Embedded Teeth

Completely embedded teet 

Partially erupted teeth

Part of the crown is visible and some parts are not.

Multiple impaction

When several teeth are impacted.

Varieties: 

- Arrested eruption of teeth in normal position 

- Impaired partial eruption due to malposition, impediment and impacted teeth 

- Non-eruption due to malposition, impediment and impacted teeth. 

Impaction: 

Impacted teeth

Causes of Impaction: Local causes:

- Irregularity in the position and the pressure of an adjacent tooth. 

- Density of surrounding or overlying bone. 

- Long continued chronic inflammation with resultant density of overlying mucous

membrane. 

-Lack of space due to overdeveloped teeth.

-Undue retention of the temporary teeth. 

- Premature loss of temporary teeth. 

- Acquired disease. Ex. Necrosis due to infection or abscess.

- Inflammatory changes in the bone due to exanthematous diseases in children.

Systemic causes of impaction: 

Prenatal:

 Heredity 
 Miscegenation - mixed genesis, mixed marriages
 Syphilis 
 Tuberculosis 
 Malnutrition


Postnatal: Condition which may interfere with the development of the child.
 Rickets 
 Anemia
 Hereditary syphilis
 Tuberculosis 
 Exanthematous disease
 Lack of space in overdeveloped jaws 
 Diseases of the jaws and the surrounding tissues
 Endocrine dysfunction

Rare conditions: 

Cleidocranial Dysostosis

 Is a rare condition in which there is defective ossification of the cranial bones. 

Oxycephaly or steeple head

In which top of the head is pointed 

Progeria

 Represents premature old age form of infantilism marked small stature, absence
of facial and pubic hair, wrinkled skin gray hair and the facial appearance,
attitude and manners of old age. 

Achondroplasia

 Disease of the skeleton beginning in fetal life and producing a form of dwarfism. 
Cleft Palate

 is one with a congenital fissure at the midline of palate.

Frequency of impacted teeth: 

- Mandibular 3rd molars 
- Maxillary 3rd molars 
- Maxillary cuspid 
- Mandibular cuspid 
- Mandibular bicuspid 
- Maxillary bicuspid 
- Maxillary central incisor 
- Maxillary lateral incisor

Classification of Third Molars: (mandibular) 

Relation of impacted third molar to the ramus of the mandible and second molar: 
 Class 1. There is sufficient amount of space between the ramus and the distal of
the second molar for the accommodation of the mesiodistal diameter of the
crown of the third molar.
 Class 2. The space between the ramus of the mandible and the distal of the
second molar is less than mesiodistal diameter of the crown of the third molar. 
 Class 3. All or most of the third molar is located within the ramus.
Relative depth of the third molar in bone: 

 Position A. Highest portion of the impacted is in level with or above the occlusal
line of the second molar. 
 Position B. highest portion of the tooth is below the occlusal plane but above the
cervical line of the second molar. 
 Position C. Highest portion of the teeth is below the cervical line of the second
molar. 

The position of the long axis of the impacted mandibular third molar in relation with the
second molar (from Winter's classification)

 Vertical 
 Horizontal 
 Inverted

Classifications of Wisdom
Tooth Impaction

 Mesioangular
 Distoangular 
 Buccoangular 
 Linguoangular

This may occur in: 

 Buccal deflection
 Lingual deflection
 Torsion

Classification of third molars: (Maxillary)

 Relative depth of the impacted maxillary third molar in the bone: 
o Class A. Lowest portion of the crown of the impacted third molar is in line
with the occlusal plane of second molar. 
o Class B. Lowest portion of the crown of the impacted molar is between the
occlusal plane of the second molar and cervical line. 
o Class C. Lowest portion of the crown of the impacted maxillary third molar
is at or above the cervical line of the second molar.
The position of the long axis of the impacted maxillary third molar in relation to the long
axis of the second molar. 

 Vertical 
 Horizontal 
 Mesioangular
 Distoangular 
 Inverted 
 Bucconangular 
 Linguoangular

This may occur simultaneously in:

 Buccal deflection
 Lingual deflection
 Torsion

Relationship of the impacted maxillary third molar to the maxillary sinus: -

Sinus approximation (SA)
 No bone or a very thin partition of bone exist between the maxillary molar and
maxillary sinus. 
- No sinus approximation (N.S.A)
 2mm or more of bone exist between the impacted maxillary third molar and
the maxillary sinus.

