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Impacted heena seminar
The document discusses impacted teeth, including definitions, etiology, indications and contraindications for removal, imaging modalities, and localization techniques. It focuses on impacted maxillary and mandibular third molars and cuspids. For maxillary third molars, it describes classification systems based on depth, angulation, and relationship to the maxillary sinus. Factors complicating their removal and common complications are outlined. Etiology and classification of impacted cuspids are also summarized.
Impacted heena seminar
- 1. PRESENTER- Dr. HEENAAGARWAL MODERATOR -Dr. MAHENDRA P.
- 2. • Definition • Etiologyof impaction • Indications & contraindications • Imaging modalities of an impacted tooth • Localization of impacted tooth • Impacted maxillary third molar • Impacted maxillary cuspids • Impacted mandibular cuspids • Reference
- 3. The word “Theword “ IMPACTIONIMPACTION’ is from Latin origin –’ is from Latin origin – IMPACTSIMPACTS Impacted tooth is one that fails to erupt and will notImpacted tooth is one that fails to erupt and will not eventually assume its anatomical arch relationship beyondeventually assume its anatomical arch relationship beyond the chronological age of eruption and its further eruption isthe chronological age of eruption and its further eruption is prevented by the surrounding soft tissue or bone ”prevented by the surrounding soft tissue or bone ” ARCHERARCHER
- 4. AnAn UNERUPTEDUNERUPTED tooth– is a tooth that is in the processtooth – is a tooth that is in the process of eruption and is likely to erupt based on clinical andof eruption and is likely to erupt based on clinical and radiographic findings.radiographic findings. MALPOSEDMALPOSED tooth - A tooth unerupted or eruptedtooth - A tooth unerupted or erupted which is in an abnormal position in the maxilla or in thewhich is in an abnormal position in the maxilla or in the mandible.mandible. AnAn EMBEDDEDEMBEDDED tooth – is the tooth that has failed totooth – is the tooth that has failed to erupt completely or partially to its correct position in theerupt completely or partially to its correct position in the dental arch and its eruption potential has been lost.dental arch and its eruption potential has been lost.
- 5. Impacted teethcan be defined as those teeth that are prevented from eruption due to a physical barrier within the path of eruption (Farman, 2004). The term impaction was defined by Peterson as tooth that fails to erupt into the dental arch within the expected time (Peterson, 1998).
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- 8. DECREASE IN JAWDECREASEIN JAW FUNCTIONFUNCTION DECREASE IN JAWDECREASE IN JAW SIZESIZE IMPACTIONIMPACTION DISUSE THEORYDISUSE THEORY
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- 10. LARGE TEETHLARGE TEETH SMALLJAWSMALL JAW LACK OF SPACE FORLACK OF SPACE FOR TOOTH ERUPTIONTOOTH ERUPTION IMPACTIONIMPACTION FATHERFATHER MOTHERMOTHER HERIDETARYHERIDETARY THEORYTHEORY
- 11. ENDOCRINE THEORYENDOCRINE THEORY ENDOCRINEDISTURBANCE DECREASED GROWTH OF JAWSDECREASED GROWTH OF JAWS LACK OF SPACE FOR TOOTHLACK OF SPACE FOR TOOTH ERUPTIONERUPTION IMPACTIONIMPACTION
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- 13. HINDERENCE TOHINDERENCE TO TOOTHMOVEMENTTOOTH MOVEMENT AND JAW GROWTHAND JAW GROWTH FORWARDFORWARD DIRECTIONDIRECTION TRAUMA ,TRAUMA , DENSE BONE ,DENSE BONE , MALOCCLUSIONMALOCCLUSION IMPACTIO IMPACTIO NN
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- 17. Order of frequencyof Impaction
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- 21. Radiographic evaluation ofimpacted teeth The diagnostic radiograph must demonstrate the following: Entire outline of the impacted teeth Outline of the follicle sac
- 22. Occlusal radiography Occlusal radiographyrepresents an excellent imaging method when the image field extends more apically then the coverage of the standard IOPA radiograph. Also helpful on patients with a limited mouth opening Anterior Maxillary topographical projection Lateral Maxillary topographical projection
- 23. Anterior Max. occlusalCross-sectional Lateral
- 24. Panaromic radiography OPG thatdisplay the entire dentoalveolar complex and adjacent anatomy are excellent for imaging many impacted teeth.
