Classification of impacted teeth and its management in exodontia

Impacted Teeth:

Impacted teeth is the one whose eruption in dental arch is impeded by physical barrier within stipulated time. 

The order of impaction: 3rd molars> maxillary canine > mandibular premolars (2nd premolar most commonly) 

Management of Impaction

Surgical extraction of impacted tooth.

Indications for extraction for the extraction of impacted tooth

Following are the indications for the extraction

a) Periodontitis 

b) Odontogenic cyst or tumors 

c) Caries 

d) Pericorinitis 

e) Root resorption 

f) Jaw fractures 

Contraindications for extraction of impacted tooth 

a) Advanced age 

b) Medically compromised 

c) Damage to adjacent structures ( nerves and teeth ) 

 Classification System for Mandibular Third Molar Impactions

 1. Winter's classification

It is based on angulation of the long axis of the impacted third molar with respect to the long axis of the adjacent second molar.

1. Mesioangular impaction

2. Horizontal impaction

3. Vertical impaction

4. Distoangular impaction

The order is based on easiest extraction.

Mesioangular being the easiest to extract. 

Mesioangular > vertical > horizontal > distoangular 

Other angulations are buccal, lingual/palatal and transverse

2. Pell and Gregory classification

 It is based on relation to anterior border of ramus and occlusal plane.

 Following are the subclasses

Class 1: Impacted 3rd molar anterior to anterior body of ramus.

Class 2: It is posterior to ramus. 

Class 3: It is within ramus .

Class A: Occlusal plane of impacted mandibular 3rd molar is at occlusal plane of mandibular 2nd molar. 

Class B: It is in the middle  of occlusal and cervical third. 

Class C: It is at cervical level. 

Class 3 and C are difficult to extract and class 1 and A are easier to extract.