Tooth impaction Research Articles

Tooth impaction refers to the failure of teeth to erupt

into the mouth within the normal time, where the failure

of outburst appears to originate from mechanical blocking. Tooth impaction may result from a number of

local causal factors. These include arch length discrepancy, ectopic positioning of the teeth, presence

of supernumerary teeth, bony barriers, and retained deciduous teeth

Angulation of tooth Most commonly used

classification system with respect to treatment

planning. Depending on the angulation the tooth

might be classified as

Mesioangular

Horizontal

Vertical

Distoangular

Palatal

Buccal

Lingual

This type of classification is based on the amount of

impacted tooth that is covered with the mandibular ramus. It is known as the Pell and Gregory classification, classes

1, 2, and 3. [3]

Impacted wisdom teeth don't always cause symptoms.

However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental

problems, you may experience some of these signs or symptoms:

Pain

Red or swollen gums

Tender or bleeding gums

Swelling around the jaw

Bad breath

An unpleasant taste in your mouth

Headache

Complications

Damage to other teeth. If the wisdom tooth pushes

against the second molar, it may damage the second molar or make it more vulnerable to infection. This

pressure can also cause problems with crowding of the other teeth or orthodontic treatments to straighten other

teeth.

Cysts. The wisdom tooth grows in a sac within the

jawbone. The sac can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Rarely, a

tumor — usually a noncancerous tumor — develops.

This complication may require removal of tissue and bone.

Decay. Partially impacted wisdom teeth appear to be

more vulnerable to tooth decay (caries) than other teeth.

This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily

trapped between the gum and a partially erupted tooth.

Gum disease. The difficulty of cleaning impacted,

partially erupted wisdom teeth also makes them a vulnerable site for the development of a painful,

inflammatory gum condition called pericoronitis (per-ih-kor-o-NI-tis)

Classification Winter's

The classification is based on the inclination of the

) to the long axis of the3rd molarimpacted wisdom tooth (

.2nd molar

The impacted tooth is tilted toward the . Angular-Mesio

direction mesial 2nd molar in a

The long axis of the 3rd molar is . Angular-Disto

l awayfrom the 2nd mola distally / posteriorlyangle

horizontal The long axis of the 3rd molar is . Horizontal

The long axis of the 3rd molar is parallel to the . Vertical

long axis of the 2nd molar.

the above, In combination with . Lingual Obliquity / Buccal

the tooth can be

(tilted lingually (tilted towards the cheek) or buccally

towards the tongue)

impacted.

This is where the tooth is in . Transverse

impacted but in a horizontally effect

tongue direction.-cheek

Classification Pell & Gregory's

This is based on the relationship between the impacted

lower wisdom tooth (3rd

(lower jaw) and the ramus of the mandible molar) to the

molar (based on the2nd

to the 2nd molar). distal space available

of the impacted tooth is at occlusal plane The . Class A

the same level as the

(The highest portion of of the 2nd molar. occlusal plane

impacted 3rd molar is on

).clusal planeoc a level with or above the

of the impacted tooth is occlusal plane The . Class B

occlusal plane between the

(The highest of the 2nd molar. cervical margin & the

portion of impacted 3rd

cervical but above the occlusal plane molar is below the

ar).of the of 2nd mol line

cervical The impacted tooth is below the . Class C

(The of the 2nd molar. margin

cervical highest portion of impacted 3rd molar is below the

of the of 2nd line

molar).

There is sufficient space available between . Class 1

theanterior border of the

aspect of the 2nd molar for distal & the ascending ramus

the eruption of the 3rd

molar.

anterior border The space available between the . Class 2

& the of the ramus

aspect of the of the 2nd molar is less than distal

of the distal width-mesio the

portion of distal It denotes that the crown of the 3rd molar.

the 3rd molar crown is

.ascending ramus covered by bone of the

The 3rd molar is totally embedded in the bone of . Class 3

anterior border of the

ack of because of the absolute l the ascending ramus

It is obvious that space.

teeth present more difficulty in removal as a Class 3

relatively large amount of

damaging bone has to be removed and there is a risk of

fracturing or the ID nerve

the mandible(or both).

Classification of Impacted Maxillary 3rd Molars

3rd molars is maxillary classification of impactedThe

similar to those used for

3rd molars. mandibular

Classification Gregory-Pell

of the impacted tooth is at occlusal plane The . Class A

the same level as the

(The lowest portion of of the 2nd molar. occlusal plane

impacted 3rd molar is on a

).occlusal plane level with or above the

of the impacted tooth is occlusal plane The . Class B

occlusal plane between the

(The lowest of the 2nd molar. cervical margin & the

f impacted 3rd molarportion o

of cervical line but above the occlusal plane is below the

the of 2nd molar).

cervical The impacted tooth is below the . Class C

(The of the 2nd molar. margin

cervical lowest portion of impacted 3rd molar is below the

of 2nd molar).of the line

Winter's Classification

Vertical Horizontal

Mesio-Angular Disto-Angular

Inverted Bucco-version

Linguo-version Transverse

These classifications have been revised / tweaked / conflated by Archer (1975) &

Kruger (1984).

Relationship of the Maxillary 3rd Molar to the Maxillary Sinus / Antrum

Sinus Approximation (SA):

No bone or thin partition of bone twixt the

impacted maxillary 3rd molar & the maxillary sinus / antr

> 2mm of bone twixt the impacted maxillary 3rd molar & the maxillary sinus /

antrum.

No Sinus Approximation (NSA):

> 2mm of bone twixt the impacted maxillary 3rd molar &

the maxillary sinus /

antrum.