impacted tooth - Medical Dictionary

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impacted tooth		A tooth that is prevented from erupting by a physical barrier, usually other teeth. Impaction may also result from orientation of the tooth in an other than vertical position in the periodontal structures. [ Articles \| Books \| Images \| Discussion groups ]

Additional comments : Free Full Text Treatment options for impacted teeth J Am Dent Assoc. 2000 May;131(5):623-32. BACKGROUND: A compilation of treatment options for impacted teeth is presented to assist dentists in discussing the sequelae of impacted teeth as well as the complications of treatment with their patients. OVERVIEW: A differential diagnosis for an impacted tooth is not possible without clinical assessment. However, an ankylosed tooth or a tooth with failure of its eruption mechanism may be mistaken for an impacted tooth. This review of national and international dental texts, journals and publications concerning impacted teeth spans more than 50 years. PRACTICE IMPLICATIONS: Treatment options for the management of impacted teeth are separated into four categories: observation, intervention, relocation and extraction. The indications, contraindications and complications of each option are presented. This information will help the clinician identify developmental conditions associated with an increased probability of tooth impaction and assess available treatment options. Management of bilaterally impacted mandibular second and third molars J Am Dent Assoc. 1999 Aug;130(8):1190-4. BACKGROUND: The authors present an interdisciplinary approach to treating bilateral impaction of mandibular second molars. CASE DESCRIPTION: A 22-year-old man had a bilateral deep horizontal impaction of his mandibular second molars. The mandibular third molars lay above and parallel to the second molars. After an orthodontic assessment, the authors decided to distally upright the third molars, remove them and then orthodontically reposition the second molars if they were not ankylosed. This combined orthodontic-surgical approach was successful. CLINICAL IMPLICATIONS: This case illustrates the importance of strong cooperation among various specialists to establish the optimal comprehensive treatment plan. Early diagnosis and interception of potential maxillary canine impaction J Am Dent Assoc. 1998 Oct;129(10):1450-4. The authors present clinical and radiographic measures for the early detection of potential maxillary canine Impaction. Intercepting the impaction process by timely removal of the primary canines, as demonstrated in several representative cases, allows the permanent canines to erupt normally and, thus, prevents their potential impaction. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars (pdf) Med Oral Patol Oral Cir Bucal. 2007 Mar 1;12(2):E139-44. BACKGROUND: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars. STUDY DESIGN: A randomized double-blind clinical trial was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. RESULTS: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions. CONCLUSIONS: The results obtained suggest that 4% articaine offers better clinical performance than 2% lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions. Reasons for third molar teeth extraction in Jordanian adults J Contemp Dent Pract. 2006 Nov 1;7(5):88-95. AIMS: To assess reasons for third molar teeth extractions in a sample of Jordanian dental patients and to evaluate the association of extractions with other independent variables. METHODS AND MATERIALS: The study sample was comprised of dental patients in North Jordan who had third molar extractions. Data were collected from 36 dentists who were instructed to administer questionnaires to their adult patients undergoing third molar extractions and then to record the primary reason for those extractions. The data in this study was analyzed using a descriptive summary and chi square statistics. RESULTS: Dentists performed 810 extractions for 648 patients. The reasons for the extractions were: dental caries and its consequences about 42%, eruption problems 39%, periodontal diseases about 7%, and approximately 9% of extractions were a result of the dentist's choice. The percentage of extractions due to dental caries significantly increased with increasing age. However, significant numbers of teeth were extracted due to eruption problems (51%-69%) in young adults. For 46+ year olds, 23% of extractions were caused by periodontal diseases. Extraction due to dental caries was distributed equally among the sexes. Persons with irregular tooth brushing and fewer dental visits had significantly more third molar teeth extracted due to caries and periodontal diseases compared to persons with regular tooth brushing and dental visits. Surgical and orthodontic treatment of an impacted permanent central incisor: a case report J Indian Soc Pedod Prev Dent. 2006 Jun;24(2):100-3. Although impaction of a permanent tooth is rarely diagnosed during the mixed dentition period, an impacted central incisor is usually diagnosed accurately when there is delay in the eruption of tooth. In this article, the impacted incisor was moved into it's proper position with surgical exposure and orthodontic traction, after which it showed good stability. Facial nerve paralysis after impacted lower third molar surgery: a literature review and case report (pdf) Med Oral Patol Oral Cir Bucal. 