Impacted Teeth

IMPACTED TEETH 

An impacted tooth is one that fails to erupt into the dental arch within the usual range of expected time. The tooth becomes impacted because adjacent teeth, dense overlying bone, excessive soft tissue, or a genetic abnormality prevents eruption. Because impacted teeth do not erupt, they are retained for the patient’s lifetime unless surgically removed or exposed because of resorption of overlying tissues. The most common impacted teeth are maxillary and mandibular third molars, followed by maxillary canines and mandibular premolars.

INDICATIONS FOR REMOVAL OF IMPACTED TEETH

Prevention of Periodontal Disease; Erupted teeth adjacent to impacted teeth are predisposed to periodontal disease The mere presence of an impacted mandibular third molar decreases the amount of bone on the distal aspect of an adjacent second molar. Because the most difficult tooth surface to keep clean is the distal aspect of the last tooth in the arch, patients commonly have gingival inflammation with apical migration of the gingival attachment on the distal aspect of the second molar. By removing the impacted third molars early, periodontal disease can be prevented, and the likelihood of bony healing and optimal bone fill into the area previously occupied by the crown of the third molar is increased.

Prevention of Dental Caries; When a third molar is impacted or partially impacted, the bacteria that cause dental caries can be exposed to the distal aspect of the second molar as well as to the impacted third molar. Even in situations in which no obvious communication between the mouth and the impacted third molar exists, there may be enough communication to allow for caries initiation.

Prevention of Pericoronitis; Pericoronitis is an infection of the soft tissue around the crown of a partially impacted tooth and is usually caused by normal oral flora. The overwhelming majority of cases of pericoronitis can be prevented only by extraction of the tooth.

Prevention of Root Resorption; Occasionally, an impacted tooth causes sufficient pressure on the root of an adjacent tooth to cause root resorption.

Impacted Teeth under a Dental Prosthesis; When a patient has an edentulous area restored, there are several reasons for removing impacted teeth in the area before the prosthetic appliance is constructed. The denture may compress the soft tissue onto the impacted tooth, which is no longer covered with bone; the result is ulceration of the overlying soft tissue and initiation of an odontogenic infection.

Prevention of Odontogenic Cysts and Tumors; Impacted teeth can rarely cause cysts and tumors. For this reason, tooth extraction is recommended.

Prevention of Jaw Fractures; An impacted third molar in the mandible occupies space that is usually filled with bone. This weakens the mandible and renders the jaw more susceptible to fracture at the site of the impacted tooth.

Facilitation of Orthodontic Treatment; When patients require retraction of first and second molars by orthodontic techniques, the presence of impacted third molars may inter- fere with the treatment. It is, therefore, recommended that impacted third molars be removed before orthodontic therapy is begun.

In elderly individuals and in cases accompanied by systemic diseases (diabetes, hypertension, etc.), impacted teeth can be kept under follow-up instead of extraction. The right decision is made with examination and radiology findings.

Most patients have more preoperative concerns about the sequelae of surgery such as pain and swelling than about the procedure itself. Although sequelae such as pain and swelling may be encountered in the early period after extraction, these sequelae can be minimized with appropriate antibiotic and analgesics. The pain a patient may experience after a surgical procedure such as tooth extraction is highly variable and depends, a great extent, on the patient’s preoperative expectations. –