6 canine impaction .pptx

IMPACTIONS

1. DR DAVIS NADAKKAVUKARAN READER MALABAR DENTAL COLLEGE CANINE IMPACTION

2. CONTENTS Introduction Frequency of impacted teeth Classification Theories of canine impaction Indications Contraindication Impacted maxillary cuspid Impacted mandibular cuspid Post-operative management Post-operative complications Conclusion Reference

3. INTRODUCTION DEFINITION: An impacted tooth is one that is partially erupted or unerupted beyond the chronological date of eruption, and will not eventually assume a normal relationship with the other teeth and tissues.

4. Frequency of impacted tooth Mandibular third molar Maxillary third molar Maxillary cuspid Mandibular bicuspid Mandibular cuspid Maxillary bicusp Maxillary central incisor Maxillary lateral incisor

5. Classification Field and Akerman classification: Maxillary canine impaction Labial position Crown in intimate relation with incisors Crown well above the incisors Palatal position Crown near the surface, in close relationship to roots of incisors Crown deeply embedded in close relationship to apices of incisors Intermediate position Crown in between lateral incisor and first premolar roots Crown between these teeth with crown labially placed and root palatally placed or vice versa Unusual position In nasal or antral wall In infraorbital region

6. Mandibular canine impaction Labial position Vertical Oblique Horizontal Unusual position At inferior border In mental protuberance Migrated to opposite side

7. Classification based on position in dental arch CLASS 1:impacted cuspid located in the palate 1-horizontal 2-vertical 3-semivertical CLASS 2:impacted cuspid located in the labial or buccal surface of maxilla 1-horizontal 2-vertical 3-semivertical CLASS 3:impacted cuspid located in both palatal process and labial or buccal maxillary bone. CLASS 4:impacted cuspid located in the alveolar process located in the alveolar process usually verticaly between the incisor anf first bicuspid. CLASS 5: impacted cuspid located in an edentulous maxilla

8. Theories of canine imapction Two theories: Genetic theory Guidance theory

9. Indication Impacted canine located very far from the occlusal plane No other methods are possible to retain the tooth Patient not willing for orthodontic treatment Leaving behind may result in resorption of adjacent tooth Pathological changes like cyst, infection No adequate space for tooth to be in functional position Unfavourable anatomy of tooth

10. Contraindication When tooth can be brought to normal position by orthodontically or surgically Medically compromised patients

11. IMPACTED MAXILLARY CUSPID The removal of impacted maxillary cuspid is one of the most difficult procedure in oral cavity. The frequency of impaction of maxillary cuspid is 20 times greater than that of mandibular cuspid .

12. Etiological factors Prolonged retention of deciduous tooth Dilacerated root Ankylosed cuspid fails to erupt Presence of canine in relation to cleft lip or palate Lack of space Thick mucoperiosteal covering Endocrinal changes

13. Clinical Evaluation GENERAL EXAMINATION Presence of any systemic disorders and precaution should be taken Patient should be assesed for undergoing certain therapies like radiation therapy and organ transplantation LOCAL EXAMINATION 1- when lateral incisor is deflected distally, impacted canine might be present in close approximation with mesial aspect root apex of lateral incisor

14. 2-when lateral incisor is tipped labially it implies that impacted canine is present on the buccal or labial aspect of the root of lateral incisor When lateral incisor is inclined lingually ,canine is impacted on the palatal aspect of the root of lateral incisor

15. Radiographic Evaluation The periapical and panoramic radiograph are available for localizing the impacted canine, the exact location of the impacted cuspid cannot be determined.

16. CLARKS TUBE SHIFT METHOD Two periapical radiograph are taken in same position. The first radiograph is taken usual manner In the second radiograph the film is positioned in the same place but tube or cone of the x ray is moved horizontally in any one direction . Principle: Due to changes in horizontal direction while taking the second radiograph, unerupted tooth seems to be moving in a mesial or distal direction with respect to adjacent anatomical structures. SLOB

17. REMOVAL OF IMPACTED MAXILLARY CUSPID IMPACTION IN PALATE Administer LA Incision is made starting from palatal aspect of neck of the maxillary central incisor of the involved side, and extending around the neck partially impacted canine. Another incision is made in midline starting from crest of interdental papilla Mucoperiosteum is elevated

18. The bulge of crown of impacted canine is seen Bone is removed by bur or chisel Holes are drilled around the crown of the impacted canine, appropriate elevator is applied and the tooth delivered out of the socket. The crown should be sectioned first and removed followed by the root which can be pushed into the space created by removal of crown

19. Impaction on the labial or buccal side The crown of impacted teeth should be exposed with appropriately designed flap Trapezoidal flap Semilunar flap Triangular flap Bone overlying the impacted tooth should be removed with bur The tooth is elevated from the socket using elevator

20. Impaction on both palatal and buccal aspect On buccal side a semicircular incision is made and the root sectioned to remove it. On palatal aspect, a palatal flap is reflected as previously mentioned and the crown of the impacted tooth is exposed by removing the overlying bone using bur or chisel. Appropriate instrument is inserted in the root end of the crown through the buccal crypt and the instrument is now tapped with mallet to remove it through the palatal exposure.

21. Removal of bilaterally impacted canine differs in the type of incision and elevation of the flap. The incision is made around the neck of the teeth extending from one periosteal flap of bicuspid to other, and a full thickness mucoperiosteal flap is elevated incising the nasopalatine nerve bundle and vessels.

22. REMOVAL OF IMPACTYED MANDIBULAR CANINE Mandibular cuspids are mostly impacted in a vertical position either buccally or lingually

23. Removal of vertically impacted cuspid tooth on the buccal aspect An incision is made and mucoperiosteal flap is reflected adequately on the buccal side to expose the site of operation Bone removed with bur or chisel Using labial cortical plate as fulcrum, the tooth is luxated out of the socket If there is any resistance to normal delivery of tooth, tooth sectioning should be considered

24. After removing the impacted tooth, the sharp bony edges are trimmed and smoothened The socket is irrigated profusely using sterile saline solution The flap is sutured back

25. Post-operative management Sockets should be thoroughly debrided with a surgical curette Sharp bony edges should be smoothened Proper irrigation Primary haemorrhage occurs immediately after tooth removal. Firm pressure should be applied atleast for a period of 2 minutes Secondary haemorrhage treated by a gauze sponge held between jaws and operative site for half an hour Patient should not rinse his/her mouth for 6 hours Swelling occuring immediately after surgery can be treated by applying ice cap, followed by heat application in subsequent 4 days mastication of hard food should be avoided Strict oral hygiene

26. Post operative complications Injury to nerves Infection Injury to surrounding tissues Disturbance to normal blood supply Fracture of roots or accidental displacement of fractured root into antrum Oroantral fistula Postoperative sequelae like excessive swelling, severe dysphagia, severe pain

27. Conclusion Removal of impacted teeth is mandatory only if it cannot be brought into its normal functional position Retaining the tooth in impacted position can lead to infection, fracture of bone, cystic or neoplastic changes, malocclusion and crowding Proper diagnosis should be made on impacted tooth and appropriate treatment modality should be followed

28. REFERENCES Textbook of Oral And Maxillofacial Surgery – Balaji Textbook of Oral And Maxillofacial Surgery – Neelima Anil Malik

29. THANK YOU