28-25طه

Prof. Ragab ShaabanProf. Ragab Shaaban

Text bookText book

Contemporary Oral and Contemporary Oral and Maxillofacial surgeryMaxillofacial surgery

Peterson-HuppPeterson-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

1. Mandibular third molars.

2. Maxillary third molars.

3. Maxillary canines.

4. Mandibular premolars.

5. Mandibular third canines.

6. Maxillary premolars.

7. Maxillary central incisors.

8. Mandibular lateral incisors.

1. Infections

2. Caries

3. Pathological resorption

4. Enlarged follicular space

5. Association with cystic

6. Association with neoplasm

57%

20%

6%

4%

2%

0.5%

7. Involvement in a fracture

8. Causing malposition of adjacent

teeth

9. Causing impaction of adjacent teeth

10. Causing crowding of the lower

anteriors

11. Causing no apparent problems

1%

3%

4%

8%

3%

Indications for operation

Pain.

Orthodontic conditions.

Association with path. lesions.

Patient travelling.

Young patients.

Before constructing dentures.

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.

Relation of tooth to the ramus and the

second molar

Class I.

Class II.

Class III.

State of eruption Erupted.

Unerupted.

Partially erupted.

Angulation and position Vertical.

Mesioangular.

Distoangular.

Horizontal.

Transverse displacement.

Aberrant position.

General anaesthesia.

Intravenous diazepam and local

anaesthesia.

Incision.

Bone removal.

Sectioning of tooth.

Elevation of tooth from its socket.

Preparation of wound before

closure.

Closure of the incision.

1. Incision

a. For bony impaction.

b. For soft tissue impaction.

2. Bone removal

a. Hammer & Chisel (split bone technique).

b. Surgical burrs (Guttering).

c. Combination (POS & Stamp).

3. Sectioning of teeth if indicated

4. Elevation of the tooth

a. No excessive force.

b. Warwick Jame’s or Coupland Chisels.

c. Buccal cortex as a fulcrum.

5. Preparation of wound for closure

a. Irrigation.

b. Residual tooth sac.

c. Tags of mucosa and granulation tissue.

d. Irregular edges of bone.

e. Bleeding points.

6. Closure of the wound

a. Black 00 or 000 silk.

b. Complete closure-unerupted teeth.

c. Partial closure-partially erupted tooth.

• Control postoperative infections.

• Control postoperative pain.

• Control postoperative oedema.

• Oral hygiene and diet.

• Removal of sutures.

1. Unerupted:

a. Within bone.

b. Immediately beneath soft tissue.

2. Partially erupted.

3. Fully erupted.

1. Vertical.

2. Mesio-angular.

3. Disto-angular.

4. Laterally displaced.

5. Aberrant position.

• Relation to maxillary sinus:

a. Sinus approximation.

b. No sinus approximation.

• Root form:

a. Fused.

b. Multiple.

1. Soft tissue flap, buccal or palatal.

2. Removal of overlying bone.

3. Removal of the tooth.

4. Debridement and closure of wound.

5. Postoperative care.

• Class 1:Class 1: In the palatel.

• Class 2:Class 2: In the buccal surface.

• Class 3:Class 3: In both palatal and in a labial sides.

• Class 4:Class 4: In the alvelous.

• Class 5:Class 5: In the edentulous maxilla.

1. Clinical examination1. Clinical examination

• Bulge.

• Deflection of related teeth.

2. Radiological examination2. Radiological examination

a. Intra-oral. d. Steroscopic.

b. Occlusal. e. Tomograms.

c. Shift-sketch. f. OPT and extra oral.

1. Close relation to the neighbouring teeth.

2. Maxillary sinus approximation.

3. Nasal cavity approx.

4. Big and curved roots.

5. Difficult to localize.

1. Surgical removal.

2. Exposure of the canine for orthodontic

treatment.

3. Repositioning reimplantation.

1. Removal of palatally impacted canine.

2. Removal from labial position.

3. Removal from interemediate position.

4. Removal from edentulous ridge.

5. Removal from unusual position.