Impacted Teeth Part A

8/2/2019 Impacted Teeth Part A

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Impacted tooth

A tooth which is completely or partially un erupted beyond itsnormal time of eruption is called an impacted tooth.

OR

Any tooth which is either completely unerupted or partiallyerupted and where it is being obstructed either by adjacenttooth, bone or soft tissues where its further eruption is notpossible.

Malposed tooth

Any tooth which is un erupted, erupted partially or completelyerupted but is not in normal alignment with mandible or maxilla.

Un erupted teeth:

All those teeth which has not pierced or perforated the oralmucosa are labeled as un erupted teeth. If a tooth is in thebone & is mal-posed we will wait for its time of eruption.


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DEFINITION

Any tooth which is partially or completely

un-erupted, being obstructed by the

adjacent teeth, overlying bone or hard

fibrous tissue, so that it is unlikely to eruptbeyond its maximum time of eruption is

labeled as anImpacted tooth


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Causes of impaction

Local causes:

1.Lack of space due to irregularity in the

position & pressure of an adjacent tooth.2.Density of the overlying bone or

surrounding bone.

3.Dense & thick mucosa.4.Chronic inflammation with resultant

increase in density of overlying mucosa &

scar formation.


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5. Diseases like infection, abscess orosteomyelitis.

6. Lack of space due to under development ofjaw.

7. Early loss of deciduous teeth, resulting in;1. The mucosa overlying the permanent teeth become

fibrosed.

2. The teeth lying beside become shifted to that area &decrease the space.


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8. Prolonged retension of primary teeth, sospace for permanent teeth to come & thus it

may change the direction.9. Exanthematous diseases in children in which

skin eruption occur, also the mucosa become

fibrosed. In these diseases inflammatorychanges in the bone also occur.

10.Over crowing of teeth causes lack of space.


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Systemic diseases:

Impaction may occur where no local predisposingconditions are present;

1.Prenatal causes:

1.Hereditary factors

2.Miscegenation pt from different races e.g. mother is from

Maldives or srilanka & farther from Africa, the child getsthe jaw size from mother & teeth size from father, so theteeth will be large & jaws will be small.


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2. Post natal causes: all those systemic diseaseswhich can effect the growth of baby directly orin directly like;

1. Rickets

2. Anaemia

3. Congenital syphilis

4. Tuberculosis

5. Endocrine dysfunction

6. Malnutrition


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3. Rare conditions1. Cleido cranial dysostosis

2. Oxycephaly

3. Progeria

4. Achodroplasia

5. Cleft palate

6. Pagets disease of bone

7. Mongolism


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Chronology

Any tooth can become impacted but mostcommonly impacted teeth are third molars,maxillary canines & premolars. But any tooth

erupting late Chronologically can get impacted. Lack of space:

Inadequate dental arch length and space inwhich to erupt; i.e. total length of the alv. bonearch is smaller than the total length of the tootharch.


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1. Third molars: last teeth to erupt & likely tohave inadequate space for eruption.

2. Maxillary canine: being the longest rootedtooth, long tortuous way to travel to come intooral cavity & and when there is over crowingin upper anterior maxilla, remains impact or

become malposed.

This is because canine tooth erupts after max.Lateral incisor & 1st premolar leaving no space

for it.3. Mandibular premolar: it erupts after lower 1st

molar & mand. Canine find no space for

eruption.


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canine


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INDICATIONS FOR EXTRACTION

PREVENTION OF RECURRENTPERICORONITIS

PREVENTION OF CARIES / ROOT

RESORPTION PREVENTION OF PERIODENTAL DISEASE

PROSTHETIC CONSIDERATIONS

ORTODONTIC CONSIDERATIONS


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INDICATIONS FOR EXTRACTIONcont

PRESENCE OF PATHOLOGIC LESION

UNEXPLAINED PAIN

SOCIAL AND ECONOMIC FACTORS


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PREVENTION OF RECURRENTPERICORONITIS

Pericoronitis is the infection &inflammation of the soft tissue around thecrown of partially impacted tooth.

An indication

Paradoxically an contraindication

Bilateral concurrent pericoronitis Rare -advise to removal impaction


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Peri apical periodontitis


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Prevention of periodontaldisease/peri apical periodontitis

High incidence of periodontal pocketing distal to2nd molar.

Pocketing of gums around partially erupted 3rdmolar cause relapses even after effective

treatment. Even after 3rd molar removal distal pocketing to

2ndmolar creates problems Proper timing & appropriate technique of

impaction removal is mandatory. Caries-pulp exposure- peri apical / dento alv.

abscess


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PREVENTION OF CARIES

Partially erupted thirdmolar food trapplaque -unpleasant taste& smell- caries occ:

surface of impacted thirdmolar or distal surface ofsecond molar or both.

Second molar can be

successfully preservedafter removal of impactedtooth.

Caries/root resorption


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ORTHODONTIC REASONS

Prophylactic removal of 3rd molarscontroversial imbrication lower incisors.

Marked disproportions between tooth size & thejaw size. Radiographic & computer based

evidence at age 7-9 yrs that impaction will occur 3rd molar germ before calcified cusps united isenucleated- not popular.

Lateral trepanation at age of 16 yrs crown

completed & one 3rd

roots formed. But both have advantage of less surgicaltrauma.


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PROSTHETIC COSIDERATION

Where dental clearance indicated an OPGtaken to exclude hidden impactions orburied roots.

This will help avoidance future ill fitness ofdentures and infections or surgical trauma.


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PRESENCE OF PATHOLOGICALLESION

Prevention of formation odontogenic cysts/ tumour.

Relation to a malignant tumour.

In fracture line remove or not remove.

Prevention of mandible fracture


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LOWER 3RD RELATEDFOLLICULAR CYST


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IMPACTION RELATED TOKERATOCYST


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UNEXPLAINED PAIN

May found in search for causes / diagnosisof obscure facial pain.

Some times help but patient must beexplained a guarded prognosis.


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SOCIAL & ECONOMIC FACTORS

Busy patients either delay or want earlysurgery.

Patients from far-flung inconvenience.

Finances.

Impacted Teeth Part A

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