Impacted tooth A tooth which is completely or partially un erupted beyond its normal time of eruption is called an impacted tooth.

OR Any tooth which is either completely unerupted or partially erupted and where it is being obstructed either by adjacent tooth, bone or soft tissues where its further eruption is not possible. Malposed tooth Any tooth which is un erupted, erupted partially or completely erupted but is not in normal alignment with mandible or maxilla.

Un erupted teeth: All those teeth which has not pierced or perforated the oral mucosa are labeled as un erupted teeth. If a tooth is in the bone & is mal-posed we will wait for its time of eruption.

DEFINITION
Any tooth which is partially or completely un-erupted, being obstructed by the adjacent teeth, overlying bone or hard fibrous tissue, so that it is unlikely to erupt beyond its maximum time of eruption is labeled as an Impacted tooth

Causes of impaction
Local causes:
1.Lack of space due to irregularity in the position & pressure of an adjacent tooth. 2.Density of the overlying bone or surrounding bone. 3.Dense & thick mucosa. 4.Chronic inflammation with resultant increase in density of overlying mucosa & scar formation.

5. Diseases like infection, abscess or osteomyelitis. 6. Lack of space due to under development of jaw. 7. Early loss of deciduous teeth, resulting in;
1. The mucosa overlying the permanent teeth become fibrosed. 2. The teeth lying beside become shifted to that area & decrease the space.

8. Prolonged retension of primary teeth, so space for permanent teeth to come & thus it may change the direction. 9. Exanthematous diseases in children in which skin eruption occur, also the mucosa become fibrosed. In these diseases inflammatory changes in the bone also occur. 10. Over crowing of teeth causes lack of space.

 Systemic diseases: Impaction may occur where no local predisposing conditions are present; 1.Prenatal causes:
1.Hereditary factors 2.Miscegenation pt from different races e.g. mother is from Maldives or srilanka & farther from Africa, the child gets the jaw size from mother & teeth size from father, so the teeth will be large & jaws will be small.

2. Post natal causes: all those systemic diseases which can effect the growth of baby directly or in directly like;
1. Rickets
2. Anaemia 3. Congenital syphilis 4. Tuberculosis 5. Endocrine dysfunction

6. Malnutrition

3. Rare conditions
1. Cleido cranial dysostosis
2. Oxycephaly 3. Progeria 4. Achodroplasia 5. Cleft palate

6. Pagets disease of bone

7. Mongolism

Chronology
Any tooth can become impacted but most commonly impacted teeth are third molars, maxillary canines & premolars. But any tooth erupting late Chronologically can get impacted. Lack of space: Inadequate dental arch length and space in which to erupt; i.e. total length of the alv. bone arch is smaller than the total length of the tooth arch.

1. Third molars: last teeth to erupt & likely to have inadequate space for eruption. 2. Maxillary canine: being the longest rooted tooth, long tortuous way to travel to come into oral cavity & and when there is over crowing in upper anterior maxilla, remains impact or become malposed. This is because canine tooth erupts after max. Lateral incisor & 1st premolar leaving no space for it. 3. Mandibular premolar: it erupts after lower 1st molar & mand. Canine find no space for eruption.

canine

INDICATIONS FOR EXTRACTION

PREVENTION OF RECURRENT PERICORONITIS PREVENTION OF CARIES / ROOT RESORPTION PREVENTION OF PERIODENTAL DISEASE PROSTHETIC CONSIDERATIONS ORTODONTIC CONSIDERATIONS

INDICATIONS FOR EXTRACTION

cont

PRESENCE OF PATHOLOGIC LESION UNEXPLAINED PAIN SOCIAL AND ECONOMIC FACTORS

PREVENTION OF RECURRENT PERICORONITIS

Pericoronitis is the infection & inflammation of the soft tissue around the crown of partially impacted tooth. An indication Paradoxically an contraindication Bilateral concurrent pericoronitis Rare advise to removal impaction

Peri apical periodontitis

Prevention of periodontal disease/peri apical periodontitis

High incidence of periodontal pocketing distal to 2nd molar. Pocketing of gums around partially erupted 3rd molar cause relapses even after effective treatment. Even after 3rd molar removal distal pocketing to 2nd molar creates problems Proper timing & appropriate technique of impaction removal is mandatory. Caries-pulp exposure- peri apical / dento alv. abscess

PREVENTION OF CARIES
Partially erupted third molar food trap plaque -unpleasant taste & smell- caries occ: surface of impacted third molar or distal surface of second molar or both. Second molar can be successfully preserved after removal of impacted tooth. Caries/root resorption

ORTHODONTIC REASONS
Prophylactic removal of 3rd molars controversial imbrication lower incisors. Marked disproportions between tooth size & the jaw size. Radiographic & computer based evidence at age 7-9 yrs that impaction will occur 3rd molar germ before calcified cusps united is enucleated- not popular. Lateral trepanation at age of 16 yrs crown completed & one 3rd roots formed. But both have advantage of less surgical trauma.

PROSTHETIC COSIDERATION
Where dental clearance indicated an OPG taken to exclude hidden impactions or buried roots. This will help avoidance future ill fitness of dentures and infections or surgical trauma.

PRESENCE OF PATHOLOGICAL LESION

Prevention of formation odontogenic cysts / tumour. Relation to a malignant tumour. In fracture line remove or not remove. Prevention of mandible fracture

LOWER 3RD RELATED FOLLICULAR CYST

IMPACTION RELATED TO KERATOCYST

UNEXPLAINED PAIN
May found in search for causes / diagnosis of obscure facial pain. Some times help but patient must be explained a guarded prognosis.

SOCIAL & ECONOMIC FACTORS

Busy patients either delay or want early surgery. Patients from far-flung inconvenience. Finances.