What is a dystopic and impacted wisdom tooth? Impacted teeth: what is this pathology and how to fix it What are impacted teeth

This article will tell you:

• what is an impacted tooth;
• what are the causes of tooth retention;
• how to recognize this problem and solve it.

An impacted tooth is a segment of the dentition that is fully formed, but not erupted or not completely erupted in the jaw. Impacted dental units differ from normal ones only in that they are not able to fully erupt outwards. Impacted segments can “get stuck” both in the soft tissues of the oral cavity and in the jaw bones. Very often, impacted teeth are also dystopic, which means that they occupy an incorrect position in a row of teeth.

An impacted tooth may not manifest itself in any way, and if it does not cause inconvenience, then there are no direct indications for surgical intervention. However, in most cases, the presence of a retinated tooth in a row is reported to its owner by pain and inflammation. In this regard, some dentists strongly recommend that an impacted tooth be removed immediately after its discovery.

In mild cases of retention, orthodontic treatment can be performed - moving the segment instead of removing it, as well as excising the hood over the tooth. The removal procedure is most relevant for problematic wisdom teeth, which are considered rudimentary, since they do not actively participate in grinding food and their presence in the mouth (or absence) is hardly noticeable. The remaining teeth, if they are not supernumerary, are necessary for a person, and they try to remove them as a last resort, when it is not possible to normalize their condition or location.

Segments of the dentition, whose eruption is considered problematic, often become the culprits of both minor and major dental troubles. For example, half-impacted segments often cause inflammation of the gingival hood that covers the dental tissues, and fully impacted segments put pressure on the roots of neighboring teeth, leading to displacement of the dental units. In general, the presence of impacted segments in the mouth can cause:

• formation of periodontal cysts;
• caries of adjacent teeth;
• pulpitis;
• periostitis;
• periodontitis;
• pericoronitis;
• purulent lymphadenitis;
• odontogenic sinusitis;
• inflammation of the trigeminal nerve;
• the appearance of an abscess;
• development of phlegmon;
• resorption of the roots of adjacent teeth;
• changes in the normal arrangement of teeth in a row (which entails additional problems with bite, chewing food, deviations in the work of the temporomandibular joint).

Types of tooth retention

An impacted tooth can be both milk and permanent, that is, this problem is observed not only in adults, but also in children. However, in most clinical cases, “eights” – absolutely “adult” teeth – are impacted. They grow later than the rest of the segments, and they do not always have enough space or “strength” to cut through the way they need. In second place in terms of tendency to retention are fangs.

There are several types of retention:

1. Depending on the degree of pathology, retention happens:

• complete (the segment is hidden in soft and bone tissues, not visible and not palpable or almost not palpable);
• partial (a small part of the crown of the segment is on the surface, but most of it is hidden from view).

2. Depending on the position of the crown and the root of the segment, retention occurs:

• vertical (the crown is even, but does not protrude to a sufficient level - it seems that the tooth is lower than the rest);
• horizontal (the segment grows perpendicular to the standard growth axis);
• angular or angular (the angle between the normal axis and the tooth is less than ninety degrees, the segment can be tilted back, forward, inward or to the cheek);
• reverse (the chewing surface of the segment is directed to the alveolar ridge, and the root - to the periodontium).

3. Retention may apply to:

• one tooth (unilateral pathology);
• two teeth (pathology affects two segments symmetrical to each other).

Why do teeth become impacted?

We have looked at what an impacted tooth is, but why do the teeth not erupt or do not erupt completely? The reasons for this anomaly may be different. The main factors contributing to tooth retinal include the following:

1. Unfortunate heredity, due to which retention is transmitted from generation to generation.
2. Early loss of milk segments of the dentition.
3. Delayed replacement of milk teeth with permanent ones.
4. Completely artificial feeding of the child.
5. Anomalies of bite and crowding of dental units.
6. The presence on the way of the erupting segment of supernumerary teeth.
7. Thickened walls of the dental sac surrounding the crown of an erupting tooth.
8. Incorrect arrangement of the rudiments of permanent segments in the jaw, in which the crown of the impacted unit is directed to the root of the adjacent tooth (most often this happens with "eights").
9. Severe infectious diseases.

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Symptoms of retention of the dental unit

It is easiest to recognize a partially impacted tooth - its crown peeks out of the gum in its rightful place or outside the dental arch. Around the not completely erupted dental unit, there is reddening of the soft tissue, swelling, with pressure on the tooth, pain occurs. If an inflammatory process occurs in the gum near the tooth, the body temperature may rise slightly, weakness and malaise may appear.

