Intra Alveolar Extraction 1 PDF

EXODONTIA TOOTH EXTRACTION  Painless removal of the whole tooth, or tooth root, from its socket with minimal trauma to the investing tissues, so that the wound heals properly and no postoperative prosthetic problem is created. - Geoffrey L.Howe ...

EXODONTIA TOOTH EXTRACTION  Painless removal of the whole tooth, or tooth root, from its socket with minimal trauma to the investing tissues, so that the wound heals properly and no postoperative prosthetic problem is created. - Geoffrey L.Howe  Indications & Contra-Indications of Extractions Indications Of Extraction: -Unrestorable carious tooth. -Pulp necrosis and irreversible pulpitis; untreatable by endodontic therapy, calcified root canal, patient refusal. Indications Of Extraction: -Severe periodontal disease; Bone loss, grade III mobility, furcation involvement. -Impacted teeth ;Mal-aligned, resorption of roots of adjacent teeth, failure of eruption Indications Of Extraction: Pathological lesions surrounding teeth; Tooth involved in jaw cyst with inadequate PDL support or excessive resorption of their roots or tooth involved by tumors of the jaw) Root Fragments Pre-radiation therapy ; prophylactic removal of teeth in the direct field of radiotherapy to the jaws to guard against OSTEORADIONECROSIS (ORN) that might develop upon tooth extraction in the future Indications Of Extraction: -Cracked and fractured tooth Tooth in fracture lines, pain, infection. -Mal-aligned teeth ; mal-positioning. Indications Of Extraction: Supernumerary teeth Orthodontic treatment ; Crowding, Space creation. (Maxillary and Mandibular 1st Pre-molar).  Indications Of Extraction: -Pre-prosthetic extraction ; Unsuitable abutments, interference with appliance. Before surgical procedures Focal sepsis Indications Of Extraction: Economical reason ; Unaffording patient. Esthetics Over-retained deciduous teeth -Lack of time ; Unavailability of time for other options. -Teeth traumatizing soft tissue, if other treatment will not prevent this trauma. Contraindications Of Extraction: MAY BE: Systemic Local  Local Contraindications: 1. Extraction done in an area of radiation may result in ORN. 2. Teeth in area of tumor, especially a malignant tumor, shouldn’t be extracted as this surgical procedure may lead to the spread of tumor cells. 3. Pericoronitis is not a contraindication to extraction unless a difficult surgical procedure is anticipated. If pericoronitis is mild and the tooth can be removed easily, then the procedure can be performed immediately. If severe, non-surgical treatment is 1st attempted by irrigation, AB and extraction of impinging maxillary tooth. 4. Acute dentoalveolar abcess, if an infection has progressed from the tooth into the bone, access and anesthesia become difficult. Therefore, if access and anesthesia considerations can be met, the tooth should be removed as early as possible, otherwise the infection is 1st treated with hydration, AB and I&D. 5. Acute oral infection such as ANUG due to extensive distribution, greater degree of systemic reaction and debilitation.  Local Contraindications Systemic Contraindications: 1. Severe uncontrolled metabolic situations such as:-uncontrolled diabetes and end stage of renal disease with uncontrolled uremia. 2. Leukemia and lymphoma, there is increased risk of infection & bleeding due to deficient blood platelets and infection due to non- functioning WBCs. 3. Severemyocardial ischemia such as recent myocardial infarction, uncontrolled severe hypertension due to persistent bleeding and acute myocardial insufficiency and CVA. 4. Bleeding disorders such as hemophilia and severe platelet disorders contraindicate tooth extraction unless the underlying coagulopathy is corrected by administration of either the coagulation factors or platelet transfusion. 5. Pregnancy : 1st and 3rd trimesters are better avoided. However, the latter part of the 1st trimester and the 1st month of the last trimester are as safe as the 2nd trimester for a routine uncomplicated extraction. 6. Drugs: steroids, chemotherapy, immunosupressive agents and anticoagulants PRE-OPERATIVE EVALUATION Pre-operative evaluation Clinical assessment Radiological assessment CLINICAL ASSESSMENT  Heavy restoration  Grossly decayed  Inclined/rotated  Firm/mobile  Supporting structures may be diseased or hypertrophied  Attrition  Non-vital teeth  Accessibility to tooth  INDICATIONS OF PREOPERATIVE RADIOGRAPHS  A history of difficult or attempted extraction.  Tooth which is abnormally resistant to forceps extraction.  Heavily restored or pulpless teeth.  If it has been decided to remove the tooth by dissection.  All mandibular 3rd molars, or misplaced canines. The root pattern of such teeth is often abnormal.  INDICATIONS OF PREOPERATIVE RADIOGRAPHS  Any teeth or roots in close relationship to either the maxillary antrum, inferior dental and mental nerves.  Any tooth affected by periodontal disease accompanied by some sclerosis of supporting bone.  Any tooth which has been subjected to trauma.  INDICATIONS OF PREOPERATIVE RADIOGRAPHS  An isolated maxillary molar, especially if it is unopposed & over erupted.  Any tooth with abnormal crown might indicate possibility of dilaceration, gemination or odontome.  Partially erupted or unerupted tooth  Retained root.  INDICATIONS OF PREOPERATIVE RADIOGRAPHS  Any condition which predisposes to dental or alveolar abnormality, e.g. a)Osteitis deformans- hypercementosis b)Cleido-cranial dysostosis- hooked roots c)Osteopetrosis-difficult extraction d)irradiated bone-osteonecrosis. RADIOGRAPHIC EVALUATION OF TOOTH FOR EXTRACTION REVEALS:  Relationship of associated vital structures.  Configuration of roots.  Condition of the surrounding bone.  Periapical pathologies. TYPES OF EXTRACTION TYPES OF EXTRACTION: INTRA- ALVEOLAR EXTRACTION TRANS- ALVEOLAR EXTRACTION TYPES OF EXTRACTION: CLOSED METHOD/FORCEPS EXTRACTION /INTRA-ALVEOLAR EXTRACTION-consists of removing the tooth or root by use of forceps or elevators or both. OPEN METHOD/ SURGICAL / TRANS- ALVEOLAR EXTRACTION -consists of dissecting the tooth or root from bony attachments by removal of some bone investing the tooth/roots, which are then delivered by use of elevators and/or forceps Biomechanics of Tooth Extraction  Appling displacing force to the tooth.  Expansion of the tooth socket.  Sectioning the tooth into parts.  Removal of bone. Thank You: