قال رب اشرح لى صدرى ويسر لى أمرى واحلل عقدة من لسانى يفقهوا قولى P قال رب اشرح لى صدرى ويسر لى أمرى واحلل عقدة من لسانى يفقهوا قولى طه 25-28

IMPACTION Prof. Ragab Shaaban

Contemporary Oral and Maxillofacial surgery Peterson-Hupp Text book Contemporary Oral and Maxillofacial surgery Peterson-Hupp

Impacted tooth is a tooth prevented from eruption by adjacent teeth, dense overlying bone or excessive soft tissue.

Impacted tooth is an unerupted or partially erupted tooth that passed its normal time of eruption

Frequency of Impacted Teeth Mandibular third molars. Maxillary third molars. Maxillary canines. Mandibular premolars. Mandibular third canines. Maxillary premolars. Maxillary central incisors. Mandibular lateral incisors.

Impacted Lower Third Molar Surgical Anatomy

Problems Caused by Impacted Teeth Infections Caries Pathological resorption Enlarged follicular space Association with cystic Association with neoplasm 57% 20% 6% 4% 2% 0.5%

Problems Caused by Impacted Teeth Involvement in a fracture Causing malposition of adjacent teeth Causing impaction of adjacent teeth Causing crowding of the lower anteriors Causing no apparent problems 1% 3% 4% 8%

Impacted Teeth Indications for operation Pain. Orthodontic conditions. Association with path. lesions. Patient travelling. Young patients. Before constructing dentures.

Impacted Mandibular Third Molar Clinical and radiological examinations State of eruption. Pericoronal tissues. Second molar and the impacted tooth. Classification of impaction. Relation to important anatomical structures. Possibility of jaw fracture. Difficult access to the field.

Impacted Lower Third Molar Classification Relation of tooth to the ramus and the second molar Class I. Class II. Class III.

Impacted Lower Third Molar Classification State of eruption Erupted. Unerupted. Partially erupted.

Impacted Lower Third Molar Classification Angulation and position Vertical. Mesioangular. Distoangular. Horizontal. Transverse displacement. Aberrant position.

Impacted Lower Third Molar Choice of Anaesthesia General anaesthesia. Intravenous diazepam and local anaesthesia.

Impacted Mandibular Third Molar Standard Operative Plan Incision. Bone removal. Sectioning of tooth. Elevation of tooth from its socket. Preparation of wound before closure. Closure of the incision.

Impacted Lower Third Molar Standard Operative Plan 1. Incision For bony impaction. For soft tissue impaction.

Impacted Lower Third Molar Standard Operative Plan 2. Bone removal Hammer & Chisel (split bone technique). Surgical burrs (Guttering). Combination (POS & Stamp).

Impacted Lower Third Molar Standard Operative Plan 3. Sectioning of teeth if indicated

Impacted Lower Third Molar Standard Operative Plan 4. Elevation of the tooth No excessive force. Warwick Jame’s or Coupland Chisels. Buccal cortex as a fulcrum.

Impacted Lower Third Molar Standard Operative Plan 5. Preparation of wound for closure Irrigation. Residual tooth sac. Tags of mucosa and granulation tissue. Irregular edges of bone. Bleeding points.

Impacted Lower Third Molar Standard Operative Plan 6. Closure of the wound Black 00 or 000 silk. Complete closure-unerupted teeth. Partial closure-partially erupted tooth.

Impacted Lower Third Molar Postoperative Care Control postoperative infections. Control postoperative pain. Control postoperative oedema. Oral hygiene and diet. Removal of sutures.

Impacted Maxillary Third Molar A. Classification 1. Unerupted: Within bone. Immediately beneath soft tissue. Partially erupted. Fully erupted.

Impacted Maxillary Third Molar B. Classification Vertical. Mesio-angular. Disto-angular. Laterally displaced. Aberrant position.

Impacted Maxillary Third Molar Classification Relation to maxillary sinus: Sinus approximation. No sinus approximation. Root form: Fused. Multiple.

Surgical Technique for Removal of Impacted Maxillary Third Molar Soft tissue flap, buccal or palatal. Removal of overlying bone. Removal of the tooth. Debridement and closure of wound. Postoperative care.

Impacted Maxillary Canine Archer's Classification Class 1: In the palatel. Class 2: In the buccal surface. Class 3: In both palatal and in a labial sides. Class 4: In the alvelous. Class 5: In the edentulous maxilla.

Impacted Maxillary Canine Localized Impacted Canine 1. Clinical examination Bulge. Deflection of related teeth.

Impacted Maxillary Canine Localized Impacted Canine 2. Radiological examination a. Intra-oral. d. Steroscopic. b. Occlusal. e. Tomograms. c. Shift-sketch. f. OPT and extra oral.

Factors Complicating the Removal of The Impacted Canine (Localized Impacted Canine) Close relation to the neighbouring teeth. Maxillary sinus approximation. Nasal cavity approx. Big and curved roots. Difficult to localize.

Impacted Maxillary Canine Management of Impacted Maxillary Canine Surgical removal. Exposure of the canine for orthodontic treatment. Repositioning reimplantation.

Impacted Maxillary Canine Surgical removal of Impacted Maxillary Canine Removal of palatally impacted canine. Removal from labial position. Removal from interemediate position. Removal from edentulous ridge. Removal from unusual position.