Fully impacted segments cannot be seen, and their presence is felt only if they provoke any dental disease or put pressure on the roots of adjacent teeth. Sometimes such teeth can still be felt by probing with a finger the area of ​​\u200b\u200bthe gums in which the segments are supposedly located. Of course, the absence of a tooth in its place can be seen with the naked eye. But to understand whether there is a dental unit in the jaw at all, radiography helps. Having taken a picture, the patient will know for sure whether there is an impacted segment in the jaw (for example, the germ of a wisdom tooth in the jaw with a high degree of probability may not exist at all if the person is already twenty-five years old and the tooth has not yet begun to erupt).

Impacted tooth - to remove or not to remove?

Extraction of impacted teeth is a common procedure, but its expediency depends on each individual clinical situation, and there cannot be a universal solution. Statistically, impacted segments are removed more often than left, but the decision to extract such teeth is due to one of the following reasons:

1. Anxiety that the impacted segment gives the patient (this may be discomfort when chewing, tooth pain due to stress, frequent swelling of the periodontal tissue).
2. Incorrect position of the impacted segment. Removal of an impacted dystopic tooth is performed in almost every case.
3. The presence of caries on a tooth that has not completely erupted, which can cause disease in neighboring segments.
4. The presence of an abscess, fistula or cyst in the area of ​​the problem segment.
5. The presence of pericoronitis (inflammation of the tissues covering the tooth).
6. High risk of an inflammatory process in the bone tissue.

The doctor and the patient should decide the fate of the impacted segment together. If the patient does not want to part with the tooth, and it does not interfere with him, then there is no need to remove it, but the patient must be aware of the possible consequences of the presence of an impacted unit in his jaw.

How is the impacted segment extracted?

Removal of impacted teeth is a complex surgical procedure. It can only be trusted by an experienced dentist-surgeon. The cost of removing an impacted tooth exceeds the cost of removing normally erupted teeth, and this fact must also be taken into account by the patient. After the operation, the patient has to deal with pain for some time, and there is a high probability of developing complications after the removal of impacted segments. To minimize all the troubles after surgery, the patient must follow dental recommendations and properly care for the oral cavity.

The operation of deleting an impacted segment proceeds according to the following plan:

1. Diagnosis of the problem and sanitation of the oral cavity. If necessary, a few days before the operation, the patient is prescribed vitamins and sedatives.
2. Anesthesia. Local or general anesthesia may be used.
3. Gingival incision and removal of soft tissue to expose bone. Work with gum tissue is carried out using a laser or a scalpel. If the doctor uses a laser, the gums tolerate the intervention better, but the cost of the procedure increases.
4. Preparation of bone tissue with a bur and opening access to the segment to be removed.
5. Extraction of the entire tooth unit using special forceps. In cases where the tooth cannot be removed immediately, the doctor has to saw it with a bur and remove it piece by piece.
6. Plastic surgery of hard/soft tissues, suturing (if necessary), treatment of the operated area with antiseptics and anti-inflammatory drugs.

Postoperative care

After tooth extraction, it is very important to provide proper oral care to prevent infection from entering the operated area and speed up the healing process of the wound. Dentists advise patients at first:

• do not drink, eat or smoke (in the first three to four hours after the operation);
• limit physical activity;
• do not expose the body to extreme temperatures;
• eat food with caution, refuse hard, too hot and cold food and do not chew on the operated side of the jaw;
• brush your teeth carefully, bypassing the operated area, do not rinse your mouth;
• Painkillers can be taken to relieve pain.

Where to find an experienced dentist in Kharkov?

Since only a highly qualified specialist in the field of dental surgery can remove an impacted tooth with a quality guarantee, if retention is suspected or after it has been diagnosed, the patient needs to look for a good doctor. In a big city with a huge number of dental institutions, an independent search for a doctor can take a long time. But it is not necessary to seek a specialist alone.

Your services are offered to you by the free information service "Guide to Dentistry", which exists in order to provide free and impartial assistance in choosing dentistry to each potential client of the Kharkov dental institution. To get advice, you need to call our service and state the essence of the matter.

The staff of the Guide to Dentistry will listen to you carefully and quickly select a trusted specialist and a worthy dental institution, where you can be provided with high-quality dental care in accordance with your needs and wishes.

Before answering the question - to remove or treat impacted and dystopic teeth, it is necessary to understand what it is, what threat it poses, how to diagnose, and whether it is possible to prevent this pathology.

What is retention

So, what does an impacted tooth mean? In dentistry, an impacted tooth is considered to be a tooth that has not erupted for various reasons, but has formed, remaining entirely in the jaw or partially hidden by the gum. Retention is divided into two types:

1. complete - the tooth has not erupted and is completely hidden inside the bone under the gum. It cannot be seen or felt,
2. partial - the tooth has not completely erupted and only a separate part of it looks out from under the gum.

