Third molar is the most commonly impacted tooth in the Oral cavity. Surgical removal of Impacted tooth is the most common Surgical procedure in Dental Clinic. Diagnosis in Impaction is most important because of the location and structures surrounding the impacted tooth. Treatment plan should be determined only after proper Diagnostic evaluation is done.
Types of Examinations Required for Diagnosis of Surgical Impaction Technique:
- Local Examination:
- Radiological Examination:
Local Examination for Diagnosis of 3rd Molar Impaction:
Eruption Status of Impacted Tooth: Its should be kept in mind that impacted tooth is removed only after 2/3rds of the Root is formed. Because if the Roots are completely formed it becomes difficult to remove and surgical Splitting of tooth is required. So depending on the status of formation, tooth removal should be done.
Resorption of Second Molar: Because of the lack of space 3rd molar often impinges on the Second molar trying to erupt into occlusion. In the process we can see resorption of the Second molar Root if 3rd molar impinges near the Roots.
Presence of Local Infection: Inflammation of the Soft tissue covering the crown of the Erupting 3rd molar is called as Operculum which is called as Pericoronitis. Treatment of Pericoronitis is Antibiotic Coverage and wait to watch or Surgical Excision called as Operculectomy. In presence of recurrent pericoronitis early removal of Impacted tooth is required.
Caries in Impacted 3rd molar or Adjacent tooth: Impacted tooth during eruption due to lack of space will form a V shaped trench between the crown’s of 3rd and 2nd molar, htis leads to accumulation of food and debris which will lead to Caries, Occlusal caries in 3rd molar and Cervial caries in 2nd molar. So removal of 3rd molar should be done immediately to save 2nd molar.
Orthodontic Requirement: In Orthodontic treatment removal of erupting 3rd molar is necessary to prevent crowding and to gain space before starting Orthodontic Treatment.
Relationship of Impacted tooth to Inferior Alveolar/Dental canal: There are various types of relationships of the Inferior dental canal to the tip of the Roots of impacted tooth. Explained in detail here: Relationship of Impacted tooth to IDC
Occlusal Relationship: In Impacted teeth there is recurring Pericoronitis which can be seen on the opposing arch if 3rd molar is removed in this arch. So Occlusal relationship should be considered and 3rd molar of the adjacent arch should also be taken into consideration.
TMJ pain: In many cases due to irregular occlusal relationship there can be pressure on the TMJ which inturn causes pain in the TMJ leading to TMJ dysfunction.