Presentation on theme: "طه 25-28 Prof. Ragab Shaaban Text book Contemporary Oral and Maxillofacial surgery Peterson-Hupp."— Presentation transcript:
Prof. Ragab Shaaban
Text book Contemporary Oral and Maxillofacial surgery Peterson-Hupp
Impacted tooth is a tooth prevented from eruption by adjacent teeth, dense overlying bone or excessive soft tissue.
Impacted tooth is an unerupted or partially erupted tooth that passed its normal time of eruption
Mandibular third molars. Maxillary third molars. Maxillary canines. Mandibular premolars. Mandibular third canines. Maxillary premolars. Maxillary central incisors. Mandibular lateral incisors.
Infections Caries Pathological resorption Enlarged follicular space Association with cystic Association with neoplasm 57% 20% 6% 4% 2% 0.5%
Involvement in a fracture Causing malposition of adjacent teeth Causing impaction of adjacent teeth Causing crowding of the lower anteriors Causing no apparent problems 1% 3% 4% 8% 3%
Indications for operation Pain. Orthodontic conditions. Association with path. lesions. Patient travelling. Young patients. Before constructing dentures.
Clinical and radiological examinations State of eruption. Pericoronal tissues. Second molar and the impacted tooth. Classification of impaction. Relation to important anatomical structures. Possibility of jaw fracture. Difficult access to the field.
Relation of tooth to the ramus and the second molar Class I. Class II. Class III.
State of eruption Erupted. Unerupted. Partially erupted.
Angulation and position Vertical. Mesioangular. Distoangular. Horizontal. Transverse displacement. Aberrant position.
General anaesthesia. Intravenous diazepam and local anaesthesia.
Incision. Bone removal. Sectioning of tooth. Elevation of tooth from its socket. Preparation of wound before closure. Closure of the incision.
1. Incision For bony impaction. For soft tissue impaction.
2. Bone removal Hammer & Chisel (split bone technique). Surgical burrs (Guttering). Combination (POS & Stamp).
3. Sectioning of teeth if indicated
4. Elevation of the tooth No excessive force. Warwick James or Coupland Chisels. Buccal cortex as a fulcrum.
5. Preparation of wound for closure Irrigation. Residual tooth sac. Tags of mucosa and granulation tissue. Irregular edges of bone. Bleeding points.
6. Closure of the wound Black 00 or 000 silk. Complete closure-unerupted teeth. Partial closure-partially erupted tooth.
Control postoperative infections. Control postoperative pain. Control postoperative oedema. Oral hygiene and diet. Removal of sutures.
Relation to maxillary sinus: Sinus approximation. No sinus approximation. Root form: Fused. Multiple.
Soft tissue flap, buccal or palatal. Removal of overlying bone. Removal of the tooth. Debridement and closure of wound. Postoperative care.
Class 1:Class 1:In the palatel. Class 2:Class 2:In the buccal surface. Class 3:Class 3:In both palatal and in a labial sides. Class 4:Class 4:In the alvelous. Class 5:Class 5:In the edentulous maxilla.
1. Clinical examination Bulge. Deflection of related teeth.
2. Radiological examination a. Intra-oral.d. Steroscopic. b. Occlusal.e. Tomograms. c. Shift-sketch.f. OPT and extra oral.
1.Close relation to the neighbouring teeth. 2.Maxillary sinus approximation. 3.Nasal cavity approx. 4.Big and curved roots. 5.Difficult to localize.
1.Surgical removal. 2.Exposure of the canine for orthodontic treatment. 3.Repositioning reimplantation.
1.Removal of palatally impacted canine. 2.Removal from labial position. 3.Removal from interemediate position. 4.Removal from edentulous ridge. 5.Removal from unusual position.