Maxillary Impaction

CLASSIFICATION

1. Relative depth of impacted maxillary third molar in bone.

CLASS I : Lowest portion of the crown of the impacted maxillary third molar is on a line with the occlusal plane of the second molar.

CLASS II : Lowest portion of the crown of the impacted maxillary third molar is between the occlusal plane of the second molar and the cervical line.

CLASS III : Lowest portion of the crown of the impacted maxillary third molar is above the cervical neck of the second molar.

2. Position of the long axis of impacted maxillary third molar in relation to the long axis of the second molar:

A. Vertical
B. Horizontal
C. Inverted
D. Mesioangular
E. Distoangular
F. Buccoversion
G. Lingoversion

3. Relationship with maxillary sinus

a. Sinus approximation--Thin portion of bone between impacted maxillary third molar and maxillary sinus.

b. No maxillary bone between maxillary sinus and impacted maxillary tooth.

FACTORS COMPLICATING

1. Present immediately within the vicinity of the roots of second molar.
2. Fusion with the roots of second molar.
3. Abnormal root curvature.
4. Proximity of the Zygomatic process.
5. Extreme bone density.
6. Difficult access to the operating site.

MAXILLARY CUSPIDS

CLASS I : Impacted cuspids located in palate.

1. Horizontal
2. Vertical
3. Semi Vertical

CLASS II : Impacted cuspids located in the labial or buccal surface of the maxilla

1. Horizontal
2. Vertical
3. Semi Vertical

CLASS III : Impacted cuspids located in both the palatine and maxillary bones.

CLASS IV : Impacted cuspids located in the alveolar process usually vertically between incision and first bicuspid.

CLASS V : Impacted cuspids in edentulous mouth.

FACTORS COMPLICATING THE TREATMENT

1. Fear of damaging the adjacent tooth since crown and root are in close proximity with the teeth.
2. Possibility of infection or root being forced into maxillary sinus due to its close proximity.
3. Most of the cuspids have hypercementosed roots.
4. Marked curvature of the roots.

POST OPERATIVE TREATMENT

1. Sockets should be cleaned and check for any tooth remnants.
2. Periphery of the socket should be trimmed and then smoothened.
3. Sutures should be placed properly to appose the tissue and cover the socket.
4. In case of excessive bleeding. Check for the bleeding site and apply gel foam.
5. Alternate hot and cold packs should be applied.
6. Possibility of swelling is always present and so is ecchymosis.
7. If pain develops in the socket then so called dry socket treatment must begin immediately.
8. Basic vitamin tablets should be given.
9. Sutures to be removed seventh day post operatively.

POST OPERATIVE COMPLICATIONS

1. Exposure of inferior dental canal.
2. Parasthesia.
3. Acute trismus.
4. Disruption of blood supply.
5. Fracture of a large section of alveolar process.
6. Traumatization or dislodgement of adjacent teeth.
7. Injury to the lips or cheeks due to traumatization.
8. Opening into maxillary sinus or tooth forced into the pterygopalatine fossa.
9. Dry Socket.
10. Extensive exposure of adjacent tooth resulting in premature loss.