Principles of management of

impacted teeth

Dr.Mohamed Rahil
(( Maxillofacial surgeon ))
Tikrit dentistry college
2015 2016
 impaction
An impacted tooth is any tooth that is prevented
from reaching its normal position in the mouth by
tissue, bone, or another tooth.
Indications for Extraction
 Indications for Extraction

Localized or Generalized Neuralgias

Pericoronitis
Production of Caries
Destruction of Adjacent Teeth Due
to Resorption of Roots
Participation in the Development of
Various Pathological condition
Restrict the Placement of a Partial
or Complete Denture.
Restrict the Normal Eruption of
Permanent Teeth
Provoking or Aggravating
Orthodontic Problems
 Timing
most suitable time is when the patient is young due
to :

younger patients generally well tolerate surgical

procedure and stress .
faster postsurgical wound healing compared with
older patients.
Bone removal more easy in young than older
patient.
 Steps of Surgical Procedure
1. Incision and reflection of the mucoperiosteal flap

2. Removal of bone to expose the impacted tooth

3. Luxation of the tooth

4. Care of the postsurgical socket and suturing of the

wound
 Impacted Third Molar
Classifications
Mesioangular
Distoangular
Vertical
Horizontal
Buccoangular
linguoangular
Inverted
 Class A: The occlusal surface of the impacted tooth is at the
same level as, or a little below that of, the second molar
Class B: The occlusal surface of the impacted tooth is at the
middle of the crown of the second molar or at the same level as
the cervical line
Class C: The occlusal surface of the impacted tooth is below the
cervical line of the second molar
 Class 1: The distance between the second molar and the anterior
border of the ramus is greater than themesiodistal diameter of
the crown of the impacted tooth

Class 2: The distance is less and the existing space is less than the
mesiodistal diameter of the crown of the impacted tooth

Class 3: There is no room between the second molar and the

anterior border of the ramus, so that the entire impacted tooth
or part of it is embedded in the ramus
 Types of Flaps

Triangular flap:
The incision for this type of
flap begins at the anterior
border of the ramus (external
oblique ridge) with special
care for the lingual nerve and
extends as far as the distal
aspect of the second molar,

while the vertical releasing

incision is made obliquely
downwards and forward,
ending in the vestibular fold .
Types of Flaps
 Types of Flaps
Horizontal (envelope) flap:
The incision for the flap also
begins at the anterior border
of the ramus and extends as
far as the distal aspect of the
second molar, continuing
along the cervical lines of the
last two teeth, and ending at
the mesial aspect of the first
molar.
This type of flap is usually
used in cases where
impaction is relatively
superficial.
Removal of Bud of Impacted Mandibular
Third Molar
Extraction of Impacted Third Molar
in Horizontal Position
Extraction of Third Molar with
Mesioangular Impaction
 Extraction of Third Molar
with Distoangular Impaction
Extraction of Impacted Third Molar
in Edentulous Patient
Impacted Premolar
Impacted Canine
Extraction of Impacted Maxillary Teeth
Impacted Third Molar
Impacted Canines
Extraction Using Labial Approach
Extraction Using Palatal Approach
Ectopic Impacted Canine
Exposure of Impacted Teeth
for Orthodontic Treatment
Impacted Mandibular Canine
with Labial Position
thank you for listening