What are the most commonly impacted teeth?
8 > upper 3 > upper 1 > lower 4 > lower 5 > supernumerary [83145$]
What are some potential complications of impacted teeth?
- Pericoronitis
- Resorption = unerupted teeth accelerate resorption of overlying primary teeth
- Cystic change = overlying halo, leading to destruction of bone in local area – if perforates buccal cortex get infection there also
- Food trap
- Mandibular fracture – if tooth is in the line of the fracture remove it as it decreases healing by leaving tooth present
Some indications to remove wisdom teeth?
o Caries, pulpal, periapical pathology, cellulitis, abscess, osteomyelitis, resorption, tooth fracture, disease of the follicle
o Repeated pericoronitis
o One severe bout pericoronitis
Exceptions where pathology is not necessary for removal of wisdom teeth?
Orthognathic surgery = usually extracted ~1 year before surgery
Some symptoms of an impacted tooth?
• Retention of deciduous tooth
• Tooth missing
• Swelling
• Mobility of adjacent tooth
• Tilting of adjacent tooth – especially upper
anteriors
• Loss of vitality of adjacent tooth
• PericoronitisFactors to examine on a radiograph for impacted teeth?
Depth Angulation Crown Features Root morphology Texture bone – difficult to do Relationship to vital structures (mental, and inferior alveolar nerve, maxillary sinus) Adjacent teeth
What are some red flags that root morphology is close to the inferior alveolar canal?
Darkening of the root
Diversion of the canal
Interruption of the cortical outline
What radiograph would you request if you suspected involvement of the IAC?
CBCT
Parallax views – 2 radiographs with a tube shift inbetween
2 Periapicals (CLARK’S METHOD)
Occlusal and DPT
What are some surgical problems to warn the patient of?
Vital structures (IAN 2.2%, LING 0.3%) Root displaced into maxillary antrum
Don’t speak in jargon