The impacted elements deform the gums, provoke their inflammation, and adversely affect the process of chewing food. If the problem is not solved in time, an infection may develop that will harm other internal organs. Also, due to the significant load during chewing, the impacted tooth can break. In such cases, long-term treatment requiring significant material costs will be required.

What is dystopia

Dystopic is a tooth, the formation and growth of which occur with deviations. For example, it develops correctly, but grows in the wrong place, or, conversely, takes its place, but the growth angle is disturbed.

Based on these possible options, dystopic teeth may have the following disorders:

1. tilt left or right
2. change in the axis of growth,
3. violation of the position relative to the rest of the teeth in the row - they are literally "pressed" into the mouth or shifted forward, towards the lips or cheek.

Ignoring such a pathology can cause the formation of a malocclusion, which in turn will negatively affect the aesthetic appeal of a smile.

Important! Retention and dystopia can complement each other i.e. an abnormally growing tooth can be impacted and vice versa. It hurts, interferes, constantly disturbs the patient. The development of dual pathology is fraught with a serious threat to the health of not only the oral cavity, but also the body as a whole. By the way, it is most often found in the so-called wise "eights".

Causes of retention and dystopia

So why do these pathologies occur and can they be avoided? The causes of anomalies may be the following:

• genetic predisposition: the patient could inherit the structural features of the jaw,
• presence: they cut through quite late and most often combine both retention and dystopia at the same time. Eruption of "eights" can be difficult due to abnormalities in embryonic development (for example, with increased density of soft tissues),
• jaw injuries resulting from mechanical damage,
• bite anomalies: this may be, for example, the presence of supernumerary teeth - they are “superfluous” and take the place allotted by the main ones, which grow later. Due to bite defects, the load on the jaws increases, which can lead to their destruction, deep damage to the periodontal tissue and functional disorders of the temporomandibular joint,
• dental diseases: inflammatory processes in the mouth, premature loss or vice versa, the prolonged presence of milk teeth prevent the formation of a correct permanent bite,
• diseases: rickets, infectious and somatic disorders that have depleted the body and disrupted metabolism.

Important! Make sure that the diet contains coarse vegetable and animal fibers, hard vegetables and fruits. It was thanks to this that the jaws of our ancestors received the necessary load, as a result of which the risk of bone tissue atrophy and retention was excluded.

Symptoms and Diagnosis

Often, retention is asymptomatic and is only detected at the dentist's appointment. But it is not difficult to identify a semi-retinated tooth on its own, it can be detected by carefully feeling an excessively protruding gum. Partial cutting of the crown also indicates the presence of incomplete retention, as a result of which the mucosa can be systematically injured, edema appears on it, its shade changes, and the inflammatory process begins. To make a final diagnosis, you need to take an x-ray, and sometimes undergo a computed tomography.

Important! With retention, some patients complain of pain, including when chewing food, inconvenience when opening the mouth. Cervical caries, pulpitis, chronic periodontitis often appear on impacted teeth. Another sign is the formation of follicular cysts. They can suppurate and provoke sinusitis, abscesses, purulent-necrotic processes of the jaws.

Dystopia is detected by a dentist-therapist or orthodontist during the examination. However, the patient himself can notice it. This anomaly provokes the formation of malocclusion, leads to damage to the tongue, lips, cheeks. As a result of injury, ulcers form, pain is felt during meals. Complete oral hygiene becomes impossible, and poorly removed plaque and food debris serve as fertile ground for the development of caries.

What to do with "abnormal" teeth

Important! Even if you do not have obvious signs of retention or dystopia, the best prevention of complications will be annual check-ups at the dentist and x-rays, which will reveal hidden processes. After a thorough diagnosis of the disease, only a qualified specialist will prescribe the correct treatment and give recommendations for care.

Treatment is prescribed based on the characteristics of the clinical history of the individual patient, the results of x-ray examination. The tooth is saved if it does not pose a potential threat to health, and its presence is not fraught with consequences and does not cause concern. But most often, removal is indicated, especially for the lower teeth - in the event of inflammation, the likelihood of infection penetrating into the extensive structures of the bone tissue is greater here than in the upper jaw.

Abnormal elements of a smile are often removed, and various factors may be indications for removal: a delay in the change of milk teeth, the absence of physiological resorption of the roots, the presence of “extra” teeth, improper positioning, lack of space for growth, pronounced clinical symptoms, complications.

Removal is performed surgically. The operation is carried out in several stages. First, the patient is given local anesthesia, the gum is incised, opening the bone, a hole is drilled in it with a drill. Then the problematic unit is removed with tongs, the debris is removed. At the final stage, the bone protrusions are smoothed out, the hole is treated with a special solution and sutured.

