Tooth Extraction

• Involves removing the entire tooth
• Some extractions need minimal elevation
• Some extractions need gingival incisions and surgical removal of bone

Indications for extractions

• Periodontal Disease
• Tooth Resorption
• Fractures
• Endodontic/Periapical Disease
• Caries
• Persistent Deciduous Teeth
• Malocclusion
• Supernumerary Teeth
• Non-Functional Malformed Teeth
• Unerupted Teeth
• Fractured/Retained roots
• Teeth Involved in Osteomyelitis & Necrosis
• Traumatically Avulsed Teeth
• Better to Extract than leave a pathology untreated

Patient Preparation

• Secure airway and prevent unnecessary strain on jaw
• Ideally, extractions are performed in a clean mouth
• Peri-operative antibiotics may be required, veterinarian decides
• Analgesia is always necessary
• Pre-extraction radiographs are needed, the vet may modify technique

Key factors for successful extractions include

• Anatomy knowledge
• Having the right equipment
• Skilled operator
• Proper techniques
• Patience

Instruments for Extractions

• Elevator is thicker than a luxator, curved blades & designed to wrap around the tooth to be extracted
• Periosteal Elevator instruments used to elevate the gingiva off the bone
• Root Tip Pick is thin and pointed for retrieving root fragments
• Luxator is used for cutting periodontal ligament & expanding the sulcus (socket)
• Luxators are not used for elevation or leverage
• Luxators have a fairly thin, flat blade as compared to the curved thicker blade of the elevator
• All tools held with a short stop grip, for control & patient safety
• Autoclaving can dull instruments and can weaken the metal of instruments

High Speed Handpiece

• Burs are inserted into the tip, used in tooth extraction or endodontics
• Air Driven, water can be turned on or off
• Most burs are friction gripped but also can be right angled
• SL = Surgical Length – shaft is shorter
• L = long - shaft is longer

Burr Description & Uses

• Round (1/4, ½, 1, 2, 4 & 6) burs are general purpose, used for root canal, cavity prep and cutting small teeth
• Used for burring away alveolar bone, lots of smoothing
• Fissure Crosscut (500's – 700's) are some of the best all round burs and are slightly tapered
• Used for cutting top and sides, root canals, cutting teeth and cavity prep
• Inverted (30's) burs, the higher the # is, the larger the bur, undercutting cavity prep, wider at tip than shank
• Pear (320's, 330's) are a cross between round, crosscut & inverted, round cutting tip, sides and slight taper for undercutting, all purpose for cavity prep
• Diamond burs are for crown prep, wide range of shapes & coarseness, round diamond good for smoothing alveolar bone (fine grit sandpaper)

Extraction Techniques

• X = Simple Extraction
• XS = Sectioned Extraction
• XSS = Surgical Extraction

Possible Complications

• Profuse hemorrhage (roll gauze onto site and off, preserves clot that formed)
• Dry Socket (Alveolar Osteitis) – always suture sockets!
• Food can get stuck which causes bacterial growth
• Flush sulcus, ensure bleeding before suturing with 3.0-5.0 Monocryl, tension free sutures
• Retained roots
• Trauma

Post-Op Care is Vital

• Post-Op Radiographs may be needed! There may be shards left behind – pathology missed
• Pain management
• Feeding instructions should be soft food only for 7-14 days

Client Education

• Educate on bloody discharge
• Educate on sutures
• Educate to do rechecks - make sure
• Neoplasia and infection could be the reason for an extraction site that doesn't heal

Sharpening Elevators

• Use Acrylic Stick test used to see if sharpening is required
• Blunt off end
• Sharpen, back of instrument on stone (30 degree angle)

Overview of tooth extractions, including indications. This includes periodontal disease, tooth resorption, fractures, endodontic/periapical disease and caries. Radiographs are needed before extractions and analgesia is always necessary.