Surgical Exodontia Overview

Study Notes

Surgical exodontia is a specialized procedure for removing teeth that are challenging to extract using standard techniques.
Techniques are categorized into closed and open.
Excessive force during forceps extraction can damage bone and the tooth itself.
Atraumatic extraction is essential, avoiding excessive force.
The open technique is sometimes less traumatic.

These types of teeth require surgical procedures for proper extraction.
X-ray images (radiographs) demonstrate their position relative to the surrounding bone and teeth.

Teeth close to the sinus floor increase the risk of fracture and sinus perforation.

Constant grinding or clenching can give teeth denser bone and stronger periodontal ligaments, making extraction more difficult.

Large cavities or fillings in teeth can weaken teeth, creating a need for more careful extraction.

Evaluating bone density, especially the buccal cortical plate, helps determine extraction method.
Dense or thick bone may require surgical extraction.

Carefully choosing open extraction can sometimes reduce complications during procedure.

Choosing the correct technique for tooth extraction minimizes trauma.
Incorrect techniques commonly cause trauma and lengthen the extraction procedure.

Three key elements determine the success of extractions: appropriate access to the tooth, a clear access channel for extracting the tooth, and appropriately controlled force for removing the tooth.

Properly designed mucoperiosteal flaps protect vital oral structures while facilitating tooth extraction.
Flaps need to be full thickness, covering mucosa, submucosa, and periosteum.
Adequate sizing with a broad base on intact bone is essential.

Envelope Flap: A crevicular incision without releasing incision.
Triangular Flap: Single vertical incision, often used when greater exposure is needed.
Trapezoidal Flap: Multiple releasing incisions creating four corners, providing significant access.
Semilunar Flap: To access root apices, the incision avoids the marginal attached gingiva
The Y-incision is useful in palatal torus removal.
Pedicle Flap
This has mobility and can be rotated to fill an area with a soft tissue defect.

Avoid crossing canine eminences, as this increase risk of wound dehiscence.
Appropriate flap design prevents damage to important structures.
Flaps must not damage lingual or mental nerves when placed on the mandible.
Maxillary alveolar process procedures do not commonly damage nerves or arteries.
Surgical procedures require careful consideration of blood supply to the hard and soft palate, nasopalatine nerves and vessels.

Instruments for incision and flap reflection include scalpels (various blade types).
Handheld devices used for separating soft tissue and bone, including periosteal elevators, and cheek or tongue retractors to maintain a field of clear visualization.
Retractors, including Austin, Weider, and Minnesota models, help to hold the cheek or tongue away from the surgical area, providing a view for the procedure.