12- included upper third molars

What 3 factors are involved in the inclusion of U3rdM?

Increased porosity of maxilla

Area less sensitive

Better spatial relationship between bone and muscle

(Milder symptoms)

How can you classify included U3rdM?

Depending on type of retention and development

Depending on degree of impaction

What are the 6 types of impacted teeth based on retention and development classification?

Type 1- tooth germ

2- incomplete root formation

3- retention with normal axial position

4- tooth tilted mesial

5- tooth tilted distally

6- rotated and transverse tooth in alveolar process

What are the 3 types of impacted teeth based on degree of impactation?

Light- highest cusp of 3rd M is at occlusal level of 2nd M

Moderate- highest cusp of 3rd M below occlusal of 2bd M but higher than cervical line

Severe- highest cusp of 3m is below or at level of cervical line of 2nd M

What anatomical structures near U3rdM?

Buccinator (outside)

Anterior palatine nerve, palate veil, bone foil (inside)

Posterior alveolar nerve, maxillary tuberosity, pterygomaxillary region (behind)

Max sinus and 2nd M (ahead)

Max artery and upper alveolar nerves (above)

Surgical treatment of impacted 3rdM?

Anesthesia- retrotuberosity- blocks posterior superior alv nerve and anterior palatine nerve

Incision- triangular, start D on max tuberosity, vertical relieving M/D of 2nd M

Detach flap, ostectomy, mouth closed or semi open

5 Complications of U3rd M?

Fracture maxillary tuberosity or pterygoid apophysis

Upper 3rd molar displaced (sinus, fossa,pterygomaxillary space or into vestibule)

Haemorrhage, because lesion of posterior palatine artery in maxilla

Bichat ball hernia

Injure distal root of 2nd molar

6 Post op complications?

Post-extraction haemorrhage

Haematoma

Trismus

Dry alveolitis

Infection

Emphysema