IMPACTED TOOTH
Impaction comes from the Latin impactus, namely obstruction of tooth eruption caused by a physical obstacle or ectopic position. Impaction can include teeth that partially erupt or do not erupt at all and cannot achieve a normal relationship with other teeth (Malik, 2012). Surgery to remove impacted third molars is one of the most frequently performed procedures by an oral and maxillofacial surgeon. Odontectomy or surgical extraction is a method of removing a tooth from its socket after creating a flap and reducing part of the bone surrounding the tooth (Fragiskos, 2007).
According to Malik (2012), the causes of impaction can be divided into local and systemic causes. Local causes are:
- There are obstacles to eruption, which can be caused by irregular position and the presence of teeth that are in the way and the density of the bone above and around the teeth.
- Lack of space in the jaw arch, can be in the form of crowding or the presence of supernumerary teeth.
- Ankylosis of primary or permanent teeth
- Persistence of primary teeth.
- The tooth bud is in an ectopic position
- There is a lesion in the soft tissue or bone that prevents the tooth from erupting
Systemic causes are:
- Prenatal factors are hereditary
- Postnatal factors, for example rickets and malnutrition
- Disorders of the endocrine glands of the thyroid, parathyroid or pituitary gland such as hypothyroidism, achondroplasia, etc. where there is primary retention of the dentition due to a lack of osteoclastic activity so that bone resorption does not occur around the tooth germ.
- The presence of hereditary syndromes, for example cleidocranial dysostosis and cleft palate where there is a failure of the bone around the tooth bud to resorb and form a pathway for tooth eruption.
Indications for removing impacted teeth based on the Scottish Intercollegiate Guideline Network (SIGN, 2000) are:
- The third molar tooth that causes complaints, especially if there is an infection such as pericoronitis, cellulitis, abscess or pathology in the pulp or periapical which cannot be treated.
- There is caries in the third molar and the tooth is useless if treated or it causes caries in the second molar which cannot be treated before the third molar is removed.
- Pulpal and periapical lesions that cannot be treated.
- Part of the management and prevention of the development of periodontal disease due to the position of the third molars and their relationship to the second molars.
- Dentigerous cysts or other related oral pathologies such as ameloblastoma or keratocyst occur.
- External or internal resorption, either in the third molar, or in the second molar which is thought to be caused by the third molar.
- Ectopic position (malposition, supraposition, traumatic occlusion)
- Abnormalities in the size and shape of teeth that are not necessary for normal function
- Abnormalities in the field of orthodontics (for example teeth need to be removed to meet space requirements) and increased stability of dental occlusion.
- Need for orthognathic or reconstructive surgery.
- Fracture of the mandible where the tooth obstructs or is useless in a fracture splint.
- Facilitate prosthetic rehabilitation.
- Taken for preventive or prophylactic purposes in patients with certain medical or surgical conditions or treatments (eg bisphosphonate therapy, chemotherapy, radiotherapy).
- Clinically, a fracture was found in the tooth.
- The patient refuses non-surgical procedures to restore the condition of his teeth.
- The anatomical position of the teeth has the potential to cause damage to the surrounding teeth.
- The third molar tooth will be used as a donor tooth for a tooth transplant.
Contraindications for removing impacted teeth are:
- In patients where unerupted teeth are thought to be able to erupt fully and have a functional role.
- There is no history of local or systemic pathology related to impacted teeth.
- Conditions where the medical history means that removing impacted third molars carries a greater risk of harm than the benefits.
- If there is a clear increased risk of complications, for example the risk of mandibular fracture or permanent nerve damage
Referensi :
Fragiskos, 2007, Oral Surgery, W. B. Saunders Co, Philadelpia, pp 121-143.
Malik, NA., 2012. Text Book of Oral And Maxillofacial Surgery. 3rd ed, Jaypee Brothers Medical Publisher (P) Ltd. New Delhi. 106-117p
Scottish Intercollegiate Guideline Network, Management of Unerupted and Impacted Third Molar Teeth – SIGN 43, https://www.scottishdental.nhs.scot