Postoperative care

The period after surgery plays a significant role in the successful completion of treatment. Usually the patient receives recommendations that must be followed very carefully:

• within 3-4 hours after the operation, you can not eat, drink, smoke,
• during hygiene procedures, it is necessary to be especially careful and not get carried away with intense pressure, and even rinsing in the wound area,
• when chewing food, you need to use the healthy side: the food should be soft, not too cold or hot, so as not to injure the wound,
• in the first two days after the operation, physical activity should be limited.

Often a person does not pay attention to such smile defects, believing that they will not harm, or simply experiencing fear of visiting the dentist. But in most cases, a neglectful attitude to the problem is fraught with serious consequences: the development of bite pathologies, a disorder in the functioning of the digestive organs, and the threat of losing neighboring teeth. If you run it, it threatens to injure the tongue, cheeks and mucous membranes, which also explains why the gums become inflamed. The patient may develop defects in diction and asymmetry of the face, which causes problems in communication and establishing personal contacts.

To minimize the risk of complications, it is enough to monitor the condition of the jaw in children during its development, as well as timely treat emerging problems.

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When undergoing a planned comprehensive examination by a dentist, many patients are offered an x-ray of both jaws. Often, a surprise can be expected in the picture in the form of a tooth inside the jawbone. An impacted tooth - what is it, why does it appear and what are the reasons for the delay in its eruption? All this will be discussed in this article.

Impacted tooth - what is it?

How does teething normally occur?

The mechanism of the appearance of teeth in the oral cavity is a mysterious and complex process. Clear and reliably proven by research mechanisms of eruption have not yet been identified. There are only more or less true theories and hypotheses that consider individual factors that can play a role in eruption. This includes the pushing of the teeth during the successive development of the root, the tension of the collagen ligaments of the tooth, the pressure on the gums during chewing, and other factors.

One way or another, the rudiments of teeth, or follicles, are laid in the bone, which gradually increase, harden and turn into a full-fledged crown of the tooth, which moves towards the surface of the bone and gums. In this case, the bone is absorbed along the path of the retractable tooth and re-formed behind it. The gum before eruption slightly changes its composition, becomes denser and more elastic, and then locally atrophies due to the pressure of the tooth, making room for a new tooth.

When talking about proper teething, several criteria are implied.

What are impacted teeth?

The development of the tooth germ in the case of complete retention most often proceeds without deviations. This means that a full-fledged tooth is normally and correctly formed in the thickness of the bone. However, he is in no hurry to come to the surface due to the influence of extraneous factors. Such a tooth can linger for a couple of years, then barely hatch with one tubercle, or it can remain in the bone for life. However, the insidiousness of such teeth is that their position in the bone is not always beneficial for neighboring ones. Attempts by impacted teeth to erupt can lead to inflammation and constant pain in the jaw area.

Which teeth are most likely to be impacted?

Since milk teeth are much smaller than permanent teeth, and the child's jaw is constantly growing, teething difficulties in children are relatively rare. Therefore, retention is more characteristic of permanent occlusion. It is logical that the most difficult to erupt are those teeth that stand in the dentition later than the others - fangs, second small molars and wisdom teeth. After most of the teeth have erupted, it is already difficult for them to find a free place, especially when there is disharmony in the size of the teeth and jaws and a bite shift.

Table. What are the types of retention.

What are the reasons for the development of retention?

On average, each person should have a set of 28 teeth by the age of majority. The next 2-3 years are expected to erupt the latest four teeth - the upper and lower wisdom teeth. However, evolutionarily it so happened that human jaws become smaller with each generation, since our food is mostly easy to digest and chew. The transition to soft and high-carb foods allowed the volume of the human brain to increase, and the mass of the jaw bones to decrease, which made it possible to leave the load on the spine unchanged.

However, the number of teeth in many people is still "old" and all teeth cannot erupt on a reduced jaw. This is often associated with tooth retention.

Another reason for retention is any malocclusion that has appeared in a person since birth or is associated with childhood bad habits. In this case, the position of the teeth changes, there is crowding or gaps between the teeth, which prevents new teeth from erupting in the right places.

Relatively rare, but occurring causes of retention include the presence of "extra" or supernumerary teeth. Their appearance is often due to heredity. Such teeth are defective in shape and location and are almost always removed, as they do not have proper antagonists, violate the position of neighboring teeth and make cleaning difficult.

In some cases, the cause of retention may be the initial misangulation of the tooth. For this reason, upper canines that have taken a position perpendicular or inclined to the normal axis of eruption may not erupt. The table above lists many options for the position of the tooth inside the bone, which cannot be predicted. However, only a strictly vertical position can ultimately lead to a full eruption of the tooth.

Retention of any permanent tooth can be caused by belated loss of the milk antecedent. If the temporary tooth does not fall out for one reason or another (this may be due to complications of caries, trauma or genetic characteristics), the place of the permanent one will be occupied and it will not be able to erupt.

