Exodontia

Exodontia, Extraction, tooth Extraction, Indications of Extraction, Contraindications of Extraction, principles of elevators, principles of forceps, dry socket, complications of extraction, movement for extraction, haemorrhage, stobie's technique, maxilla, mandible, upper canine, lower canine, upper pemolar, lower premolar

1. Dr. Ashish Kr. Kushwaha Maxillofacial Surgeon SBB Dental College EXODONTIA

2. EXTRACTION - Is defined as the painless removal of the whole tooth or tooth root, with minimal trauma to the investing tissues, so that the wound heals uneventfully and no post-operative prosthetic problem is created.

3. Indications Of Extraction Grossly Carious Pulpal Necrosis Severe Periodontal Disease Orthodontic Purpose Malopposed Teeth Fracture Teeth Preprosthetic Extracion Impacted Teeth Supernumerary Teeth Teeth Associated with Pathologic Lesion Preradiation Therapy Tooth In Fracture Line Esthetics Economical Condition

4. Absolute Contraindications Haemangioma A-V Malformation Relative Contraindications Acute Cellulitis Uncontrolled Diabetes Mellitus Hypertension Bleeding Disorders Cardiovascular Disease Patients on long term Steroid therapy Teeth that have undergone Radiation Contraindications Of Extraction

5. 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 TYPES OF EXTRACTION -

6. 1. LEVER & FULCRUM PRINCIPLE : 3 basic components- Fulcrum, Effort, Load Fulcrum is present in b/w effort and load Maximum advantage is when effort arm is longer than load arm. Mechanical Advantage - 3 MECHANICAL PRINCIPLES INVOLVED IN EXTRACTION

7. 2. WEDGE PRINCIPLE: Here 2 movable inclined planes with a base on one end and blade on other end Effort is applied to the base of the plane and resistance has its effect on slant side Used to split, expand or displace the portion that receives it. Elevators to luxate tooth when applied b/w bone and tooth. Mechanical Advantage – 2.5

8. WHEEL AND AXLE PRINCIPLE: Effort is applied to circumference of wheel which turns the axle so as to raise the weight Greater the diameter of wheel more is the mechanical advantage Used in crossbar elevators for removal of mandibular roots Mechanical Advantage – 4.6

9. 1. Expansion of bony socket by use of wedge shaped beaks of the forceps & the movement of the tooth itself with the forceps. 2. Removal of tooth from socket Principles of Forceps Use

10. SOCKET EXPANSION WEDGE

11. Presurgical assessment Medical history Dental history (history of difficult extraction) Clinical examination Radiographic examination

12. Clinical examination Presence of infection Restriction of mouth opening Condition of the crown of the tooth Tooth mobility Tooth alignment in the arch

13. Indications for a preoperative radiograph History of difficult or attempted extraction Tooth abnormally resistant to forceps extraction If a transalveolar approach is going to be used Teeth or roots in close relationship to maxillary sinus or inferior dental & mental nerves

14. Heavily restored or pulpless teeth Tooth subjected to trauma Isolated maxillary molar Partially or unerupted tooth Retained root

15. If only a thin layer of bone is present between the sinus & the molar teeth, there is increased potential for perforation of the maxillary sinus during extraction Relationship to Maxillary sinus

16. Configuration of roots First evaluate number Then Curvature Shape Size length

17. Basic steps in Forceps extraction Grasping the tooth – engaging the beaks 1-2 mm beyond the CEJ Expansion of the bony socket Mobilization of the tooth Delivery of the tooth

18. APPLICATION OF FORCEP BLADES

19. Basic forces used to mobilize the tooth Apical pressure Buccal force Lingual force Rotational force Traction force

20. Application of force related to tooth morphology Maxillary A nteriors Have conical roots Lateral incisors being slightly longer & slender Canine usually the longest Alveolar bone thin on the labial side Initial movement in labial direction, a less vigorous palatal force is then used, followed by rotational force

21. INCISOR CANINE FORCEP APPLICATION

22. Application of force related to tooth morphology Maxillary first premolar Bifurcated usually in the apical 1/3 to ½ Roots extremely thin & subject to fracture Buccal pressures should be greater than palatal pressures Rotational force should be avoided

23. Maxillary premolar

24. Maxillary 1 st & 2 nd molars Have 3 large roots buccal roots are relatively close together strong buccal force is used with minimal palatal forces

25. Maxillary 3rd molars

26. Mandibular anteriors have fine roots with flattened sides

27. Stobie’s technique

28. Mandibular Premolars Have tapered roots and their apices may be distally inclined Extracted with lateral movements Only in the case of the 2 nd premolar can initial movements be rotatory Mandibular molars Have 2 roots flattened mesiodistally Strong buccal and lingual motion is used to expand the socket & the tooth is delivered in the buccoocclusal direction

29. PREMOLAR MANDIBULAR 1 & 2 MOLAR MANDIBULAR 3 MOLAR

30. Policy for leaving root fragments 3 conditions must exist for a tooth to be left in the alveolar process Root fragment must be small Root deeply embedded in bone Root must not be infected

31. Immediate complication Failure to secure LA Failure to remove the tooth Fracture of the tooth # of the alveolus and max. tuberosity Oroantral communication Displacement of the tooth or root into the adjacent tissues Aspiration of the tooth

32. # or subluxation of an adjacent tooth. Collateral damage to the surrounding soft tissues Thermal injuries Bleeding Dislocation of the TMJ # of mandible Damage to branches of the TN

33. Delayed complications Excessive pain , swelling & trismus Hemorrage Localized alveolar osteitis (dry socket) Oroantral fistula Infection of soft tissues Nerve damage Failures of the socket to heal

34. Late complications Chronic osteomyelitis Osteoradionecrosis

35. References Some early dental extraction instruments including the pelican, bird or axe? Australian Dental Journal 2002; 47:2 Fonseca Oral & Maxillofacial Surgery Vol:1 Contemporary Oral & Maxillofacial Surgery Peterson . Ellis . Hupp . Tucker 2 nd Edition Textbook of Practical Oral & Maxillofacial Surgery . Daniel E Waite 3 rd Edition Minor Oral Surgery Geoffrey Howe 3 rd edition The extraction of teeth Geoffrey Howe 3 rd edition The Dental Clinics of North America : Basic procedures in Oral Surgery Apr 1994 38:2

36. Oral & Maxillofacial Surgery Jonathan Pedlar Principles of Oral & Maxillofacial Surgery U J Moore 5 th edition A synopsis of Minor Oral Surgery G Dimitroulis Killey and Kays outline of Oral Surgery Part 1 Laskin Vol:2 Dentistry an illustrated history Melvin Ring British Journal of Oral and Maxillofacial Surgery, Volume 40, Issue 3, June 2002, Pages 248-252 I. L. Evans et al New England Journal of Medicine May 22 1997

37. Thank you…