Overview
Impacted teeth are those that fail to erupt into the oral cavity due to obstruction or lack of space, often requiring surgical intervention for removal 1.Diagnosis
Clinical Examination: Presence of toothache, swelling, or failure of tooth eruption 1.
Radiographic Imaging: Panoramic radiographs, CBCT scans to assess depth, angulation, and proximity to vital structures 1.
Grading: Utilize classification systems like Pell and Gregory or Winter classification to determine the complexity of impaction 1.Management
Surgical Extraction: Preferred method for impacted teeth, especially when anatomical challenges are present 1.
Conscious Sedation: Considered for patients with high anxiety levels to enhance comfort during surgery 1.
Dynamic Navigation System (DNS): Emerging technique for precise localization and minimally invasive extraction, particularly useful in complex cases 1.Special Populations
Pediatrics: Specific considerations for growth and development; conservative management may be preferred initially 1.
Elderly: Increased risk of complications; careful assessment of comorbidities and use of sedation as needed 1.Key Recommendations
Utilize dynamic navigation systems for extraction of deeply impacted teeth near critical structures to minimize surgical risks and enhance precision (Evidence: Weak 1).
Employ conscious sedation in patients with significant anxiety to improve surgical outcomes and patient comfort (Evidence: Expert opinion 1).
Conduct thorough pre-operative imaging, including CBCT, to accurately assess the position and relationship of impacted teeth with adjacent structures (Evidence: Moderate 1).References
1 Zhang Z, Huang G, Gong Z, Yang S. Dynamic Navigation System-assisted extraction of fully impacted mandibular second molars under conscious sedation: a case report and literature review. British dental journal 2026. link