essay 25 - removal of partially erupted and impacted teeth. Indications. Contraindications. Techniques. Complications. Germectomy

what does removal of partially erupted and impacted teeth entail

• it is a open extraction indicated when a tooth fails to erupt within the expected time frame. Commonly impacted teeth include:

• 3rd molars (wisdom teeth)

• maxillary canines

• mandibular premolars

• ideal time for removal = 17-20 years (Younger patients = less dense bone, incomplete root formation)

what are the classifications of impaction based on

• based on nature of the overlying tissue

• winter's classification

• Pell and Gregory classification

describe classification of impaction based on nature of the overlying tissue

• soft tissue impaction

• partial Bony impaction

• Complete Bony impaction

describe classification of impaction based on winter's classification

• mesioangular impaction

• distoangular impaction

• Vertical impaction

• horizontal impaction

• Bucolingual impaction

describe classification of impaction based on Pell and Gregory classification

• Class A/B/C = evaluates the depth of impacted teeth in relation to the occlusal plane

• Class 1/2/3 = evaluates the relationship to the anterior border of the mandibular ramus

indications removal

• prevention of periodontal disease

• prevention of dental carriers

• prevention of pericoronitis

• prevention of root resorption of adjacent teeth

• teeth under dental prosthesis

• prevention of odontogenic cyst/tumours

• management of unexplained pain

• prevention of mandibular fractures

• orthodontic treatment facilitation

• Optimal Periodontal healing

contraindications for removal

• Extreme ages = very young or elderly

• poor General health (e.g systemic illness)

• risk of excessive trauma to adjacent atomical structures

surgical technique for impacted tooth removal

1. flap creation

• triangular mucoperiosteal flap

• incision from distal of second molar to anterior border of ramus

2. bone removal

• round bur to expose the crown

• guttering technique = buccal/distal bone groove for pathway creation

3. tooth elevation

• straight elevator in mesial area

• tooth rotated and luxated distally

4. socket debridement

• remove follicular sac and bone fragments

• smooth sharp bone margins

5. irrigation and suturing

• irrigate with saline

• Suture starting at flap corner. Remove sutures in 7-10 days

6. post operative instructions

• provide written and oral instructions

• ensure follow up care

complications faced during removal

• Bleeding

• infection

• dry socket (alveolar osteitis)

• damage to nearby teeth or nerves (e.g paresthesia)

• Oroantral communication

• swelling, christ

what is germectomy

the surgical removal of the tooth bud of an impacted 3rd molar before root formation

List The steps of germectomy

1. incision and flap reflection

2. bone removal - guttering technique

3. tooth elevation

4. cleaning and bone smoothing

5. irrigation and suturing

6. Postoperative Instructions and Follow

describe first step of germectomy - incision and flat reflection

• a triangular incision is made using a scalpel

• the mucoperiosteal flap (full thickness) is reflected (lifted) starting from the distal aspect of the second molar, and extended posteriorly to the anterior border of the ramus

• this gives direct access to the bone overlying the tooth bud

describe second step of germectomy - bone removal bone removal (guttering technique)

• the bone covering the tooth is removed using a round bur

• since the two this still developing (the root not yet formed), it moves easily inside the socket, making elevation difficult

• to allow controlled removal, a groove is created on the buccal and distal aspect of the crown to allow controlled removal, a groove is created on the buccal and distal aspect of the crown- this is called the guttering technique. this avoids excessive bone removal while still creating a path for extraction

describe the third step of germectomy- tooth elevation

• once enough crown is exposed, a straight elevator is inserted mesially and a distal rotational movement is applied

• this movement lifts a tooth bud out of the socket in a controlled manner

describe the 4th step of germectomy - cleaning and bone smoothing

• the follicular sac (which surrounds the developing tooth) and any bone fragments are removed

• the socket is checked for sharp edges - if present, they are smoothed with a bone file or bur

describe the fifth step of germectomy- irrigation and suturing

• the area is thoroughly irrigated with....to clean debris and prevent infection

• the wound is sutured:

— the first suture is placed at the corner of the flap to ensure proper repositioning

— additional sutures are placed along the posterior and vertical incisions

describe the 6th and final step of germectomy - Post operative instructions and follow

• both oral and written instructions are given to the patient (e.g avoid rinsing for 24 hours, no smoking, cold compresses, medication guidance)

• sutures are removed after 7-10 days during a follow up visit