EXODONTIA
PAIN AND ANXIETY CONTROL PRESURGICAL MEDICAL ASSESSMENT . INDICATIONS FOR REMOVAL OF TEETH Severe Caries Pulpal Necrosis Severe Periodontal Disease Orthodontic Reasons Malopposed Teeth
Cracked Teeth Preradiation Therapy Teeth Involved in Jaw Fractures ?
Esthetics Preprosthetic Extraction Impacted Teeth Supernumerary Teeth Teeth Associated with Pathologic Lesions
Economics .
CONTRAINDICATIONS FOR THE REMOVAL Systemic Contraindications severe uncontrolled metabolic diseases. Brittle diabetes end-stage renal disease uncontrolled leukemias and lym-phomas nonfunctioning white cells &BLEEDING. inade-quate number of platelets unstable angina pectoris recent myocardial infarction INFECTION
severe uncontrolled cardiac diseases
severe uncontrolled hypertension persistent bleeding, acute myocardial insufficien-
cy, and cerebrovascular accidents stress caused by the extraction .
Pregnancy is a relative contraindication
first &last trimester. severe bleeding diathesis
Local Contraindications history of therapeutic radiation for cancer. osteoradionecrosis
Teeth that are located within malignant tumor disseminate cells , hasten the metastatic process
severe pericoronitis
acute dentoalveolar abscess ? It is abundantly clear from many prospective studies that the most rapid
resolution of an infection sec-ondary to pulpal necrosis is obtained when the tooth is removed as early as possible. Therefore acute infection i not a contraindication to extraction. If access and anesthesia considerations can be met, the tooth should be
removed as early as possible.
Access to Tooth Any limitation of mouth opening . cause of the reduction of opening infection (TMJ) dysfunction muscle fibrosis
location and position of the tooth to be extracted .
Mobility. less-than-normal mobility -hypercementosis or
ankylosis of the roots. Ankylosis -primary molars , nonvital teeth endodontic therapy many years before the extraction. Greater-than-normal mobility is frequently seen with severe periodontal disease
Condition of Crown presence of large caries or restorations fracture grasp the root portion of the tooth large accumulation of calculus, calculus may
contaminate the empty tooth socket .
assess the condition of the adjacent teeth. the surgeon should use elevators with extreme
caution,
RADIOGRAPHIC EXAMINATION OF TOOTH Relationship of Associated Vital Structures maxillary molars -be aware of the proximity of
the molars' roots to the floor of the maxillary sinus. mandibular molars impactedIAC mandibular premolar teeth close to mental foramen.
Configuration of Roots number of roots , curvature , degree of root divergence , hypercementosis,
size n shape of root. Root caries Root resorption
previous endodon-tic therapy. ankylosis,brittle.
Condition of Surrounding Bone Bone that is more radiolucent easy extraction. radiographically opaque difficult. apical pathology. -periapical radiolucencies
granulomas or cysts. should be removed at the time of surgery
PATIENT AND SURGEON PREPARATION universal precautions -surgical gloves, surgical
mask, and eyewear with side shields , surgical cap A sterile drape should be put across the patient's
chest to decrease the risk of contamination antiseptic mouth rinse,
CHAIR POSITION FOR FORCEPS EXTRACTION maxillary occlusal plane is at an angle of
about 60 degrees to the floor.
Extraction of mandibular teeth upright position when the mouth is opened widely, the
occlusal plane is parallel to the floor
MECHANICAL PRINCIPLES INVOLVED IN TOOTH EXTRACTION Lever principle Forceps,straight elevator.
long lever arm and a short effector arm.
Wedge principle tips of the forceps into the periodontal ligament space
to expand the bone and force the tooth out
wheel and axle principle. The handle then serves as the axle, and the tip of the
triangular elevator acts as a wheel and engages and elevates the tooth root from the socket .
Types of extraction Closed Simple. Foeceps tech.
Open Surgical Flap tech.
Fundamental principles of extraction adequate access and visualization of the field
of surgery an unimpeded pathway for the removal of the tooth. the use of controlled force to luxate and remove .
Closed extraction -5 steps. Loosening of soft tissue attachment from the
tooth. sharp end of the no. 9 periosteal elevator . ensure that profound anesthesia allows easy entrance of the beveled wedge tip of
the forceps beaks. allows the elevator to be placed directly onto alveolar bone, without crushing or injuring the gingival papilla.
Luxation of the tooth with a dental elevator . Expansion and dilation of the alveolar bone tearing of the periodon-tal ligament The straight elevator is inserted perpendicular to
the tooth into the interdental space, inferior portion of the blade rests on the alveolar bone and the superior, or occlusal, portion of the blade is turned toward the tooth being extracted . Strong, slow, forceful turning of the handle moves the tooth in a posterior direction Excessive forces can damage and even displace the teeth adjacent to those being extracted
Adaptation of the forceps to the tooth apical to the cervical line. The lingual beak is usually seated first and then
the buccal beak. confirm that the tips of the forceps beaks are beneath the soft tissue and not engaging an adjacent tooth . The beaks of the forceps must be held parallel to the long axis of the tooth . apply force with the shoulder and upper arm without any wrist pressure . Apicalbuccallingual(rotation)---traction.
Luxation of the tooth with the forceps The major portion of the force is direct-ed toward
the thinnest and therefore weakest bone . forces applied in the buccal and lingual directions should be slow, deliberate pressures and not jerky movements. force should be held for several seconds to allow the bone time to expand.
Removal of the tooth from the socket. Once the alveolar bone has expanded sufficiently
and the tooth has been luxated, a slight tractional force, usually direct-ed buccally, can be used.
Role of Opposite Hand reflecting the soft tissues of the cheeks, lips. supporting and stabilizing the lower jaw
when mandibular teeth are being extracted. provides tactile information to the operator concerning the expansion of the alveolar process during the luxation period
