"SOMETHING BURNED"

Scenario 4
Tutorial 6
 Group Members
FARHAN WIRANDA (1910070110006)
LAILA SYAFIRA (1910070110008)
SRI DEWI SAFITRI (1910070110015)
LINDA PUSPITASARI (1910070110019)
DZAKY ZAHRAN MUSTI (1910070110024)
BAGAS PRAMUDYA P (1910070110026)
CITRA NANDYA KIRANA (1910070110027)
NABILA SUPRIADI (1910070110028)
AMIA PRATAMA (1910070110038)
SITI FATIMAH (1910070110076)
RULLY CAHYO SERCIO (1910070110091)
 SCENARIO 4

"SOMETHING UNDERSTANDED"
A 21 year old woman came to RSGM complaining of pain in her right lower
wisdom molar, since three days ago. The patient is unable to open his mouth
wide. On intra-oral examination, there was swelling and redness of the
gingiva region 48. On radiographic examination, the teeth were buried with
room conditions between the distal second molar and the ramus sufficient
for the eruption of the third molar, the highest part of the tooth located
parallel to the occlusal plane with the tooth positioned toward mesial. Before
the dentist took action, he first established a diagnosis and classified the
teeth according to the Pell and Gregory classification. After that he
prepared a type of surgery to remove the tooth.
 Clarification of Terms

1 2
The Pell and Ramus
Gregory
classification
Analyzing Problems
SOMETHING BURNED

21 years old woman to

RSGM

Complaint Intraoral Radiographic

Examination
Examination

Impacted 3rd Molar Teeth

Etiology Classification Indication and Management Complication

Contraindication
 Learning Objectives
Students are able to understand and explain the etiology and symptoms
1. of cases in the scenario.

Students are able to understand and explain the classification of cases in

2. the scenario.

Students are able to understand and explain the indications and

3. contraindications of cases in the scenario

Students are able to understand and explain clinical examination and

4. case support examinations in the scenario.

Students are able to understand and explain case management in

5. scenarios.

Students are able to understand and explain the complications of cases

6. in the scenario.
 Students are able to
understand and explain the
1. etiology and symptoms of
cases in the scenario.
Etiology Symptoms

• Barriers around the teeth that can occur due to thick

and dense bones, lack of space for these teeth,
• Bone fracture or jaw fracture
neighboring teeth blocking the eruption of these teeth,
and the presence
Writeofapersistent deciduous
pending task here teeth.
• Pain or burning around the gums or jaw and a long
• The resistance of the tooth itself can occur due to the
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abnormal location the seed, horizontally, vertically,
distally, and the presence of tooth eruption is lacking.
• Cyst or follicular
• Excessive retention of baby teeth
• Due to malposition of tooth germ during the ectopic
• Resorption of neighboring teeth due to the abnormal
stage
location of the seeds so that they absorb the adjacent
• Partial mandibular third molar
teeth
• Impacted mandibular third molars can also
interfere with the chewing process and often cause
• Inflammation, namely swelling around the jaw and
various complications.
reddish color of the gums around the tooth that is
• In principle, impaction problems arise because of a
suspected of being impacted
mismatch between the size and shape of the teeth and
jaw.
 Students are able to
understand and explain the
2. classification of cases in the
scenario.
 Classification
The Pell and Gregory classification
• Class I, is the mesio-distal size of the third molar
is smaller than the distance between the distal
second molar and Supplies on hand
the mandibular ramus.
• Class II, is the mesio-distal size of the third
■ Write
your supplies
molar is greater than the distance between the
distal second molar and the
■ Write mandibular
your supplies ramus.
• Class III, is all■or Write your
most of thesupplies
third molars are in
the ramus of the■ mandible.
Write your supplies
■ Write your supplies
■ Write your supplies
Pell and Gregory, there are three positions for the
third molars, namely positions A, B and C.
• In position
SuppliesA, theto
highest
buypart of the third molar
is at the level of the occlusal line.
■ Write supplies to buy
• In position B, the highest part of the third molar
is below
■ the occlusal
Write line
supplies to but
buy still higher than the
cervical line of the second molar.
■ Write supplies to buy
• In position
■ Write C, supplies
the highest part of the third molar
to buy
is below the cervical line of the second molar.
■ Write supplies to buy
■ Write supplies to buy
 Students are able to
understand and explain the
3. indications and
contraindications of cases in
the scenario
 Indications for Extraction of Impacted Teeth:
1. Infection due to late and abnormal eruptions (pericoronitis).
2. Young Age
Healing generally occurs more quickly and more completely in younger patients, but surgical
removal of impacted third molars at a very young age (at age 8 or 9 where M3 tooth seed
develops) is contraindicated.
3. The presence of an infection such as Sellulitis.
4. The presence of pathological conditions such as caries in the hidden teeth and the neighboring
teeth.
5. Development of the follicle into a pathological condition, eg odontogenic cyst.
6. Deviation of the length of the arch and to help maintain the stability of the orthodontic
treatment result.
7. So as not to interfere with prosthetic or restorative treatment.
 Contraindications for Extraction of Impacted Teeth:

1. The patient does not want to have his teeth pulled out.
2. There is a high probability that there will be damage to the important structures around it or
damage to a large area of the supporting bone.
3. Before the root length reaches one-third or two-thirds and when the bone covers it too much
(premature extraction).
4. If the patient's ability to deal with surgery is impaired by certain physical or mental
conditions.
5. Elderly sufferers. The bones that cover the impacted teeth in elderly patients are very
mineralized and dense, making it difficult to perform an odontectomy. In addition, elderly people
are usually exposed to general conditions that are not recommended for surgery.
 Students are able to
understand and explain
4. clinical examination and
case support examinations
in the scenario.
 Clinical Examination
Examination of impacted teeth is enforced based on clinical
examination, namely subjectively and objectively outside and inside the
mouth. Radiographic examination with different shooting angles will
help establish the diagnosis and treatment plan

Supporting Examination
Radiography is a method that can be used to diagnose and determine the
anatomical location of the oral tissue. The accuracy of objective radiographic
measurements is an important factor in obtaining a diagnosis and determining a
proper treatment plan. This X-ray can be used to evaluate impacted teeth,
eruption patterns, dentition growth and development, detect disease and evaluate
trauma.

Occlusal Periapical
The periapical projection is the first projection which is commonly used to view
the teeth and periapical tissue underneath

Buccal Object Rule

The second method is the Buccal Object Rule (BOR). This method is used to
determine the position of foreign bodies or overlapping anatomical structures,
whether they are buccal or lingual.
 Students are able to
5. understand and explain case
management in scenarios.
 1. By Surgery (Operculectomy, Odontectomy)
As with surgery on other parts of the body, it is necessary to watch out for systemic diseases,
especially in older adult patients such as metabolic disorders, cardiovascular system diseases,
and drugs that are being taken, for example aspilet.
The surgery performed depends on the type of case, ranging from simple procedures such as
operculectomy with cautery, namely the removal of the operculum covering the tooth which is
predicted to appear on the surface of the gingiva.
 Odontectomy, which is the surgical removal of impacted teeth. Odontectomy, under local
anesthesia, can be performed in cooperative patients, and is sufficiently outpatient. In patients
with high levels of anxiety, given local anesthesia plus conscious sedation, or with general
anesthesia. General anesthesia is especially given in cases of very difficult impactions, or in
patients who are not cooperative, such as those with mental disorders.
 2. Without Surgery
A person can live with both partial and totalist impacted teeth without experiencing
interference. In partially impacted wisdom teeth, clean, asymptomatic, odontectomy can still be
delayed or even avoided. If so decided, vigilance needs to be emphasized in the form of more
careful personal care efforts by maintaining good oral and dental hygiene, as well as carrying
out routine dental examinations.
 Students are able to
understand and explain the
6. complications of cases in the
scenario.
 Complications of Impaction Teeth
1. Dentis caries
Both second molars and third molars are prone to dental caries
because these areas are prone to retention of food debris and
difficult to clean. This causes decalcification of the enamel, the Dentist Caries
dentin, and then causes such extensive damage that it penetrates the
pulp roof.

2. Infection
• Pericoronal infection
In normal conditions, the operculum, namely the gingival mucosa
which includes the tooth seed which is in the process of eruption, will
physiologically open, gradually atrophy and disappear, allowing the
teeth to appear in the oral cavity.
3. Other Abscesses
The general condition of the patient is decreasing, it can
cause pericoronal abscess to easily spread to the
peritonsilar / parafaryngeal area, becoming a
peritonsilar abscess or parafaryngeal abscess which can
block the airway.

4. Cysts / Tumors
Tooth seeds that grow imperfectly can also become
tumors. Physiologically, each tooth seed is covered by a
pocket that will disappear if the eruption is normal.
Dentigerous cysts can even develop into tumors, namely
ameloblastoma. Ameloblastoma can enlarge,
THANK
YOU