIL 1994
References
Thank youThank you
Condition of the Masticatory mucosa in relation to the adjacent tooth.
If planned under GA, other impacted teeth should also be considered for removal.