How to identify the symptoms of retention?

Despite the fact that tooth retention occurs quite often, for many it does not manifest itself in any way during life. The discovery of a completely hidden tooth in this situation will occur by chance when performing a full x-ray of the jaws.

However, asymptomatic course is not always possible. First of all, the suspicion of a “hidden” insidious wisdom tooth may appear when the rest of the teeth begin to move forward for no apparent reason. This occurs when the third chewing tooth is tilted towards the second and presses on it, causing displacement. Eventually, crowding will also occur in the anterior region, disrupting the aesthetics of a once even smile. In some cases, a similar tilt of the third molar causes local resorption of the roots of the adjacent tooth, which can eventually lead to mobility and removal of both chewing teeth.

Often one of the leading complaints in patients with partially erupted teeth is bad breath. This symptom is due to the fact that the crown of the tooth is partially covered by the gum, which prevents the patient from thoroughly cleaning the tooth. In this regard, plaque continues to accumulate, caries and tartar develop, and hence the fetid odor from the oral cavity.

The accumulation of plaque on the tubercles of a semi-retained tooth leads not only to halitosis, but also to local inflammation of the gums. With the passage of time and the exacerbation of the process, a purulent discharge may even appear, and therefore, immediate surgical treatment will be required. With a running purulent process, there will be a limited opening of the mouth, a sharp pain, the inability to eat normally or even brush your teeth.

In some cases, the location of the tooth in the bone is such that, with one part or another, it presses the nerves and vessels passing nearby. In turn, this can lead to constant pain in the jaw, persistent headaches and a decrease in overall well-being.

It is possible to visually determine the presence of an impacted tooth when it has come out of the bone, but is completely or partially hidden by the gum. In the place of potential eruption, the gum will have a swollen appearance, differ in a red tint and be especially sensitive. Semi-retention is easier to determine, because part of the tooth crown will be visible.

Often, with difficult eruption of canines and third molars, pain appears in the lymph nodes of the head and neck. They can also be felt on their own in the form of small swollen "bumps" under the jaw or in the neck.

Undoubtedly, the best assistant in the accurate diagnosis was and remains an x-ray. It can be made in a flat form to obtain an overall overview picture. However, if an operation is planned to remove or expose an impacted tooth, a three-dimensional image taken using computed tomography will be required.

How to treat impacted teeth?

In the event that the tooth has a vertical slope, does not cause discomfort, does not cause displacement of adjacent teeth, and is not noticeable at all in the oral cavity, treatment may not be required. With teeth hidden in the jaw, you can live your whole life and they will not affect your health in any way if they do not start to move.

In the event of pain from the eruption of an impacted tooth or an exacerbation of inflammation around the tooth, it is permissible to take one painkiller tablet and, as soon as possible, contact a dentist to plan an extraction operation.

Third molars have no functional value if they do not have enough space for the correct location in the dentition. The problem is also the fact that these teeth often do not have an upper or lower neighbor. This means that they do not take part in chewing and are in the oral cavity without a purpose, while accumulating a thickness of plaque and caries on their surface. It is extremely difficult to clean these deeply located teeth, which, again, contributes to the accumulation of infection and inflammation not only in the tooth, but also on the gum. Treatment of the canals (nerves) of such teeth is also practically impossible due to the fact that the endodontic instrument simply does not reach the tooth for proper and complete therapy. In connection with all these facts, semi-impacted or mispositioned third molars in most cases serve as candidates for extraction.

A different tactic is used in case of canine retention. This problem is somewhat rarer than difficulty in eruption of third molars. The approach to treatment is changing due to the fact that the absence of fangs is not the norm and dramatically distorts the harmony of the smile, giving the impression that something is wrong with it. Often, to correct the situation, one has to resort not only to the help of a dental surgeon, but also to the help of an orthodontist.

In cases where the canine is located vertically or its slope is insignificant, the so-called exposure of the crowns of the canines through a surgical operation is possible. Further, a bracket system is fixed on all teeth, including fangs, and the teeth are pulled into the correct position. Before such a manipulation, space is made for displaced fangs. If the canines are perpendicular and cause resorption of the roots of adjacent incisors, they are most often removed in a similar way to impacted wisdom teeth.

When is the best time to remove an impacted tooth?

The ideal time to have third molars removed is before the age of 20. At this time, the root of the impacted tooth has not yet formed, which greatly facilitates the procedure for its removal from the bone. It will also greatly facilitate the healing and recovery period after surgery. Severe operations to remove horizontal wisdom teeth can be complicated by large swelling, difficulty in swallowing, eating, speaking and opening the mouth. Removal of teeth at a later age is also complicated due to the coarsening of the bone structure and increasing its fragility. In some cases, even fractures are possible during an operation of this kind at the wrong age.