2006 Mar 1;11(2):E175-8. Facial nerve paralysis (FNP) is the most common cranial nerve disorders and it results in a characteristic facial distortion that is determined in part by the nerves branches involved. With multiples etiologies, these included trauma, tumor formation, idiopathic conditions, cerebral infarct, pseudobulbar palsy and viruses. FNP during dental treatment is very rare and can be associated with the injection of local anesthetic, prolonged attempt to remove a mandibular third molar and subsequent infection. We report a case of a 21 years-old black woman who developed a Bell's palsy after an impacted third molar surgery under local anaesthesia, present a FNP classified like a grade IV by the House-Brackmann's grading system. The treatment was based of prescription of a cytidine and uridine complex (NUCLEO CMP tm) one tablet twice per day and a close follow up. Three months later that had beginning the treatment, the patient recovery her normal facial muscle activity. Rescue surgery (surgical repositioning) of impacted lower second molars (pdf) Med Oral Patol Oral Cir Bucal. 2005 Nov-Dec;10(5):448-53. The impaction of lower second molars, given that its incidence is 0.03 to 0.21%, is a rare complication in tooth eruption. It has been detected more often in unilateral form than bilateral and is more common in the mandible than in the maxillary. It has a slight predilection for males, and mesial inclination is more usual. A wide variety of therapeutic approaches have been published, basically referring to surgical techniques, independent or complemented by means of orthodontic technical aids, with the aim of placing the tooth in the correct position, and which are encompassed under the concept of surgical rescue. In cases resolved with repositioning of an impacted tooth, prophylactic root extraction has been proposed as obligatory. We present a case of a 12 and a half year old patient referred to the University of Seville due to non-eruption of the left lower second molar. The patient was referred by her orthodontist, who detected the impaction before starting orthodontic treatment. The orthodontist requested that, if it was possible, we did not extract the root of the third molar, because its eruption would be feasible in the future (there would be sufficient space in the arch). The spaces available were measured and we decided to attempt the repositioning of the impacted tooth without extracting the root of the wisdom tooth, which was carried out successfully. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery Br J Anaesth. 2005 May;94(5):642-8. Epub 2005 Mar 24. BACKGROUND: The purpose of this randomized double-blind study was to compare the efficacy and safety of propacetamol 2 g (an i.v. acetaminophen 1 g formulation) administered as a 2-min bolus injection (n=50) or a 15-min infusion (n=50) with oral acetaminophen 1 g (n=50) or placebo (n=25) for analgesia after third molar surgery in patients with moderate to severe pain after impacted third molar removal. METHODS: All patients were evaluated for efficacy during the initial 6 h period after treatment administration (T(0)) and for safety during the entire week after T(0). RESULTS: The onset of analgesia after propacetamol was shorter (3 min for bolus administration, 5 min for 15-min infusion) than after oral acetaminophen (11 min). Active treatments were significantly better for all parameters (pain relief, pain intensity, patient's global evaluation, duration of analgesia) than placebo (P<0.05). Adverse events were more frequent after propacetamol, especially pain at the injection site. Propacetamol bolus resulted in a much higher incidence of local adverse events than the infusion (propacetamol bolus 90% vs propacetamol infusion 52%) with no clinically significant benefits in terms of analgesic efficacy. CONCLUSION: I.V. propacetamol, administered as a 15-min infusion, is a fast-acting analgesic agent. It is more effective in terms of onset of analgesia than a similar dose of oral acetaminophen. Patients' perceptions of recovery after surgical exposure of impacted maxillary teeth treated with an open-eruption surgical-orthodontic technique Eur J Orthod. 