Third molar /certified fixed orthodontic courses by Indian dental academy
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The document discusses impacted third molars, providing information on their prevalence, causes, classifications, indications for removal, surgical removal process, and potential complications. Specifically, it notes that 17% of people over 20 have an impacted tooth, with mandibular third molars being the most common at 18%. Reasons for removal include recurrent pericoronitis, dental disease, cyst formation, and prophylactic reasons. The surgical procedure involves raising a mucoperiosteal flap, removing bone, and extracting the tooth, with risks including nerve damage, bleeding, and fracture.
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Third molar /certified fixed orthodontic courses by Indian dental academy
- 1. Impacted third molar INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
- 3. Impacted third molar What its so special about third molar •Frequently encountered surgical problem •Commonly performed oral surgical procedure •General practitioner likely to see first •Need to decide a. Whether to remove or not b. Remove himself/herself or send to a specialist www.indiandentalacademy.com
- 4. Impacted third molar How often are teeth impacted? Only 17% of people over 20 years have an impacted tooth Maxillary third molars 22% Mandibular third molars 18% Maxillary canine 0.9% Ref:- Dachi S.F,Hovell oral surgery14:1165.1961 www.indiandentalacademy.com
- 8. Impacted third molar The exact cause is unclear could be multifactorial 1.Phylogenic theory 2.Mendelian theory 3. Endocrine disorders 4. Skeletal growth disturbances 5.Systemic conditions 6. Local factors www.indiandentalacademy.com
- 9. Impacted third molar Indications for removal - Repeated attacks of pericoronitis - Dental caries -Periodontal disease - Resorption of second molar - Prior to orthodontic treatment www.indiandentalacademy.com
- 10. Impacted third molar Indications for removal (Continued) - Presence in an edentulous jaw - Involved in cyst formation - Obscure facial pain - In line of fracture of mandible - Prophylactic reasons www.indiandentalacademy.com
- 11. Impacted third molar Pericoronitis Infection of the soft tissues around and above the crown of a partially erupted tooth Common condition between ages 17 and 25 Affects males and females equally Highest incidence in spring and autumn Predisposing factors Lowered tissue resistance, Upper respiratory infection Emotional stress, Fatigue, Pregnancy www.indiandentalacademy.com
- 12. Pericoronitis Classification Acute, subacute and chronic Acute characterized by -Pain Severe, Throbbing, Radiating, Intermittent, Interferes with sleep, exacerebated by chewing -Extra oral swelling -Limitation of mouth opening -Lymph nodes enlarged & tender www.indiandentalacademy.com
- 15. Acute (continued) Constitutional symptoms Rise in temperature, increased pulse and respiratory rates, looks ill and Leukocytosis Intra-orally Gum pad swollen, tender, red in appearance, pressure causes discharge of pus from beneath the flap and foetor oris www.indiandentalacademy.com
- 16. Pericoronitis Management General measures Bed rest is ideal Soft and nourishing diet Relief of pain by analgesics Antibiotic therapy www.indiandentalacademy.com
- 17. Pericoronitis Management Local measures Frequent use of hot saline mouth washes Incision and drainage, if pus in buccal sulcus Impinging maxillary third molar removal Removal of third molar after infection has subsided www.indiandentalacademy.com
- 20. Resorbtion of second molar www.indiandentalacademy.com
- 21. Resorbtion of second molar www.indiandentalacademy.com
- 22. Impacted third molar Classifications : George Winter’s Pell and Gregory’s Kay’s www.indiandentalacademy.com
- 23. George Winter’s classification Based on the relationship of the long axis of impacted 3rd molar with the long axis of 2nd molar:Vertical Mesioangular Distoangular Horizontal Buccoangular Aberrant positons www.indiandentalacademy.com
- 26. Pell & Gregory(1942) Classification Based on three aspects Position & Angulation Space between second molar and ramus Depth of the third molar in the bone www.indiandentalacademy.com
- 27. Pell & Gregory classification Position & Angulation George Winter’s Classification is adopted Mesioangular Vertical Distoangular Horizontal www.indiandentalacademy.com
- 28. Space between second molar & ramus www.indiandentalacademy.com