What complications can arise from impacted teeth?

With a long absence of treatment of an impacted or semi-impacted tooth, a number of complications can develop:

• abscess, suppuration in the area of ​​the wisdom tooth;
• chronic discomfort and pain in the mouth;
• the spread of the infection;
• caries of adjacent teeth due to the accumulation of plaque on a partially gummed tooth;
• violations of occlusion (occlusion), smile disharmony, crowding in the lateral / anterior part of the dentition;
• food and plaque stuck in the area of ​​semi-retained teeth, which provokes inflammation of the gums;
• periodontal disease, the formation of periodontal pockets and suppuration from the gums;
• damage to the nerve of the lower jaw when the wisdom tooth is close to the canal in which this nerve is located; manifests itself in the form of bouts of unbearable pain.

A separate list of complications can occur when teeth are not erupted - from edema to a jaw fracture. Therefore, the removal of such teeth should not be shelved, it is better to get rid of annoying teeth at a young age, especially when the chances of their successful eruption are close to zero (dense arrangement of teeth, malocclusion, small jaw).

To avoid complications during the third molar extraction operation, follow all the instructions of the doctor, and also perform a volume x-ray on a CT scanner so that the dental surgeon can more accurately determine the location of the tooth, choose a convenient access and save you the tooth without consequences.

Video - Extraction of impacted teeth of the lower jaw

- a tooth fully formed in the jaw, but not erupted (or partially erupted) outwards. In some cases, impacted and semi-retinated teeth do not manifest themselves in any way; in others, they cause pain, inflammatory processes (pericoronitis, periodontitis, periostitis, abscess, phlegmon), combined with dystopia. The presence of impacted teeth in the oral cavity is detected using targeted radiography and orthopantomography. Depending on the clinical situation, tactics in relation to impacted teeth may be different (excision of the "hood" in pericoronitis, removal of an impacted tooth, orthodontic movement, etc.).

General information

An impacted tooth is a difficulty in the full eruption of a tooth located in the jawbone or covered by the gum. Retention is a common anomaly of teething. According to statistics, the most frequently impacted are the lower and upper third molars (wisdom teeth), the canines of the upper jaw and the second premolars of the lower jaw. At the same time, non-cut "eights" are found in 35-45% of cases. The treatment of impacted teeth is a complex and urgent problem of modern surgical dentistry and orthodontics.

Causes of tooth retention

The presence of impacted teeth may be due to embryological features. Teeth may remain impacted due to excessively thick walls of the dental sac around the crown of an erupting tooth, dense gingival tissue, and weak growth force. These circumstances prevent the full eruption of the tooth, as a result of which it remains impacted or semi-impacted.

The embryological prerequisites for retention should also include the incorrect position of the axis of the tooth germ, leading to its collision with the adjacent, previously erupted tooth. In this case, it is more correct to speak not of an impacted, but of an impacted tooth - that is, a tooth whose eruption is impaired due to an obstacle from the neighboring tooth, and the result of which was retention.

There is a theory that in the process of evolutionary development, due to the reduction in the human diet of coarse animal and vegetable food, and, consequently, less chewing load, there is a reduction in the jaws due to a decrease in the distal alveolar bone. This leads to a lack of space for the teeth that erupt later than the others (in particular, for wisdom teeth), and can cause their retention.

Risk factors

Risk factors that increase the likelihood of impacted teeth may include:

• genetic predisposition
• early loss or removal of milk teeth
• the presence of supernumerary teeth
• developmental anomalies of the jaws
• bad food,
• general infectious exhaustion and somatic weakness of the body, etc.

Classification

Depending on the degree, full and partial retention and, accordingly, impacted and semi-impacted teeth are distinguished. An impacted tooth is completely covered by gum or bone tissue, is not visible in the oral cavity and is not accessible for palpation. The crown part of the semi-impacted tooth is partially cut through, but most of it remains covered by gum tissues. Taking into account the depth of occurrence, impacted teeth are distinguished with tissue immersion (the tooth is located in the gum tissues) and bone immersion (the tooth is located in the jawbone).

The position of the root and crown of an impacted tooth in the gum or bone can be:

• vertical- the axis of the tooth has a normal position, coinciding with the vertical line;
• horizontal- the axis of the tooth forms a right angle with the vertical; while the position of the tooth can be transverse, sagittal or oblique;
• angular (angular)- the axis of the tooth forms an angle with the vertical, less than 90°. Depending on the inclination, there are medial-angular (with an inclination forward), distal-angular (with an inclination back), lingual-angular (with an inward inclination, towards the tongue) and buccal-angular (with an outward inclination, towards the cheek) position.