2004 Dec;26(6):591-6. This study assessed patient perceptions of immediate post-operative recovery after the surgical exposure of impacted maxillary teeth with an open-eruption technique. Thirty patients (24 females and six males) underwent surgical exposure of 39 impacted maxillary teeth using this technique. After surgery the patients were contacted by telephone daily for 7 days, to complete a health-related quality of life (HRQOL) questionnaire, which assessed their perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. Severe pain was reported by 30 per cent of the patients in the first post-operative day (POD 1), which declined to 6.7 per cent by POD 6. Consumption of analgesics declined gradually over the post-operative days (POD 1: 80 per cent, POD 7: 20 per cent). Difficulty in eating required 5 days to reach minimal levels; enjoying everyday food, 2.5 days; school attendance, limitations in daily routine, swallowing, and speech, 2 days each; swelling, bad taste/smell, 1.5 days each; within 1 day all other measures attained minimal levels. The need for bone removal during the exposure resulted in delayed recovery with regard to the ability to eat. In general, females reported delayed recovery for pain. The present data may serve as basic guidelines against which future studies which assess post-operative management of patients after surgical exposure of impacted teeth by an open-eruption technique may be compared. Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars J Am Dent Assoc. 2004 Mar;135(3):312-8. BACKGROUND: The authors conducted a study to evaluate the predictive value of five radiographic markers on the panoramic radiograph, or PR, to point out the relationship between the mandibular canal and the impacted third molar. METHODS: The authors evaluated the accuracy of the radiographic markers by comparing the PR with an axial computed tomographic, or CT, scan. They identified a sample of 73 third molars that showed a close relationship between the tooth roots and the mandibular canal on the PR, and then classified them on the basis of five radiographic markers. They also detected contact between the third molar and the mandibular canal on the CT scan. RESULTS: The distribution of the five radiographic markers was as follows: 37 teeth exhibited increased radiolucency, 13 exhibited superimposition, 14 exhibited interruption of the radiopaque border, 14 exhibited narrowing of the canal and seven exhibited diversion of the canal. In 11 cases, two or more markers were recognizable. The predictive values of a positive test result were as follows: increased radiolucency, 73 percent; superimposition, 38.5 percent; interruption of the radiopaque border, 71.4 percent; narrowing, 78.6 percent; and diversion, 100 percent. The authors detected contact in all of the cases that exhibited two or more markers. CONCLUSION: Increased radiolucency, narrowing and interruption of the radiopaque border, as well as the concomitant presence of two or more radiographic markers, on the PR were highly predictive of contact between the third molar and the mandibular canal. An axial CT scan probably is indicated in such cases. CLINICAL IMPLICATIONS: The results of this study may lead to some guidelines for oral surgeons evaluating whether to obtain an axial CT scan for further investigation after examining an impacted mandibular third molar via PR. Maxillary canine impaction; a final twist in the tale? J Orthod. 2004 Mar;31(1):13-4. A case is presented with a displaced maxillary canine, where one year subsequent to the radiographic diagnosis, a bend in the apical one third of the adjacent premolar root had developed. This finding lends further support to a recent hypothesis, that in such circumstances, the canine impaction results in the deviation of the developing premolar root, rather than the obverse. Surgical uprighting and repositioning of severely impacted mandibular second molars J Am Dent Assoc. 2003 Nov;134(11):1459-62. BACKGROUND: Impacted second molars can create problems with esthetics, masticatory function and dental arch stability. Treatment options include surgical extraction, surgical uncovering with orthodontic-assisted eruption and surgical uprighting. CASE DESCRIPTION: The authors review the literature concerning surgical molar uprighting, and present a case in which the procedure was performed successfully to treat an impacted second molar in a female adolescent. The authors surgically repositioned a horizontal, right mandibular second molar that was partially impacted in bone. The patient was followed up for three years, during which time she was free of complications. CLINICAL IMPLICATIONS: Surgical molar uprighting has been shown to be a predictable and reliable procedure. When a molar tooth is severely impacted, surgical uprighting provides a viable option when other treatment modalities are contraindicated. Surgical repositioning of an impacted dilacerated incisor in mixed dentition J Am Dent Assoc. 