SURGICAL MANAGEMENT

OF IMPACTED TEETH

Presented by-
Shreya Sawant
Devanshi Shah
Yashvi Shah
Affra naushin Shaikh
Samiksha Shaha
Nidhi Sharma
Aakash Shah
 CONTENTS
 INTRODUCTION
 CAUSES
 ORDER OF FREQUENCY OF IMPACTION
 INDICATIONS
 RISKS AND BENEFITS OF INTERVENTION
 CLASSIFICATION
 DIFFICULTY INDEX
 RADIOGRAPHIC FEATURES
 ISOLATION
 LOCAL ANAESTHESIA
 INCISION(FLAP DESIGN)
 BONE REMOVAL
 TOOTH SECTIONING
 ELEVATION
 DEBRIDEMENT
 CLOSURE
 COMPLICATIONS
 INTRODUCTION
Definition-

An impacted tooth is the one that is unable to fully erupt in its normal functional occlusion/location by its expected age of
eruption, because it is blocked by overlying soft tissue or bone or another tooth.
-by WHO

An impacted tooth or an embedded tooth is the tooth that has failed erupt completely to its correct normal position in the
dental arch, and its eruption potential has lost.
-by Archer(1975)
Fully impacted tooth is the one, which is not completely encased in the jaw bone.

Partially impacted tooth is the one, which is not completely encased in the jaw bone and has communication in the oral
cavity.
 CAUSES OF IMPACTION OF TEETH
THEORIES RESPONSIBLE FOR CAUSING IMPACTION OF TEETH-especially 3rd molars

Durbeck orthodontic theory ( inadequate space in the dental arch for eruption):
growth of the jaw and teeth occurs in forward direction , any interference in growth pattern will cause impaction
because of small jaw with decreased space.

Phylogenic theory(Nodine 1943):

due to the evolution over centuries, the human jaw size is becming smaller than our ape like ancestors and since
the third molar is last to erupt, there may not be room for it to emerge in the oral cavity.
Also, the modern food habits are changed from earlier raw, fibrous diet to cooked/processed food , which does not require
forceful mastication which offers less stimulation for jaw growth (Disuse theory)

Mendelian theory:
it says that genetics play a major role. If the individual genetically receives a small jaw from one of the parent
and/or large tooth from another parent, then impacted teeth can be seen., because of ‘lack of space’.
 LOCAL CAUSES
 Obstruction for eruption
 irregularly in position and presence of an
adjacent tooth
 density of the overlying and surrounding
bone. Condensing osteitis
 Lack of space in dental arch
 crowding
 supernumerary teeth
 micrognathia
 retrognathia
 Ankylosis of primary or permanent teeth
 Nonabsorbing , over retained deciduous teeth
 Non absorbing alveolar bone
 Ectopic position of tooth bud
 Dilaceration of roots(trauma)
 Associated soft tissue or bony lesions-
 cysts
 tumors
 thick fibrous growth
 Habits involving tongue, finger, thumb , cheek,
pencil, etc.
 SYSTEMIC CAUSES
 Prenatal : heredity
 Postnatal:
 rickets
 anemia
 tuberculosis
 malnutrition
 congenital syphilis
 Endocrinal /metabolic disorders of:
Cleft palate
 thyroid ,parathyroid
 pituitary gland like hypothyroidism,
hypopituitiarism achondroplasia,
mucopolysaccharides,etc.
 Herditary-linked disorders:
 down’s syndrome
 hunter’s syndrome
 osteoporosis
 cleidocranial dysplasia
 cleft palate
 treacher-collins syndrome
 gardener syndrome Cleidocranial dysplasia
 occipitomandibular syndrome
 yunis-varon syndrome
 ORDER OF FREQUENCY OF IMPACTED TEETH

ORDER OF FREQUENCY INCIDENCE(%)

Mandibular 3rd molars 17-32

Maxillary 3rd molars -
Maxillary canine 3.58- 8.80
Mandibular PM 2.0- 2.7
Maxillary PM -
Mandibular canine 0.3
Maxillary CI -
Maxillary LI -
Maxillary 2nd molar-rare 0.10- 0.06