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

2. IMPACTION
Prof. Ragab Shaaban

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

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

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

8. 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.

9. Impacted Lower Third Molar
Surgical Anatomy

12. 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%

13. 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%

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

18. 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.

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

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

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

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

26. 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.

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

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

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

40. 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.

42. 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.

43. 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.

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

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

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

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

50. 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.

54. 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.

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

56. 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.

61. 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.

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

63. 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.