Exo 1 Flashcards
Exodontia
painless removal of the
whole tooth, or tooth root, with minimal trauma to the investing tissues
Methods of tooth extraction
- CLOSED METHOD/FORCEPS EXTRACTION/INTRA- ALVEOLAR EXTRACTION:
- OPEN METHOD/SURGICAL/TRANS-ALVEOLAR EXTRACTION:
Indications of tooth extraction
- Severe Caries
2- Pulpal Necrosis - Severe Periodontal Disease
4- Orthodontic Reasons - Malposed teeth
- Pre prosthetic Extractions
- Cracked Teeth
- Impacted Teeth
- Supernumerary Teeth
- Teeth Associated with Pathologic Lesions (where apicoectomy is contraindicated)
11- Preradiation Therapy (Teeth in the line of radiation therapy should be extracted at least 3 weeks before radiotherapy)
12- Tooth involved with jaw fractures
13. Retained deciduous
teeth
- Remaining roots and fragments
- Economics
Systemic contraindications.
- Severe uncontrolled metabolic diseases
- Uncontrolled leukemias and lymphomas
- Severe uncontrolled cardiac diseases
- Severe uncontrolled hypertension
- Severe bleeding diathesis
- Pregnancy – middle trimester is safe
- Medications
- Toxic Goiter
Local contraindications of tooth
extraction
1- History of radiotherapy for
head & neck cancer
2- Teeth that are located
within an area of tumor
3- Acute pericoronitis around
partially erupted third molar
4- Extraction of maxillary teeth during acute maxillary sinusitis
5- Acute dentoalveolar abscess
(acute infection is not a contraindication to extraction once the access and anesthesia can be ensured.)
6- Absolute contraindication: Presence of haemangioma in the extraction site.
Periapical radiographs…..
Panoramic radiographs….
Occlusal radiograph……
-provide the most accurate and
detailed information concerning the tooth, its roots, and the surrounding tissue.
- for impacted teeth as opposed to erupted teeth.
-to localize the position of impacted teeth in a bucco-lingual direction, especially impacted maxillary canine.
Indications for Pre-Operative
Radiographs
- A history of difficult extraction.
- A tooth which is abnormally resistant to forceps extraction.
- Any teeth or roots in close relationship to either the maxillary antrum, inferior dental and mental nerves.
- All mandibular and maxillary third molars
- Any tooth which has been subjected to trauma.
- Any partially erupted or impacted teeth.
- Retained roots.
- Any tooth with abnormal crown form.
- Any tooth that has been decided to be removed surgically.
- Heavily resorted and pulpless teeth.
- Any isolated upper molar for long time.
- Any condition which predisposes to dental or alveolar abnormality, e.g.
(hypercementosis) paget
(hooked roots) clido crinal
(difficult extraction) osteoppetrosis
(osteoradionecrosis)
Values of Pre- Extraction Radiograph
1- Relationship to vital structure :
a- Maxillary sinus
b- Inferior dental canal
C- Mental foramen
2- Configuration of Roots:
a- Number of roots
b- Root curvature & divergence
c- Size and shape of the root
3- Condition of the surrounding bone:
a- Bone density
b- Presence of apical pathology
Patient preparation includes
A sterile drape
Before the extraction, patients should rinse their mouths with an antiseptic mouth rinse, such as chlorhexidine.
Position of the patient For extraction of maxillary teeth:
height of the patient’s mouth is at or slightly below the operator’s elbow
level
occlusal surface of the maxillary teeth must be at a 60° angle
patient’s head toward the operator except the extraction anterior portion of the arch, the patient should be looking straight ahead.
Position of the patient For extraction of mandibular teeth:
level of the mandible about the level of the elbow.
occlusal surface of the mandibular teeth must be parallel to the horizontal
Position of the surgeon For extraction of maxillary teeth:
Right-handed dentists during extraction using forceps is in front of
and to the right of the patient ( 8 o’clock)
Left-handed dentists should be in front of and to the left of the patient.
Position of the surgeon For extraction of mandibular teeth:
Right-handed dentists during extraction of anterior and left side
teeth using forceps, is in front of and to the right of the patient ( 8 o’clock).
Right-handed dentists during extraction of right side teeth using
forceps, is in behind to and to the right of the patient ( 11 o’clock).
Mechanical principles of extraction
- Expansion of the bony socket.
- The use of lever.
- Insertion of wedge or wedges.
- Wheel and axle.
most frequently used principle
lever principles , class 1
wedge principle is for
Upper teeth
• It is also useful when a straight elevator is used to luxate a tooth
from its socket
Wheel and axle, is most closely identified with the
triangular elevator (craer)When one root of a multiple- rooted tooth is left in the alveolar process
When one root is removed and the other stuck
First and second most important instruments
1- extraction forceps
2- elevator
Classification of Dental elevators
A. According to use:
- To remove the entire tooth.
- To remove roots.
- To reflect the mucoperiosteum.
Classification of Dental elevators
B. According to form:
- Straight elevators all types ( coupland elevator).
- Curved elevators right and left (e.g. Cryer’s elevator).
- Angulated elevators right and left (apexo elevator).
- Pick type elevators.
- Cross bar design elevators.
Straight elevators , The concave surface is placed
buccally,
either perpendicular to the tooth or at an angle
Triangular (curved)elevators ( Cryer) is most useful when + what technique
broken root
remains in the tooth socket and the adjacent socket is empty
Wheel and axle
Warwick James elevator most useful in .
luxation of upper third molars
Apexo elevator useful in ? And who much angles
used to remove root stumps.
Apexo Elevators are straight one and have a biangulated and sharp, straight working tip
ck type elevators:
Crane pick.
root tip pick
Winter’s Elevator use and principal
can generate large amounts of force that may fracture the mandible and therefore must be used with
caution.
– Used like Cryer elevator.
Rules of elevator use
- Never use adjacent tooth as fulcrum unless it needs extraction.
- Never use buccal plate as fulcrum except in lower third molars.
- Never use lingual plate as fulcrum.
- Always use finger guards to protect the patient in case elevator slips.
- Forces applied should be under control & in
the right direction.
Procedure for closed extraction:
– Step 1: Loosening of soft tissue attachments from the tooth.
– Step 2: Luxation of the tooth with a dental elevator.
– Step 3: Adaptation of the forceps to the tooth.( The beaks of the forceps must beheld parallel to the long axis of
the tooth.)(without any wrist )pressure
– Step 4: Luxation of the tooth with the forceps (The forceps must be apically seated as far as possible and reseated periodically during the extraction.)
– Step 5: Removal of the tooth from the socket.
Rules of application of forceps
• Long axis of forceps beaks must be parallel to long axis of the tooth.
• Beaks must not impinge on adjacent teeth
during the luxation.
The forceps can apply five
major motions to luxate the
teeth and expand the bony
socket:
1.Apical pressure (first movement for all teeth ).
2.Buccal pressure.
3.Lingual pressure.
4.Rotational pressure.
5.Tractional pressure.