 Classification of maxillary impacted cuspids 

o Class 1. Impacted cuspids located in the palate:
 Horizontal
 Vertical
 Semi Vertical 
  Class 2. Impacted cuspids located in the labial or buccal surface of the
maxilla:
 Horizontal 
 Vertical 
 Semi vertical
Class 3.
 Impacted cuspids located in both the palatine and maxillary
bines, that is the crown on the palate and the root passes
through between the roots of the adjacent teeth in the alveolar
process ending in a sharp angle on the labial or buccal surface of
the maxilla. 
Class 4.
 Impacted cuspids located in the alveolar process usually
vertically between incisor and first bicuspid. 
Class 5.
 Impacted cuspid located in an edentulous maxilla.
Clinical pathology: 
 If third molars are partially erupted the flap of tissue covering the unexposed
portion of the tooth, May become inflamed and pus may develop. 
 The inflammation, is called pericoronitis or circumcoronitis, and the pus
formed is called pericoronal abscess. 
Complications or sequelae 
 Local
o  Resorption of impacted teeth if the reduced enamel epithelium will be
destroyed by infection and subsequent formation of cementum on the
crown.

Inflammatory process - pericoronitis and pericoronal abscess. 

Resorption and displacement of adjacent tooth.  

Hypercementosis – loosening of adjacent tooth in an attempt of third molar to erupt,

there is force applied on the root of second molar and subsequent loosening of the tooth. 

Systemic 

> Pain from impacted third molars may cause headache, fever, facial

paralysis and trismus.

Third dentition (Tertiary dentition, Post permanent Dentition) 

- These are teeth that erupts on the spots vacated by deciduous teeth and later
by the permanent teeth. 

ANOMALIES IN POSITION IN THE DENTAL ARCH: 

Types of classification:

General Malalignment of the teeth 

Due to underdevelopment of the mandible resulting to crowding of permanent

teeth. 
Diastema between the teeth

Due to acromegalic gigantism or hyperplasia of the jaw or due to hypertrophied lip or

due to retained deciduous roots or supernumerary tooth.

Individual Malposition of teeth 

Labioversion
 Anterior teeth are malposed towards the lips. 
Buccoversion
 Malposition towards the cheeks 
Linguoversion
 Malposed towards the tongue 
Mesioversion
 Tilting toward the mesial due to break in occlusion or absence or loss
of a tooth
Distoversion
 Tilting towards the distal side 
Torsoversion
 Teeth are rotated along its longitudinal axis 
Supraversion
 The elongation of tooth over the occlusal level associated with the loss of
opposing teeth. 
Infraversion
 Associated with closed bite due to arrested development and decreased rate of
eruption of the posterior teeth.

Relation: 
Orthodontia
 Malposed teeth can be corrected with orthodontic appliance. 
Oral Medicine
 Effect of malposed teeth to surrounding structure, will be inflammation of
gingivae due to constant contact of food. 
Operative and restorative Dentistry
 We can restore the lost teeth if it create space.

ANOMALIES IN SHAPE AND FORM

Anomalis in Crown:
Fusion 
 A condition in which two normally separate tooth germs become united. 
Etiology
 Trauma or pressure or sudden force may cause the union of two enamel organs.
 Inherited 
Clinically
 Maybe unilateral or bilateral, more common in deciduous than in permanent.

Gemination (twin formation)

 Is a condition in which a single tooth germs divides during the period of tooth
formation and forms a double crown with a single root and root canal. 
 Asymmetrical Invagination will produce two crowns not resembling the normal
teeth.
 Symmetrical Invagination will produce normal appearing crowns. 
Taurodontism (bull-like teeth)
A Dental anomaly in which the body of the tooth is enlarged at the expenses of the root.

Dens Invaginatus (dens en dente)

One tooth within another is the meaning of dens en dente, actually this is a misnomer
because there is a deep invagination of the lingual pit of an incisor into the rest of the
crown, the result is a cavity inside of the tooth line with enamel and opening on the
lingual side of the crown. 
Etiology

Cause of dens en dente is invagination during developmental stage of tooth

which maybe coronal or radicular in location thus produce a tooth within a tooth
in X-ray, made up of enamel as well as dentin and cementum.