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- 28. Special technique CT scans CTscans are useful and indicated if an impacted tooth is positioned in an ectopic positioned in an ectopic position distant from the oral cavity or associated with neoplastic or inflammatory process with morbidity in the contiguous tissues.
- 32. Based on anatomicposition A) Relative depth of the impacted third molar in bone: Class A: The lowest portion of the crown of the impacted maxillary 3rd molar is on a line with the second molar. Class B: The lowest portion of the crown of the impacted maxillary 3rd molar is between the occlusal plane of the second molar and cervical line. Class C: The lowest portion of the crown of the impacted maxillary 3rd molar is at or above the cervical line of second molar.
- 33. B)The position ofthe long axis of the impacted maxillary third molar in relation to the long axis of the second molar: 1. Vertical 2. Horizontal 3. Mesioangular 4. Distoangular 5. Inverted 6. Buccoangular 7. Linguoangular
- 34. C) Relationship ofimpacted maxillary third molar with maxillary sinus 1. Sinus approximation (S.A.): no bone or a thin portion of bone between the impacted maxillary 3rd molar and the maxillary sinus, known as maxillary sinus approximation. 2. No sinus approximation (N.S.A.): 2 mm or more of bone between the impacted maxillary 3rd molar and the maxillary sinus, known as no maxillary sinus approximation.
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- 39. Factor complicating surgicalremoval
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- 48. Reasons for canineimpaction 1. BECKER CONCEPT (1984) Hypothesized 2 processes in palatal impaction 2. MC BRIDGE CONCEPT Canine formed high in anterior wall – below the floor of orbit – long tortous path of eruption. Absence of initialAbsence of initial early guidanceearly guidance Failure of buccalFailure of buccal movement ofmovement of caninecanine
- 49. MOYERS CONCEPT :summarised by BISHORA
- 50. BERGER CONCEPT (systemic cause of impaction) Malnutrition, Syphilis, Rickets, Progeria etc Syndromes – Cliedocranial dysplasia, Achondroplasia, VONDER HEYDT CONCEPT Total arch length of permanent teeth -established very early in life Canine is larger and later erupting -it may get impacted.
- 51. GUIDANCE THEORY –MILLER Canine usually have more mesial development path, which is guided downwards apparently along the distal aspect of the lateral incisor roots. PECKS AND PECKS CONCEPT Palatal impacted canine is an inherited trait occurs in combination with tooth size reduction, supernumery tooth and other ectopicaly tooth Palatally impacted canine as dental anomaly as genetic origin
- 53. FIELD AND ACKERMANCLASSIFICATION (1935) MAXILLARY CANINES a LABIAL POSITION Crown in intimate relationship with incisors. Crown well above the apices of incisors. b PALATAL POSITION Crown near the surface in close relationship to roots of incisors. Crown deeply embedded in close relationship to apices of incisors.
- 54. c. INTERMEDIATE POSITION Crownbetween lateral incisor and 1st premolar roots. Crown above these teeth with crown labially placed and root palatally placed or vice versa. d. UNUSUAL POSITION In nasal or antral wall. In infra orbital region.
- 55. Class I: Impactedcuspids located in the palate a. Horizontal b. Vertical c. Semivertical Class II: Impacted cuspids located in the labial or buccal surface of the maxilla a. Horizontal b. Vertical c. Semivertical
- 56. Class III: Impactedcuspids located in both the palatal process and labial or buccal maxillary bone. Class IV: Impacted cuspid located in the alveolar process, usually between the incisor and first bicuspid. Class V: Impacted cuspids located in an edentulous maxilla
- 57. Indication Changed positionof adjacent teeth Resorption of roots of adjacent teeth Cyst formation Cleft palate Before the fitting of full or partial denture Neurologic symptom
- 58. Contraindication When the cuspidcan be brought into normal position either by surgical positioning or combination of surgery and orthodontia at an early age .
- 59. Factor complicating theremoval of impacted maxillary cuspid Proximity of impacted cuspid to adjacent teeth and vital structure. Possibility of forcing cuspid into maxillary sinus. Most impacted cuspid roots have a pronounced curvature at the apical third
- 80. Impacted mandibular cuspids- usually vertically impacted - found close to the labial surface. Occasionally - located beneath the apices of the mandibular incisors lying transversely at a 45 degree angle to the lower border of the mandible. Rarely - found in a horizontal position or on the lingual side of the dental arch.
