IMPACTED 3RD MOLAR REMOVAL

PRE OPERATIVE ASSESSMENT

WHO IS GOING TO DO IT
General dental surgeon / Referral Oral surgeon who has the;
1. 2. 3. experience or trained in. facilities know possible complications intra operative & post operative 4. Choice of anesthesia i.e. L.A or G.A

Pre operative assessment

CLINICAL ASSESSMENT

General factors (Hx ) Local factors

1. Acute inflammation 2. Mouth opening (clinical access
Poor Good - External oblique ridge guide for access

3. Second molar 4. Missing 1st molar

Pre operative assessment

Radiographic Assessment Peri apical view Bite wing Occlusial view. Lateral oblique. OPG.

cont1.

Pre operative assessment

cont2.

Interpretation of standardized intra oral radiograph 1. Access: 2. Position & depth: 3. Root pattern: 4. Shape of crown: 5. Texture of the investing bone: 6. Position & root pattern of the 2nd molar: 7. Inferior dental canal

Classification
A. Relation ship of tooth to the ramus & 2nd molar.
Class I. Class II. Class III.

B. Relationship of 3rd molar in bone.

Position A. Position B. Position C.

WINTERS CLASSIFICATION
Long axis of 3rd molar in relation to long axis of 2nd molar. Describes 3rd molar impactions as vertical, Mesio-angular, Disto-angular & Horizontal. Howe modified it using the Winter Lines importance of the vertical depth of 3rd molar.

PELL & GERGORY

Similar to winter but uses the three tilts of long axis of 3rd molar; Uses relationship to;
Ramus (Class I, II & III) Relative depth (Position I, II, III) 2nd molar (Angulations- horizontal mesioangular, distoangular etc.)

MESIO & DISTO-ANGULAR IMPACTIONS

HORIZONTAL IMPACTIONS

ACCESS
Radio-opaque line cast by external oblique ridge
Vertical-poor.
Horizontal- excellent

POSITION & DEPTH

Winter lines.
White-axial inclination & depth of imp. tooth. Amber- margins of alv. bone enclosing imp. tooth Red-depth of the tooth in side the mandible. Longer the line deeper the imp.

ROOT PATTERN

SHAPE OF CROWN

Large square & prominent cusps more difficult. Small conical crowns & flat cusps- easy. Tooth impaction

TEXTURE OF THE INVESTING BONE

Large cancellous spaces & fine bone structure- bone elastic. Small cancellous spaces & bone shadow- bone is sclerotic.

POSITION & ROOT PATTERN OF 2ND MOLAR

RELATIONSHIP TO INFERIOR DENTAL CANAL