surgical technique for the removal of third molars.pdf

Indications, assessment and surgical technique for the removal of third molars Dr Amur Alsenaidi BDS, MFD, CCST(OMFS-OMSB) Assistant Professor, Oral & Maxillofacial Surgeon, ODC Wisdom teeth Initial calcification Occurs around 8-9 years. Crown Minerali...

Indications, assessment and surgical technique for the removal of third molars Dr Amur Alsenaidi BDS, MFD, CCST(OMFS-OMSB) Assistant Professor, Oral & Maxillofacial Surgeon, ODC Wisdom teeth Initial calcification Occurs around 8-9 years. Crown Mineralization Usually completed by age 12 to 14. Root Formation Usually half-formed by age 16.  Root Completion 2/3rdor fully formed roots with open apices are usually present by age 18. Impacted tooth Is a tooth that fails to erupt into its normal functioning position in the dental arch within the expected time. Impeded in its path of eruption. (The term Unerupted includes both impacted teeth and teeth that are in the process of erupting) Local Causes of impaction Prolonged deciduous tooth retention. Malposed tooth germ (ectopic). Arch length deficiency (crowding). Pathology e.g Cysts, Odontogenic tumors. Abnormal eruption path. Cleft lip and palate. Frequency of impaction 1.Mandibular3rd molar 2.Maxillary 3rd molar 3.Maxillary cuspid 4.Mandibular cuspid 5.Mandibularpremolar 6.Maxillary premolars 7.Maxillary central and lateral incisors Evaluation of impacted teeth Clinical assessment Radiographic assessment OPG Periapical. Parallex/ Occlusal. Cone Beam CT (CBCT) Classifications of impacted third molar 1. Winter classification (angulation). 2. Pell and Gregory classification. Winter classification Pell and Gregory classification Lower third molar radiographic assessment: Features to be identified : 1. Lower third molar itself. Angulation Crown Roots Depth of the tooth in alveolus Buccal or Lingual. 2. Lower second molar. 3. The surrounding bone. 4. Relationship with ID canal. Lower third molar radiographic assessment: Angulation: The position of long axis of the impacted tooth in relation to the long axis of second molar. Mesioangular Distoangular Horizontal Vertical Inverted Transverse Lower third molar radiographic assessment: Angulation: Lower third molar radiographic assessment: 1-Vertical: the long axis of the third molar is parallel to that of the 2nd molar. Lower third molar radiographic assessment: 2-horizontal:the long axis of the third molar is at right angle to that of the 2nd molar. Lower third molar radiographic assessment: 3-mesioangular impaction. Lower third molar radiographic assessment: 4-Distoangular impaction: Lower third molar radiographic assessment: Transverse: Buccally deflected Lingually deflected Lower third molar radiographic assessment: 5. Inverted impaction Lower third molar radiographic assessment: Evaluation of the crown : Size Shape Presence/extent of caries Lower third molar radiographic assessment: Evaluation of the Roots : 1. Number. 2. Shape. 3. Curvatures –favorable/unfavorable. 4. Stage of development. 5. Presence/severity of resorption.  Lower third molar radiographic assessment: Relation to ID canal: Superimposition or intimate relationship? 1. Loss of tramlines. 2. Narrowing of tramlines. 3. Change in direction of tramlines. 4. A radiolucent band across the root. Lower third molar radiographic assessment: Depth in alveolus: Winter’s lines –imaginary lines Using roots of second molar as a guide Lower third molar radiographic assessment: Winter’s Lines 1. White line 2. Red line 3. Amber line  Winter’s Lines 1. White line 2. Red line 3. Amber line The white line is drawn along the occlusal surfaces of the erupted mandibular molars & extended over the 3rd molar posteriorly. It indicates the difference in occlusal level of the 1st & 2nd molars & the 3rd molar.  Winter’s Lines 1. White line 2. Red line 3. Amber line Red line is an imaginary line drawn perpendicular from the white line to an imaginary pint of application of an elevator. Usually, this is the. Indicates the amount of bone that will have to be removed before elevation of the tooth (the depth of the tooth).  Winter’s Lines 1. White line 2. Red line 3. Amber line The amber line is drawn from the surface of the bone on the distal aspect of the 3rd molar to the crest of the inter-dental septum between the 1st & 2nd molars. The amber line represents the (height of the) bone level. This line denotes the margin of the alveolar bone covering the 3rd molar. Gives some indication to the amount of bone that will need to be removed for the tooth to come out. Factors that Make Surgery Less Difficult Young patient. Roots 1/3 –2/3 formed (present in the younger patient). Wide periodontal ligament (present in the younger patient). Large follicle (present in the younger patient). Elastic bone (present in the younger patient). Mesio-angular impaction Fused conical roots Separated from 2nd molar Separated from IDN Soft tissue impaction Factors that Make Surgery More Difficult Older patient Narrow periodontal ligament (present in the older patient) Thin follicle (present in the older patient) Dense, inelastic bone (present in the older patient) Disto-angular impaction Long thin roots Divergent curved roots Tight contact with 2nd molar Close to IDN Complete bony impaction What are the indications of removal of Wisdom teeth ? What are the complications of surgical removal of Wisdom teeth ? Thank you