طه 25-28 prof. ragab shaaban text book contemporary oral and maxillofacial surgery peterson-hupp
TRANSCRIPT
28-25طه
Prof. Ragab ShaabanProf. Ragab Shaaban
Text bookText book
Contemporary Oral and Contemporary Oral and Maxillofacial surgeryMaxillofacial surgery
Peterson-HuppPeterson-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
1. Mandibular third molars.
2. Maxillary third molars.
3. Maxillary canines.
4. Mandibular premolars.
5. Mandibular third canines.
6. Maxillary premolars.
7. Maxillary central incisors.
8. Mandibular lateral incisors.
1. Infections
2. Caries
3. Pathological resorption
4. Enlarged follicular space
5. Association with cystic
6. Association with neoplasm
57%
20%
6%
4%
2%
0.5%
7. Involvement in a fracture
8. Causing malposition of adjacent
teeth
9. Causing impaction of adjacent teeth
10. Causing crowding of the lower
anteriors
11. 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
a. For bony impaction.
b. For soft tissue impaction.
2. Bone removal
a. Hammer & Chisel (split bone technique).
b. Surgical burrs (Guttering).
c. Combination (POS & Stamp).
3. Sectioning of teeth if indicated
4. Elevation of the tooth
a. No excessive force.
b. Warwick Jame’s or Coupland Chisels.
c. Buccal cortex as a fulcrum.
5. Preparation of wound for closure
a. Irrigation.
b. Residual tooth sac.
c. Tags of mucosa and granulation tissue.
d. Irregular edges of bone.
e. Bleeding points.
6. Closure of the wound
a. Black 00 or 000 silk.
b. Complete closure-unerupted teeth.
c. Partial closure-partially erupted tooth.
• Control postoperative infections.
• Control postoperative pain.
• Control postoperative oedema.
• Oral hygiene and diet.
• Removal of sutures.
1. Unerupted:
a. Within bone.
b. Immediately beneath soft tissue.
2. Partially erupted.
3. Fully erupted.
1. Vertical.
2. Mesio-angular.
3. Disto-angular.
4. Laterally displaced.
5. Aberrant position.
• Relation to maxillary sinus:
a. Sinus approximation.
b. No sinus approximation.
• Root form:
a. Fused.
b. Multiple.
1. Soft tissue flap, buccal or palatal.
2. Removal of overlying bone.
3. Removal of the tooth.
4. Debridement and closure of wound.
5. 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 examination1. Clinical examination
• Bulge.
• Deflection of related teeth.
2. Radiological examination2. 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.