Detailed power point presentation on the topic Exodontia of oral and maxillofacial surgery

Provides a complete brief insight on concepts of Exodontia possible complications and everything related to it

1. Exodontia

2. Contents DEFINITION TECHNIQES OF DENTAL EXTRACTION INDICATIONS CONTRAINDICATIONS PRINCIPLES OF EXTRACTION COMPLICATION REFERENCE

3. Definition According to GEOFFREY L.HOWE –”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”.

4. TechNiques of dental extraction Intra-alveolar extraction/traditional/conventional extractiON. : Removal of a tooth/root by using specially designed dental forceps and elevators. It is also known as closed method of extraction. The procedure is also termed as simple extraction.

5. Transalveolar Extraction It is a minor surgical procedure performed for the the removal of impacted, unerupted teeth that includes through a surgical flap. It is known as open method for extraction:

6. Indications Severe Caries Severe periodontal disease Retained decidious teeth Supernumerary tEeth Malpositioned teeth Impacted teeth

7. 7 tooth in the fracture line 8 prophylactic extraction 9 for orthodontic treatment 10 For prosthetic purpose 11 supraerupted tooth 12 teeth causing chronic trauma to soft tissues 13 orthognathic surgical procedure

8. Contraindications Basically classified into; Systemic contraindications Local contraindications Which is further classified as relative and absolute contraindications. Relative contraindications : systemic or local conditions of the patient can be modified/improved by proper medication and following certain treatment protocols suggested by the physician. Absolute contraindications: i f ignored, then simple extraction may turn into fatal or life-threatening event for the patient.

9. Systemic contraindications Cvs diseases like Mi,coronary heart diseases Blood dyscrasias: Anemiea, leukemia Uncontrolled diabetes Nephritis Bleeding disorders- hemophilia Neurological disorders- epilepsy,stoke Respiratory system- asthma,copd, Jaundice,cirrhosis of liver

10. Physiologic contraindications Pregnancy : First and last trimester are more crucial period. 3rd week to 8th week during differentiation, all the drugs should be avoided for the potential risk. All dental invasive procedures should be avoided, unless severe infection warrants the emergency treatment. Extraction during menstruation period: Painful and stressful condition along with mood swings for many Women. High circulating estrogen levels may cause excessive bleeding. Extreme old age: Compromised body physiology as well as fragile physical and mental conditions should be handled with utmost care.

11. Absolute contraindications Pregnancy Within 6 months of myocardial infarction Teeth in the area of central hemangioma Site of malignant tumor Recent coronary artery bYpass surgery Uncontrolled hypertension Uncontrolled hyperthyroIdism Uncontrolled diabetiEs

12. Relative local Contraindications Acute generalized periodintitis Acute necrotizing ulcerative gingivitis Acute dentoalveolar abscess Acute cellulitis Acute pericoronitis

13. Principle of extraction Lever Principle Wedge principle Wheel and Axle Principle

14. Lever principle This is the most commonly used principle. The lever principle has three basic components: fulcrum, effort and load. In a lever of first class, the position of fulcrum is between the effort and the load. In this principle to gain a mechanical advantage, the effort arm on one side of the fulcrum should be longer than the load arm on the other side of the fulcrum. The force is transmitted at the long effort arm and a mechanical advantage is gained at the short load arm.

15. Application FORCEPS : The hinge of the forceps acts as a fulcrum while the two arms represent each component of the lever. The length of the handle in relation to the blade represents the mechanical advantage. ELEVATORS : The handle of the elevator represents the effort and the working end, which engages the tooth represents the load.

16. Wedge principle The wedge consists of two movable inclined planes with a base on one end and a blade on the other end, which overcomes a large resistance at right angles to the applied force. The effort is applied to the base of the plane and the resistance has its effect on the slant side

17. Application ELEVATORS : When luxating a tooth from its socket, a straight elevator is applied between the tooth and the bone to separate the attachment of the periodontal ligament from the bone. FORCEPS : The tip of the forceps is inserted in between the mucoperiosteum and surface of the tooth. When the beaks are inserted further, the mucoperiosteum gets displaced, the bony sockets are expanded.

18. Wheel and axile Principle Modified form of lever. The effort is applied to the circumference of wheel which turns the axle so as to raise the weight. Greater the diameter of the wheel, more is the mechanical advantage.

19. Application ELEVATORS : Crossbar elevators are used for removing the mandibular roots based on this principle. The working point of this elevator is engaged deep into the space between the tooth root and the bone and the handle is rotated. The root is removed from its socket by moving about a circumference of the circle FORCEPS : The beaks of the forceps are applied firmly on either side of the tooth and force is applied in the form of an arc. According to the principle, when the force is applied on the handle of the forceps it results in a bodily rotation of the tooth in the socket. This principle can be used separately or in conjunction with wedge or lever principle

20. Complications of extraction INTRAOPERATIVE COMPLICATIONS (IMMEDIATE): Failure to luxate/remove the tooth Fracture of a tooth, alveolus, mandible, maxillarytuberosity Displacement of root/tooth in facial space,maxillary sinus, lingual pouch Aspiration of a tooth/root Nerve injury h emorrhage-primary Temporomandibular joint (TMJ) dislocation

21. POSTOPERATIVE(DELAYED COMPLICATIO n) Hemorrhage: Reactionary, secondary Pain Dry socket Postoperative edema/ swelling HematomA InFectOn Trismus

22. LATE COMPLICATIONS Chronic osteomyelitis Nerve damage: Anesthesia/paresthesia Chronic pain SYSTEMIC COMPLICATIONS: Syncope, fits, respiratory obstruction, hyperventi lation, myocardial infarction, etc.