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DENTOALVEOLAR SURGERY
IMPACTION-CLASSIFICATION
& ASSESSMENT
BY: DR. ABDUL RAZAKPOSTGRADUAT ORAL SURGERY
B.I.D.S.,BANGALORE
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Definition
Incidence Etiology
Indication
Contraindication Classification
Assessment
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Definition
A impacted tooth is that tooth which cannot or will not erupt
into its normal functioning position due to any soft tissue or
hard tissue impedement & requires treatment
Order of Incidence
Third Molars
Maxillary Canine
Mandibular Premolars
Etiology
Improper position of the developing third molar
Arch length-tooth size discrepancy
Lack of co-ordination between skeletal growth & maturation
of third molar
Lack of co-ordination of eruption of permanent teeth
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Indications
Pericoronitis
Periodontal Bone Loss
Dental Caries
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Orthodontic Considerations
Odontogenic Cyst & Tumours
Root Resorption of Adjacent Teeth
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Teeth under Prosthesis
Prevention of Jaw factures
Management of Unexplained Pain
Contraindications
Extreme of Ages
Compromised Medical Status Surgical Damage to Adjacent Structures
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Classification & Assessment
Angulation - Winter Classification
a. Mesioangular
b. Horizontal
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c. Vertical
d. Distoangular
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Relation to the Anterior Border of Ramus
Pells & Gregory Classification
a. Class 1
b. Class 2
c. Class 3
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Relation to Occlusal Plane
Pells & Gregory Classification
a. Class A b. Class B
c. Class C
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Petersons Difficulty Index
Winter Classification
a. Mesioangular 1
b. Horizontal 2
c. Vertical 3d. Distoangular 4
Depth
a. Class A 1
b. Class B 2
c. Class C 3
Ramus Relationship
a. Class 1 1
b. Class 2 2
c. Class 3 3
Difficulty Index
Very Difficult 7-10
Difficult 5-7
Minimally Difficult 3-4
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Root Morphology
a. Length of the Root
b. Curvature of the Rootc. Direction of the Curvature
d. Mesiodistal Width of the Root
e. Periodontal Ligament Space
Size of the Follicular Sac
Density of the Surrounding Bone
Contact with the Second Molar
Relationship with the Inferior Alveolar Nerve Relationship with the Maxillary Sinus
Nature of the overlying Tissue
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Classification of Impacted Maxillary Canine
Class 1- Palatally placed
Class 2- Labially placedClass 3- Involving both buccal & palatal plate
Class 4- Impacted within the alveolar bone
Class 5- Impacted in edentulous maxilla
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Wharfe Assessment
1.Winters classification
horizontal 2
distoangular 2 mesioangular 1
vertical 0
2.Height of mandible
1-30mm 0
31-34mm 1
35-39mm 2
3.Angulation of third molar
1-50 0
60-69 1
70-79 2
80-89 3
90+ 4
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4.Root shape complex 1 favourable curvature 2 unfavourable curvature 3
5.Follicles normal 0 possibly enlarged 1 enlarged 2
6.Path of Exit space available 0 distal cusp curved 1 mesial cusp also curved 2 both curved 3
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Reference
Petersons Principles of Oral & Maxillofacial Surgery
Impacted Teeth Charles C. Ailing, John F. Helfrick
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THANK YOU
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