2002 Jan;133(1):61-6. BACKGROUND: Treatment options for a dilacerated incisor are either extraction or surgery and orthodontic traction. Because patients with such incisors usually are young, and because of the root angulation of the impacted incisor, treatment usually is lengthy and complicated. Surgical repositioning provides another option for treatment of this unique problem. CASE DESCRIPTION: The author presents the case of a 9-year-old girl with an impacted dilacerated maxillary central incisor to demonstrate the timing, technique and results of the surgical repositioning treatment approach. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root's adapting to the new position. CLINICAL IMPLICATIONS: Surgical repositioning is a simplified treatment for dilacerated incisors. It is especially valuable in cases of difficult-to-treat impaction. Timing of surgical repositioning depends on the incisor's root development and the space available for the transplant. The radiographic localization of impacted maxillary canines: a comparison of methods Eur J Orthod. 2001 Feb;23(1):25-34. This study compared two different radiographic techniques for localization of impacted maxillary canines: vertical parallax (from a panoramic and a maxillary anterior occlusal radiograph) and magnification (from a single panoramic radiograph). The radiographs and the information regarding the impacted canines were obtained retrospectively from records of patients treated in the Day Stay Unit of the Eastman Dental Hospital. The two different radiographic techniques were tested blind and compared for localization of the impacted canine by six examiners. The 'gold standard' used for the radiographic comparisons was the true position of the canine as recorded at operation. The results showed a wide variation between the six examiners in the prediction of the canine position with the two different techniques. Localization with vertical parallax was more successful overall than with magnification, although the difference failed to reach significance. Seventy-six per cent of the impacted canines could be successfully located with vertical parallax and 66 per cent with magnification. Further analysis showed that, while almost 90 per cent of the palatally impacted canines could be correctly detected with both techniques, less than half of the buccal canines could be detected with parallax and only one in 10 buccal canines could be detected with magnification. If a canine is suspected to be buccally placed from its appearance on a panoramic film and cannot be palpated, further views are justified. Third molar impaction in extraction cases treated with the Begg technique Eur J Orthod. 1998 Jun;20(3):263-70. The aim of this study was to investigate the differences between two groups of patients with either erupted or impacted mandibular third molars before and after orthodontic treatment. All patients were treated with Begg appliances following extraction of the four first premolars. The erupted group consisted of 14 subjects and the impacted group 13 subjects. Lateral cephalometric films, peri-apical radiographs, orthopantomographs and orthodontic casts of each subject were taken before and after treatment. Thirteen measurements were carried out on the lateral cephalometric radiographs. The results revealed slightly more vertical growth and a smaller mandibular arc angle in the erupted group at pre-treatment, and also a more upright lower third molar position and slightly greater distance between the distal point of the lower second molars and the centre of ramus (Xi) in the same group. In the course of treatment, mandibular third molars seemed less likely to erupt when the condyle grew vertically. The lesser resorption on the anterior border of the ramus might have played a part in this finding. In addition, a greater mesial inclination of the mandibular third molars might be an indication of the tendency for these teeth to be impacted in the present study. Dentists' agreement on treatment of asymptomatic impacted third molar teeth: interview study BMJ 1997;315:1204 (8 November) The main indications for removal of a third molar tooth were outlined at a consensus development conference of the National Institutes of Health in 1979.1 These are (a) acute or chronic infection in a third molar tooth, (b) damage to adjacent teeth, (c) irreparable decay in the tooth, and (d) a cyst or space occupying lesion in the tooth. Currently a quarter of third molar teeth are removed without being diseased,2 and the need for their removal has been questioned.3 We measured the variation in and reliability of decisions made by a random sample of dentists about the treatment of asymptomatic impacted third molar teeth.

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