- 29. Depth of the third molar in the bone www.indiandentalacademy.com
- 30. Kay’s Classification ( Based on three aspects) 1.Position & Angulation- Winter’s Classification 2. State of eruption a) Erupted b) Partly erupted c) Unerupted 3. Number & pattern of roots - Fused -Two -Multiple -Favourable www.indiandentalacademy.com -Unfavourable
- 31. Difficulty index values (Pederson) Mesioangular 1 Horizontal 2 Vertical 3 Distoangular 4 level A 1 Class I 1 level B 2 Class II 2 level C 3 Class III 3 www.indiandentalacademy.com
- 32. Difficulty index (Pederson) Minimal 3-4 Moderate 5-7 Very difficult 7-10 www.indiandentalacademy.com
- 39. Winter’s imaginary lines White Line - Indicates position of 3rd molar Amber Line - Indicates margin of alveolar bone Red Line - Indicates depth of 3rd molar www.indiandentalacademy.com
- 40. Assessment of impacted third molar Purpose of assessment Possible difficulties & complications Facilities available Necessary surgical skill Decision to remove or to refer to a specialist www.indiandentalacademy.com
- 41. Clinical assessment General factors - Age - Medical condition - Temperament www.indiandentalacademy.com
- 42. Clinical Assessment Local factors Small mouth Mandibular retrusion Relationship of external Oblique ridge to the 3rd molar www.indiandentalacademy.com
- 43. Radiological assessment - Radiographs required - Periapical film - Lateral oblique view of mandible - Orthopantomogram - Lower occlusal film www.indiandentalacademy.com
- 44. Radiological assessment Points to be noticed in radiograph Augulation and depth Number and shape of roots Relationship with mandibular canal Condition of crown & root of 2nd molar Density of the bone Bone loss around the tooth Presence of first molar www.indiandentalacademy.com
- 45. Relationship with mandibular canal Normal relationship Variations - Groove - Deep Groove - Perforation www.indiandentalacademy.com
- 46. Considerations in predicting difficulty Age Young age old age Easy surgery less morbidity Difficult surgery greater morbidity Facial form Tapering Easy surgery Square & Compact Difficult www.indiandentalacademy.com
- 47. Removal of third molar Careful assessment Instruments selection Choice of anaesthesia Operative plan Post operative care www.indiandentalacademy.com
- 49. Choice of Anaesthesia Local Intravenous sedation and local General www.indiandentalacademy.com
- 50. Operative plan - Incision - Removal of bone - Removal of tooth - Preparation of the wound - Closure of the wound www.indiandentalacademy.com
- 51. Incision Principles of muco periosteal flaps Visibility Vascularity Healing www.indiandentalacademy.com
- 52. Impacted third molar Muco periosteal flap Flap consisting mucosa and periosteum Design Visibility Large enough to provide adequate access Viability Broad base wit narrow margin to provide proper blood supply Healing: Line of incision should be placed on sound bone www.indiandentalacademy.com
- 53. Impacted third molar Incision Anteriorly starts from the disto-buccal corner of the second molar runs downwards and forwards into the muco-buccal fold Posteriorly starts from middle of the distal aspect of second molar runs backwards and buccally towards external oblique ridge www.indiandentalacademy.com
- 55. Impacted third molar Removal of bone Bone is removed either by using surgical burs or chisel www.indiandentalacademy.com
- 56. Complications during surgical removal Incision Hemorrhage Lingual nerve damage Bone removal Injury to soft tissues Damage to 2nd molar Splitting of ramus Damage to bone Elevation of tooth Fracture of tooth Damage to 2nd molar Damage to I.D bundle Fracture of mandible Preparation of the wound Damage to I.D. nerve and vessels www.indiandentalacademy.com
- 57. Complications (Postoperative) - Haemorrhage - Haematoma - Oedema - Pain - Trismus www.indiandentalacademy.com
- 58. Impacted maxillary canine Classification Labial position Palatal position Intermediate position Unusual position www.indiandentalacademy.com
- 59. Impacted maxillary canine Localization-clinical Evidence of eruption Bulge on labial aspect Bulge on palatal aspect www.indiandentalacademy.com
- 60. Impacted maxillary canine Localization-radiological Vertex occlusal view Lateral skull radiograph Parallox method of clark www.indiandentalacademy.com
- 61. Impacted maxillary canine Management No surgical intervention Surgical exposure & orthodontic alignment Surgical removal & auto transplantation Surgical removal www.indiandentalacademy.com