Simple Extraction (Exodontia) PDF

Simple Extraction (Exodontia) Mohamed Mosleh Associate professor of oral and maxillofacial surgery Beni‐Suef university  Definition and Types 1‐Definition: The painless removal of the whole tooth or root with minimal trauma to the investing tissues so that the wound h...

Simple Extraction (Exodontia) Mohamed Mosleh Associate professor of oral and maxillofacial surgery Beni‐Suef university  Definition and Types 1‐Definition: The painless removal of the whole tooth or root with minimal trauma to the investing tissues so that the wound heals uneventfully and no post operative prosthetic problem is created. 2‐Types: A‐ Intra‐alveolar extraction or closed extraction or forceps extraction. B‐ Trans‐alveolar extraction or open extraction or surgical or flap extraction.  Indications 1‐ Severe caries( Non restorable tooth) 2‐Advanced periodontal diseases. 3‐Failure of Endodontic treatment( Calcified canal – broken file) 4‐Orthodontic purpose. 5‐Prothodontic purpose. 6‐Teeth in fracture line. 7‐Economically failure to preserve tooth. 8‐Supernumery teeth. 9‐Impacted teeth. 10 Malposed teeth.  Indications 11‐ Teeth with pathological lesions. 12‐Fractured teeth not amenable to restoration. 13‐Over retained deciduous teeth. 14‐Remaining roots. 15‐ Radiation therapy(Extraction before radiation to reduce the risk of osteonecrosis of the jaw) ‐Sequence of extraction: ‐upper teeth before lower teeth. ‐Posterior teeth before anterior teeth Severe caries(Non restorable tooth) Advanced periodontal diseases Failure of Endodontic treatment(Broken file) Orthodontic purpose Tooth in fracture line Supernumerary teeth Teeth in a pathological lesions Remaining roots Over retained deciduous teeth  Contraindications A‐ Local contraindication: 1‐Teeth located in a tumor area. 2‐Radiation therapy to the area(within 6 month to 1year) 3‐Severe pericoronitis. 4‐Central haemangioma(uncontrolled bleeding) B‐Systemic contraindication: 1‐Severe uncontrolled Diabetes mellitus and cardiac diseases 2‐Within 6 months of myocardial infarction 3‐Bleeding disorders (leukemia‐ haemophilia) 4‐Pregnancy (1st trimester‐3rd trimester) 5‐Uncontrolled hypertension.  Radiographic evaluation ‐Used to assess: 1‐Root number. 2‐Root configuration. 3‐Proximity to vital structures. 4‐Condition of the surrounding bone. 5‐External or internal root resorption. 6‐Wisdom teeth. 7‐Remaining root covered with gingiva. 8‐Retained deciduous. 9‐Badly decayed or restored tooth.  Patient position For maxillary extraction For mandibular of teeth : the chair extraction of teeth: the should be semi‐ supine chair should be in and maxillary occlusal upright position and plane is 45 degree with mandibular occlusal the floor. plane parallel to the floor  Operator position ‐For right handed operators: 1‐All maxillary teeth. 2‐Mandibular anterior teeth. 3‐Mandibular left posterior teeth. The operator stands in front and right to the patient(8 o’clock position) ‐Mandibular right posterior teeth : 11 o’ clock position. ‐For left handed operators: Stand to the left side of the patient at eight o’clock position except mandibular left posterior teeth at 11 o’clock. Operator position 8’oclock position(in 11 o’clock front) position( behind)  Role of the other hand 1‐Responsible for reflecting the soft tissues of the cheeks, lips and tongue to provide adequate visibility of the surgical field. 2‐ Stabilize the patient head during the extraction process. 3‐Support and stabilize the mandible when lower teeth are being extracted.  Role of the other hand Support for upper Support for lower right anterior teeth posterior teeth and lower anterior teeth  Role of other hand Support of the upper Support of lower left left posterior teeth posterior teeth  Mechanical principles used in teeth extraction 1‐Expansion of the bony socket. 2‐The use of fulcrum and lever. 3‐Insertion of wedge of wedges. 4‐Wheel and axel.  Expansion of the bony socket ‐Expansion of the bony socket by the use of the wedge‐shaped beaks of the forceps. ‐The forceps should be seated with strong apical pressure to expand crestal bone and displace the tooth in occlusal direction. ‐Sufficient tooth structure should be present. ‐The beaks should extend into the periodontal ligament space to grasp the root surface.  Expansion of the bony socket ‐The wedge principle is also used when a straight elevator is inserted into the periodontal ligament space to expand the socket  Expansion of the bony socket 1‐Buccal or labial: pressure applied to the tooth will expand the buccal cortical plate at the crestal bone with some lingual expansion at the apex. 2‐ Lingual or palatal: Pressure will expand lingual cortical plate at the crestal bone with some expansion of buccal bone at apical end.  Expansion of the bony socket ‐Buccal or labial movement is the initial movement of all teeth except the lower second and third molar where the buccal plate is reinforced by the external oblique ridge. ‐Rotation is the initial movement for extraction of upper central incisor and lower second premolar du to their conical root. ‐Waiting for few seconds after each application of force to tear the periodontal ligament and expand the socket.  Expansion of the bony socket The forceps beaks should be applied to the carious side first and movement made toward caries. ‐For malposed teeth the extraction will be in unusual direction. ‐The beaks of the forceps must be held parallel to the long axes of the tooth ‐Slow steady force.  The use of fulcrum and lever ‐Elevators are used as levers ‐They are wedged into the interdental space perpendicular to the tooth. ‐The tooth is elevated occlusally out of the socket with buccal bone used as a fulcrum.  The use of fulcrum and lever ‐Rotation of the elevator move the tooth in posterior direction causing expansion and tearing of the periodontal ligament. ‐This step is greater if the patient does not have a tooth posterior to the tooth being extracted or if the crown is broken down.  Wheel and axel ‐Used with triangular or pennant –shaped elevator ‐When one root of multiple rooted tooth is left in the alveolar process the tip of the elevator act as a wheel to engage and elevate the root. Requirements for good extraction 1‐Adequate access and visibility of the surgical field 2‐Easy pathway for the removal of the tooth. 3‐The use of controlled force to luxate and remove the tooth.  The five major motions to luxate the teeth 1‐ Apical pressure. 2‐Buccal pressure. 3‐Lingual pressure. 4‐Rotational pressure( upper central and lower second premolar) 5‐Tractional forces (to deliver the tooth) ‐Extraction of teeth is in labio ‐incisal or occluso‐ buccal direction. Steps for making closed extraction 1‐loosening of the soft tissue attachment from the tooth. 2‐Luxation of the tooth with dental elevator. 3‐Adaptation of the forceps to the tooth. 4‐Luxation of the tooth with forceps. 5‐Removal of the tooth from the socket.  Wound debridement 1‐ Inspection for any remaining root. 2‐Palpate sharp bony edges. 3‐Explore for pathologic lesions with curette. 4‐ Irrigation of the wound. 5‐ Squeeze the socket to restore normal contour.  Postoperative instructions 1‐ Bite on a pack for at least 1 hour. 2‐No spitting. 3‐No smoking for at least 2 days. 4‐No vigorous mouth rinsing. 5‐No straws in drinking. 6‐Soft cold diet on the other side. 7‐ Medications if needed. 8‐Ice packs. 9‐ Gargle with warm saline. 10‐Warm compress after one day to two days.