PRINCIPLE OF MAXILLARY IMPACTED

TEETH
DONE BY : YAMAMH EMAD
HADEEL LUAY
YASEEN TAREQ
IMPACTED TEETH

An impacted tooth is one that fails to erupt into the dental

arch within the usual range of expected time.

Causes of impacted teeth

adjacent teeth
dense overlying bone
excessive soft tissue
a genetic abnormality prevents eruption
 all impacted teeth should be removed unless removal is contraindicated.
 Removal of impacted teeth becomes more difficult with advancing age of the patient.
 Most common maxillary impacted teeth is third molar and canine
 If impacted teeth left in place will cause some problems :
 an increased incidence of local tissue morbidity
 loss of or damage to adjacent teeth and bone
 more fully formed roots may grow near structures such as theinferior alveolar nerve or the maxillary
sinus
 potential injury to adjacent vital structures
 INDICATION OF REMOVE IMPACTED TEETH

Prevention of Dental Caries

. Prevention of Periodontal Disease
 Facilitation of Orthodontic Treatment
 Prevention of Jaw Fractures
 Prevention of Root Resorption
CONTRAINDICATION OF REMOVAL IMPACTED TEETH

 Extremes age : more complication will occur in advanced age because bone
become high calcified and less flexible and more likely to bend under force
 Compromised medical status
 Probable excessive damage to adjacent structure
DIAGNOSIS

 You can evaluate the patient  teeth and mouth to determine if they have impacted
wisdom teeth or if another condition is causing they problems. Such evaluations
typically include
 Questions about the patient  dental symptoms and general health
 An examination of the condition of his teeth and gums
 Dental X-rays that can reveal the presence of impacted teeth, as well as signs of
damage to teeth or bone
 IMPACTED CANINE
 Upper or Maxillary canines erupt around age 13.
 They are the last anterior upper tooth to erupt.
 Impacted Maxillary canines are present in 1% of the general population.
 Maxillary canine are frequently oriented upside dow
 CAUSES THE IMPACTION OF CANINE

 Not enough space for eruption

 If you have Peg-shaped or missing maxillary lateral incisors, you are more likely to have
impacted canines
 Retained deciduous (baby) teeth and permanent supernumerary teeth (extra teeth) that are
blocking the canines to erupt
 Palatally inclined teeth (teeth that are facing the roof of the mouth) have difficulty erupting
even though there is enough space.
 MANAGEMENT OF TREAT IMPACTED CANINE

 The orthodontic treatment of impacted maxillary canine remains a challenge to today's

clinicians. The treatment of this clinical entity usually involves surgical exposure of the
impacted tooth, followed by orthodontic traction to guide and align it into the dental arch.
Bone loss, root resorption, and gingival recession around the treated teeth are some of the
most common complications.
 The extraction of the canine, although seldom considered, might be a workable option in the
following :
 If it is ankylosed and cannot be transplanted
 If it is undergoing external or internal root resorption
 If its root is severely dilacerated
 If the impaction is severe (e.g., the canine is lodged between the roots of the central and lateral incisors
and orthodontic movement will jeopardize these teeth)
 If the occlusion is acceptable, with the first premolar in the position of the canine and with an
otherwise functional occlusion with well-aligned teeth,
 If there are pathologic changes (e.g., cystic formation, infection), and
 If the patient does not desire orthodontic treatment.
 IMPACTED THIRD MOLAR
 Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases,
impacted wisdom teeth may cause no apparent or immediate problems. But because they're hard to clean,
they may be more vulnerable to tooth decay and gum disease than other teeth

 Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and
oral surgeons also recommend removing impacted wisdom teeth that don't cause symptoms to prevent future
problems.
 Wisdom teeth usually emerge sometime between the ages of 17 and 25. Some people have wisdom
teeth that emerge without any problems and line up with the other teeth behind the second molars. In
many cases, however, the mouth is too crowded for third molars to develop normally. These crowded
third molars become trapped (impacted).
 Causes :

 Wisdom teeth ( third molar) impacted because do not have enough room to develop normally
 Symptoms :
 Red or swollen gums
 Tender or bleeding gums
 Jaw pain
 Swelling around the jaw
 Bad breath
 An unpleasant taste in your mouth
 Difficulty opening your mouth
DIAGNOSIS

