Factors Complicating The Operative Procedure

1. Abnormal root curvature.
2. Hypercementosis
3. Proximity of mandibular canal.
4. Extreme bone density especially in elderly patients.
5. Follicular space filled with cementum or bone.
6. Ankylosis.
7. Small orbicular oris.
8. Inability to open the mouth.
9. Large and uncontrollable tongue.

Surgical Technique For Removal

• Radiographs should show the exact, full size not elongated or shortened form of the tooth. Also, number, size and curvature of the roots and proximity of crown to adjacent tooth or vital structures should be visible.
• Classify impaction.
• Determine the amount of overlying and surrounding bone.
• Carefully note the position of the roots and the inferior dental canal.
• Outline the extent of the soft tissue flaps to be used, keeping in mind the necessity for adequate exposure and maintenance of a good blood supply to the flap and the sequent support of soft tissue flap.
• Procedure or technique for removal:

  A. Sectioning of the tooth.
  B. Combination of the removal of surrounding bone and the sectioning technique.
  C. Solely by removal of surrounding bone.

• Determine the surrounding and overlying osseous structure.
• Determine the best instrument.
• Determine the best direction for the removal of impacted to7oth.

ADVANTAGE

1. Field of operation can be kept small.
2. Bone removal reduced to a considerable extent.
3. Operating time is shortened.
4. Problem is considerably reduced.
5. No damage to the adjacent teeth and bone.
6. Risk of jaw fracture is reduced.

DISADVANTAGE

1. Teeth with shallow groove do not split.
2. Teeth in elderly patient are difficult to split.
3. Sometimes it is impossible to split along the long axis of the tooth.
4. Direction control at times is difficult.