It is extremely rare to find reverse impacted teeth (usually the lower eights), in which the roots are turned towards the alveolar margin, and the crown is towards the body of the jaw. Retention of teeth can be unilateral or bilateral, symmetrical. Both milk and permanent teeth can be impacted.

Symptoms of tooth retention

A semi-retinated tooth declares itself as a partial eruption of the crown in any part of the dentition. As a result of constant injury to the mucous membrane adjacent to the erupting part of the crown, it becomes edematous and hyperemic. With inflammation of the surrounding tissues of the gums, a clinic of gingivitis or pericoronitis develops.

Impacted teeth are often asymptomatic and are incidental radiological findings. An objective sign of tooth retention is its absence in the alveolar arch. An impacted tooth with tissue immersion may be defined as gingival protrusion; in this case, during palpation, its contours or individual parts are determined.

With the pressure of an impacted tooth on neighboring teeth, their displacement and resorption of the roots may occur; subjective complaints include discomfort and soreness when chewing food, opening the mouth. At the point of contact of the impacted tooth with the erupted tooth, cervical caries, pulpitis or chronic apical periodontitis often develop. When the nerve fibers and endings are irritated, pain occurs in the area of ​​​​an unerupted tooth, paresthesia, caused by neuralgia or trigeminal neuritis.

In the area of ​​impacted teeth, follicular cysts are often formed, which can be suppurated, complicated by purulent periostitis, pericystic osteomyelitis of the jaw, purulent sinusitis, abscess, phlegmon. Inflammatory complications are accompanied by fever, general malaise.

Diagnostics

Diagnosis of a semi-retinated tooth is not difficult: during a dental examination, the top of the tooth is detected above the gum, the contours of the tooth are determined by palpation, the crown is detected by probing. An impacted tooth can only be reliably detected by spot radiography or orthopantomography; in some cases, computed tomography is required. A semi-retinated tooth with deposits of plaque or tartar may be mistaken for a tooth root affected by caries.

Treatment of tooth retention

The decision on tactics in relation to an impacted tooth should be made carefully, based on the individual clinical situation and radiological data. Often, specialists of various specializations, such as dental surgeons and orthodontists, are involved in the treatment of impacted teeth.

With a delay in the change of temporary teeth and the absence of physiological resorption of the roots, their removal is indicated. If supernumerary teeth are the cause of retention, they are also subject to extraction. In the case of the development of pericoronitis, its surgical treatment is carried out - excision of the mucous flap ("hood") in the area of ​​the impacted tooth under local infiltration anesthesia.

Surgery

Orthodontic treatment

In the absence of direct indications for the removal of an impacted tooth and there is free space for it in the dentition, the first stage is surgical treatment - excision of the gum or part of the bone, and then orthodontic treatment - moving the tooth to the correct position using braces or buttons.

Forecast and prevention

An impacted tooth is a potential source of serious complications: the formation of a periodontal cyst, the development of caries, pulpitis, periodontitis, ulcerative stomatitis, pericoronitis, periostitis, osteomyelitis, abscess, phlegmon, purulent lymphadenitis, odontogenic sinusitis, etc. In this regard, impacted teeth require mandatory treatment of the most in a suitable way. Impacted teeth can be used as autografts in the restoration of the dentition.

To date, methods for preventing tooth retention are not known. The general principles of prevention include monitoring the correct development of the child's jaws, the timing of teething, timely orthodontic treatment.

A dystopian tooth is a tooth that is incorrectly located or displaced in the dentition.

Such a tooth is dangerous because it can put pressure on the dentition, which will eventually lead to the inclination of all teeth and malocclusion. It is difficult to imagine, but it happens that the teeth are even perpendicular to the normal direction of tooth growth.

An impacted tooth is a tooth that has not erupted, which, due to some circumstances, it did not come out and remained completely or partially hidden by the gum or bone.

Impacted teeth not only deform the gums and spoil the appearance of the dentition, but also affect the chewing function, preventing the normal chewing of food. Most often these are the so-called "wisdom teeth". Many patients have already had to remove their wisdom teeth, including for this reason.

Retention that slows down teething can be:

• partial in which the tooth appears above the surface of the gums only partially. Most often, only the upper part is visible;
• complete, in which the tooth is completely hidden by bone tissue or mucous membrane.

A dystopian tooth is a tooth that is placed incorrectly in the dentition. He may not grow up in the place where he should have been. It grows at the wrong angle, perhaps even turned around its own axis. It affects the condition of the others, affecting their inclination and breaking the bite, which greatly spoils the smile. Very often there are people whose teeth have both of these flaws.

Why "wisdom teeth" do not grow correctly

Wisdom teeth, or the outermost teeth in a row, usually erupt between the ages of 18 and 25. And they grow, as a rule, with serious violations.