 You can evaluate the patient  teeth and mouth to determine if they have impacted wisdom
teeth or if another condition is causing they problems. Such evaluations typically include:
 Questions about the patient  dental symptoms and general health
 An examination of the condition of his teeth and gums
 Dental X-rays that can reveal the presence of impacted teeth, as well as signs of damage to
teeth or bone
COMPLICATION
 Impacted wisdom teeth can cause several problems in the mouth:
 Damage to other teeth. If the wisdom tooth pushes against the second molar, it may damage the second molar or increase the risk
of infection in that area. This pressure can also cause problems with crowding of the other teeth or require orthodontic treatment
to straighten other teeth.
 Cysts. The wisdom tooth develops in a sac within the jawbone. The sac can fill with fluid, forming a cyst that can damage the
jawbone, teeth and nerves. Rarely, a tumor — usually noncancerous (benign) — develops. This complication may require
removal of tissue and bone.
 Decay. Partially impacted wisdom teeth appear to be at higher risk of tooth decay (caries) than other teeth. This probably occurs
because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially
erupted tooth.
 Gum disease. The difficulty cleaning impacted, partially erupted wisdom teeth increases the risk of developing a painful,
inflammatory gum condition called pericoronitis in that area.
 If impacted wisdom teeth aren't causing symptoms or apparent dental problems, they're
called asymptomatic. Some disagreement exists in the dental community about how to
manage asymptomatic impacted wisdom teeth.
 Some dentists and oral surgeons recommend removing asymptomatic wisdom teeth to prevent future
potential problems. They argue:Symptom-free wisdom teeth may not be free of disease.If there isn't
enough space for the teeth to erupt, it's often hard to get to them and clean them properly.Serious
complications with wisdom teeth happen less often in younger adults.The procedure is more difficult and
more likely to cause complications later in life, particularly among older adults
 SURGICAL REMOVAL
 Impacted wisdom teeth that are causing pain or other dental problems are usually surgically removed (extracted). Extraction of a wisdom tooth is
usually required for:
 Infection or gum disease (periodontal disease) involving the wisdom teeth
 Tooth decay in partially erupted wisdom teeth
 Cysts or tumors involving the wisdom teeth
 Wisdom teeth that are causing damage to neighboring teeth
 The process includes:Sedation or anesthesia. You may have local anesthesia, which numbs your mouth;
sedation anesthesia that depresses your consciousness; or general anesthesia, which makes you lose
consciousness.Tooth removal. During an extraction your dentist or oral surgeon makes an incision in your
gums and removes any bone that blocks access to the impacted tooth root. After removing the tooth, the
dentist or oral surgeon typically closes the wound with stitches and packs the empty space (socket) with
gauze.
 Wisdom tooth extractions may cause some pain and bleeding, as well as swelling of the site or jaw. Temporarily, some people have trouble
opening their mouth wide due to swelling of the jaw muscles. You'll receive instructions for caring for wounds and for managing pain and
swelling, such as taking pain medication and using cold compresses to reduce swelling.
 Much less commonly, some people may experience:
 Painful dry socket, or exposure of bone if the post-surgical blood clot is lost from the socket
 Infection in the socket from bacteria or trapped food particles
 Damage to nearby teeth, nerves, jawbone or sinuses
MEDICATION
 Pain medications are normally required after your wisdom tooth or teeth removal. If you can take ibuprofen
(Motrin® or Advil®), take 400–600 mg every 6–8 hours or as prescribed by your doctor. Ibuprofen will help with
pain relief and as an anti-inflammatory. If you cannot take ibuprofen, then 1–2 tablets of regular Tylenol® should
be taken every 4-6 hours. You may also have been prescribed additional pain medication to take in addition to
your ibuprofen if the pain is severe. Follow the directions written on your prescription bottle. Be advised that
certain pain medications can cause drowsiness, dizziness, or confusion, so do not drive or work around
machinery. Also, avoid alcohol while taking some of these medications.You may have been dispensed a syringe
with a gel called Sockit!® This should be used by applying at least 4–6 times a day on the extraction site the first
few days. This will provide pain relief and promote healing. With the curved tip attached to the syringe, apply to
the extraction site with just enough to cover the area. Keep your tongue away from the area. This gel will help
soothe the area and decrease the need for other pain medications.If the pain is severe, not controlled with your
medications, or persists, call our office for further instructions.