Impacted Teeth

 Fails to erupt into dental arch within the

expected time
 Reasons:
dense overlying bone
excessive soft tissue
adjacent teeth
(inadequate dental arch length and space)
 Most common:
maxillary and mandibular third molars
maxillary canines
mandibular premolars
 Impacted teet should not be left in place until
problems arise
 Removal becomes more difficult with advancing
age
 The average age of the eruption of third molar
is age 20
 Does not erupted after 20:
covered with bone; mesioangular;
cervical of second molar
 Late eruption: 20~25
soft tissue or slightly with bone;
vertical position;
superficially positioned with respect to the
occlusal plane of the adjacent second molar
Early removal

 Reduce postoperative morbidity

 Best healing
 The younger tolerate procedure better and
recover quickly; periodontal healing is better in
the younger patient, because of better
regeneration of the periodontal tissue
 Ideal time: root formation 1/3~2/3
(age 17~20)
Indications: preventions of
 Periodontal disease: upper distal furcation
 Dental caries: communications
 Pericoronitis: Streptococci;
immune,food,trauma; H2O2; penicillin; fascial
infection:38.4 度 C; 20mm trismus;dry socket
and infection
 Root resorption: pressure; cemental repair
 Odontogenic cyst and tumors: dentigerous cyst,
keratocyst; 3mm; ameloblastoma
Indications: preventions of
 Fracture of the jaw: weaken mandible
 Impacted teeth under a dental prosthesis: edentulous
area resorption; ext before denture making; late->tend to
fracture
 Pain of unexplained origin: TMD,myofascial
 Facilitation of orthodontic treatment: molar retraction;
prevent crowding
 Optimal periodontal healing: bone height and attachment
level of 2nd molar; 25 y/o; >30,completely bony
impacted=>left
Contraindication

 Extremes of Age:
bone calcified,less flexible, unlikely to bend;>40
y/o,bone>4mm=>left, f/u every 1~2 year with x-ray
 Compromised Medical Status:
cardiovascular,respiratory function,host
defense,coagulopathy + asymptommatic =>left
 Probable excessive damage to adjacent structures:
nerves,teeth,bridges
Summary

 At age 18~19, if the diagnosis for inadequate

room can be made, the asymptomatic molar
should be removed
Classification Systems

 Accessbility is determined by the ease of:

exposing the tooth
preparing the pathway
preparing a purchase point
 Determine the dicciculty of extraction
Classification Systems


Angulation of the long axis of 3rd molar and 2nd
molar
 distoangular(6%)>horizontal(3%)>>vertical(38
%)>mesioangular(43%)
Anugulation
Angulation
Classification Systems

 Amount of bone of the ramus covering

(Pell and Gregory classification;classes 1,2,3)
 Mesiodistal diameter of the crown|ant border
of ramus: classI=>normal position
1,2,3
Classification Systems


Depth 3rd molar and height of the 2nd molar
(Pell and Gregory classification;classes A,B,C)
 Thickness of the overlying bone
 occlusal surface of impaction | occlusal
surface,cervical line of 2nd molar
A,B,C