Trans Alveolar Extraction

about Trans alveolar extraction

1. TRANSALVEOLAR EXTRACTION Dr. REVATHY MOHAN Lecturer Malabar Dental College & Research Centre

2. INTRODUCTION Comprises the dissection of a tooth or root from its bony attachments Method used for recovering the root,that are fractured during the routine extraction. Open or surgical method Mucoperiosteal flap is elevated & tooth is extracted surgically

3. INDICATIONS Failed intra alveolar attempt Retained root Endodontically restored tooth Extensively curved or dilacerated root Hypercementosed or ankylosed teeth

4. when desired to insert a denture soon after extraction Sclerosis of bone Impacted teeth or embedded teeth Teeth associated with pathology

5. PRINCIPLES OF ELEVATORS Lever principle: M ost commonly used principle . T he elevator is a lever of the first order . I n this fulcrum is in between the effort and the resistance.

6. Wedge principle : E levator is forced between the root and the bone,parallel to the long axis of tooth . The wedge is a movable inclined plane which overcomes a large resistance at right angles to the applied effort . I t is usually used in conjuction with the lever principle.

7. Wheel and axle principle : Mo dified form of lever principle . T he effort is applied to the circumference of a wheel which turns the axle so as to raise the weight . T his is applicable to cross bar elevators.

8. PRE EXTRACTION CLINICAL ASSESSMENT Presence of infection Access to tooth Hypomobility of tooth Condition of crown Tooth alignment in arch Age of patient Embedded roots

9. PRE EXTRACTION RADIOLOGICAL EVALUATION Relationship with associated vital structures . Configuration of roots . Condition of surrounding bone.

10. TECHNIQUE ELEVATION OF MUCOPERIOSTEAL FLAP REMOVAL OF OVERLYING BONE DIVISION OF TOOTH REMOVAL OF TOOTH TOILET OF SOCKET SUTURING

11. ELEVATION OF MUCOPERIOSTEAL FLAP To expose the bone covering the tooth to be retrieved Provide adequate access to site of operation Base should be wide to have an unimpaired blood supply Avoid major structures Can be buccal ,lingual or palatal Extended upto a tooth distance on both side Should not extend deep into sulcus

12. INCISIONS Incise in one continuous stroke through the bone at right angles to surface mucosa Base should be wider Dental papilla included wholly Flap should be handled gently Edges should lie on sound bone One relieving incision is sufficient,

13. REMOVAL OF OVERLYING BONE Overlying alveolar bone removed to expose part of the roots of tooth Creates pathway to deliver the tooth Should be restricted Must be just enough to insert an elevator or forceps and create a space into which tooth or root can be moved Bur or chisel used Rongeur forceps – for trimming bone edges after extraction

14. Postage Stamp Method Row of small holes made with small bur (No.3 ) Joined together with either bur or chisel Minimizes risk of damage to nerves and vessels

15. DIVISION OF TOOTH Lines of withdrawal is different for different roots Root mass divided Seperated roots removed along their path of removal Make space for application of forcep / elevator Osteotome , chisel ,burs are used

16. REMOVAL OF TOOTH Engage the elevator in notch on side of root If notch not present then create it with round bur directed at 45 degrees to long axis of root

17. SOCKET TOILET Unwanted bony prominences removed - Rongeur forceps , chisels,burs Smoothening of sharp edges- bone files , vulcanite burs Wound irrigated with warm normal saline Bone debris & infected granulation tissue removed – Mitchell trimmer , Cumine scaler

18. SUTURING To hold the cut edges to promote healing Minimize wound contamination Arrest haemorrhage

19. COMPLICATIONS DURING SURGICAL PROCEDURE: Fracture of jaw Mucosal lacerations. Punture wounds on the surrounding tooth. Extraction of wrong teeth. Fracture of alveolus. Fracture of tuberosity . Displacement of tooth into maxillary sinus.

20. Creation of oro-antral fistula. Fracture of mandible. fracture of mandible. Breakage of instrument. Luxation of adjacent tooth. Injury to inferior alveolar nerve. Injury to lingual nerve. Swallowing of teeth.

21. COMPLICATIONS AFTER THE SURGICAL PROCEDURES: Presence of bony spicule . Haemorage . Infection.

22. REFERENCES The Extraction of tooth –Geoffrey .L. Howe Textbook of Oral & Maxillofacial S urgery – S .M B alaji Textbook of Oral and Maxillofacial S urgery- N eelima A nil M alik-3 rd edition