- 81. FIELD AND ACKERMANCLASSIFICATION (1935) MANDIBULAR CANINES LABIAL Vertical Oblique Horizontal ABERRANT At inferior border On the opposite side
- 82. Complication of max.& mand. canine Infection Paresthesia Damage to adjacent structures Noneruption Loss of soft tissue flap Lack of attached gingiva. Devitalization of the pulp pain
- 83. Conclusion…. Acc toChandler and Laskin, the best way to determine the complexity of any operation is at the time of surgery. Opinions based on comparison of radiograph with operative report are more accurate than those based purely on radiographs.
- 84. References Minor oral surgery– G Howe Principle of oral & maxillofacial Surgery – Peterson Contemporary oral & maxillofacial Surgery – Peterson Impacted teeth – Alling & Alling Textbook of oral & maxillofacial Surgery – Kruger Oral Surgery – Archer Principle of oral & maxillofacial surgery – Moore & Gillbe Textbook of oral & maxillofacial Surgery – SM Balaji
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Editor's Notes
- #4 Archer defined impacted tooth tooth is one that fails to erupt and will not eventually assume its anatomical arch relationship beyond the chronological age of eruption and its further eruption is prevented by the surrounding soft tissue or bone
- #5 There are various other terms which are misinterprete with impaction such as- an unerupted tooth can be a tooth which is in the process of eruption and is likely to erupt based on clinical and radiographic findings. Next is malposed tooth.. these tooth position in the maxilla or mandible is abnormal.. And they cud b either erupted or unerupted form. EMBEDDED tooth – these tooth that has failed to erupt completely or partially to its correct position in the dental arch and its eruption potential has been lost
- #6 There are other authors also who defined impaction as those teeth whichare prevented from eruption due to a physical barrier within the path of eruption..givn b farmer in d year 2004… and peterson defined impaction as as the tooth that fails to erupt into the dental arch within the expected time (Peterson, 1998).
- #7 There are various theories which has described d etiology of impaction…such as..phylognc theory, mendeln, orthodontc, endocrine n others but I will b discussing sum main theories in brief ..first
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- #14 Orthodontc theory s gvn by durbeck it states that jaws develop in downward n forward direction..growth f d jaws n teeth occur in forward dirctn..so anything dat interfere wid such movemnt like dense bone, trauma will cause impctn…
- #15 BERGER
- #16 In systemic causes they can be prenatal and postnatal in prenatal it can be heredity..n in postnatal it can be rickets, congenital syphilis, malnutrition, endocrinal dysfunction…..hutchinson teeth, peg shaped centrl incsr,mulberry molar, poorly developd permnat molars, poorly develpd maxilla.. Rickets --
- #17 Cleidocranial dystosis- hereditary disease, delayed n incomplete ossification of calvarium, delayed n defective dentition.. Progeria- premature old age, like amitabh bachan in paa muvie, wrinkld skin,gray hair, attitude of old age.. Achondrplasia – hereditary, dwarfism occur, cartilage fail to develop properly, Achondroplasia --
- #18 Source – Archer 4th ed frequency f impacton
- #19 Impinging on coronoid process ,,formation of any pathology like dentigerous cyst, preprosthetic concerns
- #34 This may also occur simultaneously in Buccal version Lingual version Torsoversion
- #36 These are some examples, when used together to classify impacted 3rd molar..
- #43 There can be various incisions for 3rd molar extraction but commonly usedc is: envelope incision.
- #44 In deep impactn where access is required ,,a releasing incision can b givn extending from d mesia aspct of 2nd molar.
- #46 To avoid d entry f root into d maxillary sinus or pterygomaxillary space.
- #70 Incision is made around d neck f d teeth on d lingual side of max central Incisors..and extnding to d distal edge f d second premolar..incision begin at d crest o finterdental papilla on lingual side betwn max central incsrs, and carried straight back along centre f d palate for one and half Inches..dan mucoperiosteum s rflcted ..holes r drilled around d crown of impactd tooth. Opening s enlargd with crosscut surgicl bur ..tooth s elevatd from d sockt ..and suturng done.
- #72 This technique s indicatd when tip f crown s in contact wid d roots of d centrl incsrs and latrl incsors..
- #77 An incision is made mesial to latrl incsr and distl ti 2nd premolr.. labial flap is reflected
- #79 semilunar labial flap is made over the root den root is exposed and elevated out den a a palatal flap is outlined nd by using a blunt instrument it s placed at d root end f d crown nd tapped with chisel buccaly so dat crown is drawn out f d crypt palataly
- #83 Ecchymosis of the upper lip or lower lip and chin