Only the lucky ones can boast of even and straight grown “eights”. Retention and dystopia become frequent problems of wisdom teeth, in most cases even both ailments at once.

The incorrect growth of wisdom teeth is explained by the fact that, firstly, they grow in adulthood, when the bone tissue is fully formed, it is very dense and hard - naturally, it is incredibly difficult to “break through” it. Secondly, modern man does not need eighth teeth - our ancestors used them to chew raw meat. Wisdom teeth do not even have guides - milk teeth, so they have to make their own path in hard bone.

To identify the pathology of the development of the "eighth" tooth, it is necessary to make an x-ray or computed tomography. After detecting retention or dystopia, you should immediately consult a doctor. He will decide whether something can be done to save the tooth, or whether it is necessary to remove the impacted wisdom tooth, because the consequences, if nothing is done, may not be the most pleasant.

Pathologies of tooth development can cause:

• malocclusion;
• inflammation of the gums;
• injury to the mucosa, cheeks and tongue;
• infection of the maxillary sinus;
• swelling of muscle tissue.

Indications and contraindications for the removal operation

In most cases, removing an impacted or dystopic tooth is the only way to avoid further complications.

In particular, among the indications for surgical intervention:

• pain in the area of ​​the tooth, swelling of the gums;
• numbness of the face due to the pressure exerted by the impacted tooth on the nerve endings;
• high risk of changing the position of the teeth adjacent to the dystopian;
• the need to carry out a prosthetic procedure, which interferes with the problem tooth;
• retention-induced osteomyelitis or periostitis,
• chronic pulpitis or periodontitis;
• orthodontic treatment requiring extra space in the jaw.

Even a healthy impacted wisdom tooth can be removed if the “seven” adjacent to it is affected by a carious process. This is done so that the dentist can fully process the carious cavity.

Contraindications for the removal of impacted and dystopic teeth include:

• severe general condition;
• hypertensive crisis;
• exacerbation of nervous diseases;
• acute forms of heart disease;
• the advanced stage of diseases of a viral or infectious nature;
• blood diseases;
• the last days before the start of menstruation;
• the first 2 weeks after the abortion.

Pregnant women should be careful about dental procedures. It is recommended to remove an impacted wisdom tooth in the second trimester or at the very beginning of the third.

Removal of an impacted tooth

Extraction of an impacted tooth is a fairly common surgical operation.

An impacted tooth is a tooth that cannot erupt on its own, and therefore cannot be placed in the right place, therefore it remains inside the bone or is located under the mucous membrane. Most often, the removal of an impacted tooth is the removal of a wisdom tooth.

The reason for the appearance of such a tooth may be the early removal of milk teeth or the incorrect location of the molars, which shift the entire row and do not leave room for the growth of a new tooth. In all cases, the extraction of an impacted tooth is the most effective way to restore beauty and health to a smile.

Since the impacted tooth is located incorrectly, its removal is a complex procedure that requires high qualifications. To remove an impacted tooth, the doctor cuts the mucous membrane, and then drills through the bone tissue with a burr so that the tooth itself can be removed. Sometimes it is necessary to divide the tooth into parts if it reaches a large size.

After the operation, the doctor places a medicine in the hole that has formed, which speeds up healing and relieves pain. In rare cases, the doctor sews up the resulting hole, this is done if it was large enough.

The extraction of an impacted tooth sometimes takes up to three hours - it depends on the size and location of the tooth being removed. Sometimes patients develop swelling in the place that the doctor drilled with a burr, this lasts from 1 to 5 days. Also, patients may experience pain after surgery to remove an impacted tooth, but in this case, the doctor prescribes local anesthetics. The next day after the procedure, the patient needs to visit a doctor.

There is an opinion that an operation to remove an impacted tooth is not necessary if it does not cause concern.

But such a tooth is often the cause of infection, which eventually leads to caries, periodontitis, pericoronitis and other more dangerous diseases.

Extraction of a dystopic tooth

A dystopian is a tooth that is incorrectly located or displaced in a row.

Removal of a dystopic tooth is a necessary procedure that avoids pressure on the remaining teeth, and therefore prevents the tilt of all teeth or the formation of a malocclusion. Also, an operation to remove a dystopic tooth helps to avoid such complications as soft tissue injury. Canines, incisors and wisdom teeth can be dystopian.

The reason for such an anomaly is the incorrect position of the tooth germ, which has a genetic or embryonic origin, as well as the influence of external factors.

The removal of a dystopic tooth is not addressed immediately, most often dentists try to avoid surgery with the help of orthodontic treatment. But if the patient is over 15 years old, then usually it does not give results, so you have to resort to removal.

The removal of a dystopic tooth is a very complicated surgical operation, since the location of such a tooth is atypical. To be sure of the quality of the procedure, you should contact qualified specialists working with new equipment.