What are 2 common types of impacted teeth?
- Mandibular 3rd molars
2. Maxillary canines
Describe a possible history during the clinical assessment of a patient with impacted mandibular 3rd molars
- Pain / Swelling
- Bad taste
- Number of episodes
- Severity of the pain
- Antibiotic treatment
Describe 3 clinical issues in the mouth which impacted mandibular 3rd molars do not cause
- Facial pain
- Lower incisor crowding
- Movement of other teeth
Describe the intra oral examination for a suspected impacted mandibular 3rd molar
- Access to the impacted tooth
- Degree of eruption if any
- Decay in the impacted tooth or adjacent 7
- Any evidence of food packing
Describe the radiological assessment of an impacted mandibular 3rd molars
- IOPA usually not sufficient to show inferior boarder of mandible
- OPT is most commonly used
- CBCT use where increased risk or surgical difficulty as precise interpretation of relationship between tooth and IDN
What are essential components of the radiological assessment of impacted mandibular 3rd molars?
Allow assessment of:
- all of third molar
- type and orientation of impaction
- crown size and condition
- root morphology
- bone level / periodontal status
- relationship between ID canal and lower boarder of mandible
Name 2 types of impaction of impacted mandibular 3rd molars
- Soft tissue
2. Boney
Describe 4 types of boney impaction of mandibular 3rd molars
- Mesioangular (crown towards 7 and roots distal)
- Distoangular (crown towards ramus of mandible and roots mesial)
- Vertical
- Horizontal
What are Winters Lines (WAR Lines) used for?
Imaginary lines on a radiographs used to estimate depth and angle of impaction
What 3 lines make up Winters Lines?
- White line
- Amber line
- Red line
Describe the white line in Winters Lines
- Drawn along the occlusal surface or erupted mandibular molars
- Extended over the 3rd molar posteriorly
- Indicates difference in occlusal level of 1st + 2nd molars and third molar
Describe the amber line in Winters Lines
- Drawn from the surface of the bone on distal aspect of 3rd molar to crest of interdental septum between 1st and 2nd molar
- Denotes margin of alveolar bone covering 3rd molar and gives indication of amount of bone which will need removed
Describe the red line in Winters Lines
- Imaginary line drawn perpendicular from amber line to point of application
- Usually cemento-enamel junction on the mesial aspect of the tooth
Which type of boney impaction tends to be the hardest to extract?
Distoangular as the path of withdrawal for these teeth tends to be straight into the angle of the mandible
What are 4 signs that the IDN is in close proximity to the tooth?
- Deviation of the nerve canal
- Narrowing of the nerve canal
- Loss of tram lines
- Change in radiodensity of the tooth
Describe perforation of the tooth by IDN
- Uncommon
- Difficult to tell from an OPT if this is the case
- Need to obtain CBCT to verify perforation
- Difficult to extract the tooth if perforation occurs
Describe perforation of the tooth by IDN
- Uncommon
- Difficult to tell from an OPT if this is the case
- Need to obtain CBCT to verify perforation
- Difficult to extract the tooth if perforation occurs
Describe the treatment options for impacted mandibular 3rd molars
- Surgical removal
- Coronectomy
- Operculectomy
- Remove opposing tooth
- Surgical exposure
- Monitor
Describe coronectomy as a treatment option for impacted mandibular 3rd molars
- Reserved for teeth which are bigger risk
- Remove the crown of the tooth and leave the roots
- Risk of infection especially if the roots are mobile
Describe operculectomy as a treatment option for impacted mandibular 3rd molars
- Flap of the gum is removed from over the tooth
- Not carried out often as does not work particularly well
Describe removal of the opposing tooth as a treatment option for impacted mandibular 3rd molars
- Encourage lower wisdom tooth to erupt further
- Less risks associated with the upper wisdom tooth extraction
Describe surgical exposure as a treatment option for impacted mandibular 3rd molars
Not very commonly carried out for a wisdom tooth
Describe 6 indications not to remove an impacted mandibular 3rd molar
- No / minimal symptoms
- Lower incisor crowding
- Treatment for TMD
- Contralateral tooth removal
- Patient wishes
- Close proximity to IDN
Describe 7 indications for removal of impacted mandibular 3rd molar
- Pericoronitis (2 or more episodes)
- Unrestorable caries
- Non-treatable pulpal or periapical disease
- Fracture of tooth
- Disease of follicle e.g. cyst / tumour
- Tooth impeding surgery
- Resorption of tooth or adjacent tooth
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Introduction36
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Radiology45
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Impacted Teeth43
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Odontogenic Tumours0
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Non-Carious Disorders of the Teeth64
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Dentoalveolar Abscess26
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Cysts of the Mouth and Jaws51
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Diseases of the Bone - Hereditary, Inflammatory, Metabolic and Cystic65
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Disease of the Bone - Tumour-Like and Neoplastic34
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MRONJ24
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Osteoradionecrosis22
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Exodontia (1)41
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Exodontia (2)35
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Quizes - True or False69
