Tooth Extraction Simple Technique

Simple procedure of tooth extraction.

1. Tooth Extraction Simple Technique Dr. Md. Nazmul Hassan Bin Khair BDS (DU)

2. Definition Extraction: Extraction can be defined as a painless removal of the whole tooth or tooth root with minimal trauma to the investing tissue.

3. Types Intra-alveolar extraction: The blades of the forceps are forced down the periodontal membrane between the tooth root & bony socket wall. Trans-alveolar extraction: This method of extraction comprises the dissection of a tooth or root from the bony attachment.

4. Indication Severly carious teeth where endodontic treatment are not possible. Teeth with non-vital pulp where acute or chronic pulpitis when root canal treatment can not be indicated. Severe periodontitis where excessive bone loss. Third degree mobile teeth Malposed teeth Impacted & Unerrupted teeth Supernumery teeth. Retained desiduous teeth. Teeth with fractured root. Teeth directly or indirectly involving cyst & tumour .

5. Contraindication Local Acute oral infection- ANUG, Herpetic gingivostomatitis Pericoronitis Acute maxillary sinusitis Osteoradionecrosis area

6. Systemic CVS Diseases- Sub acute bacterial endocarditis Ischemic heart disease Hypertension CCF Valvular disease Blood dyscrasias Haemophilia Purpura Severe anemia Leukaemia Scurvy

7. Uncontrolled DM Thyrotoxicosis Viral hepatitis Severe Jaundice Kidney disease- Nephritis, Renal failure Vit -K deficiency Radiation therapy Epilepsy AIDS Syphilis

8. Instruments Required Local anaesthetic solution with or without adrenaline Curved elevator Straight elevator Cryer Forceps Curettor Normal saline Disposable syringe Cotton rolls Suturing materials

9. Basic necessity of extraction Adequate access Comforatable patient Adequate oral opening Proper retraction of the tissue by assistant High volume suction Patient Preparation Comforatable , mentally & physically Alleviation of fear, assurance Informed consent Minimum amount of draping Rinsing with antiseptic mouth wash.

10. Surgeon’s & Assistant’s Preparation Wearing of protective eye glass Wearing mask Wearing surgical cap Wearing gloves

11. Chair Position For Extraction MAXILLARY Extraction The chair should be tipped backward and maxillary occlusal plane is at 60 degrees to the floor. The height of the chair should be patient’s mouth is at or below the operator’s elbow level MANDIBULAR Extraction The patient should be positioned in a more upright position. The occlusal plane is parallel to the floor. The chair should be lower than for extraction of maxillary teeth.

12. Operator’s Position For all maxillary teeth and anterior with left mandibular teeth - the dentist is to the front and right of the patient. For the posterior right mandibular teeth- the dentist is positioned behind and to the right of the patient .

13. Mechanical Principles In Extraction Lever Principle of First order 3 basic components- Fulcrum, Effort, Load. Fulcrum is between effort and load. Maximum advantage is when effort arm is longer than load arm. Used in forceps along with wheel and axle and in elevators.

14. 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 used to luxate tooth when applied between mucoperiosteum and surface of tooth .

15. 3. Wheel and Axle principle Effort is applied to circumstance of wheel which turns the axle so as to raise the weight. Greater the diameter of wheel more is the mechanical advantage. When one root of a multiple-rooted tooth is let in the alveolar process , the pennant-shaped elevator is positioned in the socket and turned. The handle then serves as the axle and the tip of the triangular elevator acts as a wheel and engages and elevates the tooth root from the socket.

16. Rules of Using Forceps Catch the root not the crown Parallel to the long axis of the tooth. Initial movement. Deep grip. Firm grip. Principle movement. Final movement.

17. Principles Of Forceps Use

18. Forces applied for different teeth MAXILLARY : Incisors : labial-lingual-labial with mesial rotation. Cuspids : labial-lingual-labial with mesial rotation. First premolar: buccal -palatal-removal in buccal direction. Second premolar: buccal -palatal-removal in buccal or palatal direction. Molars : buccal -slight palatal and distal rotation.

19. MANDIBULAR:   Anteriors : labial-lingual-slight mesial to distal force and removal in labial direction. Premolars : buccal with slight mesio -distal rotation. Molars : buccal -lingual and removal in buccal direction. Third molars: buccal pressure and removal in buccal or lingual direction .

20. Postoperative instructions after a tooth extraction Day of surgery Keep gauzes in the mouth for an hour or two by maintaining a firm pressure and replace them every half-hour, as needed. Always keep your head elevated. Apply ice on the cheek at regular intervals (20 minutes every hour). Blood-tinged saliva is a normal postoperative effect. Limit your physical efforts and don’t forget to rest. Do not dislodge the blood clot that has formed in the tooth socket because it helps to heal .

21. Do not eat anything until the bleeding has stopped. Avoid drinking through a straw. Do not rinse your mouth or spit. Avoid smoking or drinking alcohol. Do not eat hard foods. Avoid brushing your teeth near the extraction site for the first 72 hours. Pain If you are experiencing some pain, take the medication that has been prescribed to you. If you were prescribed antibiotics for this treatment, continue to take them for the specified time period, even if the symptoms go away. Diet Only eat soft foods and cold liquids on the day of the extraction. Resume your usual diet as soon as you are able to.

22. From the next day and until complete healing Rinse your mouth three times a day with warm water and salt (2 ml or 1/2 tsp of salt in 250 ml or 1 cup of water). Brush and floss every day to remove plaque and ensure better results in the long term. Avoid brushing near the extraction site for the first 72 hours. Avoid eating hard foods (nuts, candies, ice). You may experience pronunciation difficulties and an increased amount of saliva. Everything should come back to normal within a week. Bruising may appear on the skin. It will disappear after five to seven days. You may have difficulty opening your mouth. It should come back to normal after four to five days. If after three days the pain increases instead of decreasing, call us.

23. COMPLICATIONS increased bleeding or slow clotting of the extraction site swelling redness discomfort or pain difficulty chewing dry socket infection

24. References Text Book of Oral and Maxillofacial Surgery 3 rd edition, Dr. Neelima Anil Malik Peterson , L. J. Contemporary Oral and Maxillofacial Surgery, 4th ed. Amsterdam Elsevier Science. 2002. ch.7 The Extraction of Teeth by- GEOFFREY L HOWE Sweedan , O. A. Textbook of Oral and Maxillofacial v, 1st ed., 2009 Fragiskos D. Fragiskos Oral Surger . 2007 Carmen Scheller BASIC GUIDE TO DENTAL INSTRUMENTS Wikipedia