EXODONTIA

PRINCIPLES AND

TECHNIQUES

DR.BILLAL 49DDCH_2017

OUTLINE• DEFINITION

• TYPES

• INDICATION OF INTRA-ALVEOLAR EXTRACTION

• CONTRA INDICATION OF EXTRACTION

• PRE OPERATIVE ASSESSMENT

• SURGEON PREPARATION

• PATIENTS PREPARATION

• TRAY SETUP

• POSTIONING OF THE PATIENTS

• SURGEON POSITON

• ANESTHESIA

• BASIC PRINCIPLES OF EXTRACTION FOR INDIVIDUAL TOOTH AND

• AFTER CARE

• POST OPERATIVE INSTRUCTION

DEFINATION & TYPES

1. DEFINATION: 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”.

2. TYPES :

A. Intra-Alveolar extraction or conventional extraction or forcep

extraction

B. Trans Alveolar extraction or surgical extraction

INDICATION OF INTRA-ALVEOLAR EXTRACTION

1. SEVERE CARIES

2. SEVERE PERIODONTAL DISEASES

3. FAILURE OF ENDODONTIC TREATMENT

4. ORTHODONTIC PURPOSE

5. PROSTHODONTIC PURPOSE

6. TEETH FROM FACTURE LINE

7. ECONOMICALLY FAILURE TO PRESERVE THE TOOTH

CONTRA INDICATION OF EXTRACTION

A. SYSTEMIC CONTRA :

1. Severe uncontrolled DM

2. Severe MI

3. Uncontrolled leukemia and lymphoma

4. Bleeding disorder

5. Pregnancy (1st & 3rd trimester)

B. LOCAL CONTRA :

1. Tumor

2. Sever infection at the extraction site

PRE OPERATIVE ASSESSMENT

A. History Taking 1. Medical History :

(i) H/O Hypertension (ii) H/O Jaundice (iii) H/O Kidney diseases (iv) H/O Rheumatoid arthritis (v) H/O Cardiac diseases(vi) H/O Asthma

(vii) H/O Bleeding disorder

2. Dental History

(i) H/O Extraction (ii) H/O Uncontrolled bleeding

B. Clinical Examination :

(i)Accessibility (mouth opening) (ii) Tooth mobility (iii) Crown Condition of the tooth (G. Caries, large restoration, facture, cervical caries)(iv) Oral hygiene status(v) Presence of infection at the site of injection

CONT……………

C. Radio logical Examination :

i. Relation To Vital Structure (Maxillary Sinus, Inferior Dental Nerve)

ii. Root Configuration (Divergent, Convergent, Dilacerations,

Ankyloses, Hypercementosis, Periapical radiolucency)

iii. Condition of the bone of the jaw

SURGEON PREPARATION

1. Wear of Hand gloves

2. Mask

3. Eye Wear with sidesheild

4. Surgical Gown

5. Sterilization of above mentioned materials

PATIENTS PREPARATION

1. Prophylactic Antibiotics

2. Prophylactic Mouth cleansing

(i) Scaling

(ii) Polishing (iii) Brushing

(iV) Rinsing with antiseptic mouth wash

(v) Placement of a towel on the patients chest

(vi) Eye wear

TRAY SETUP

Armamentarium1. Mirror

2. Twizer

3. Caries probe

4. Elevator(Straight &angular)

5. Forcep(Upper& lower,Anterior,Premolar &Molar)

6. Cryer elevator/triangular elevator

7. Bayonet forcep

8. Root forcep

TRAY SETUP

9.Bone file

10.Ronger

11.Curettor

12.Local Anesthesia

13.Syringe

14.Cotton Pallet

15.Suture Material

16.Neddle Holding Forcep

POSTIONING OF THE PATIENTS

For a maxillary extraction the chair should be tipped backward and maxillary occlusal plane is at 60 degrees to the floor. The height of the dental chair should be 8cm below the shoulder level of the operator.

For a maxillary extraction of mandibular teeth, the patient should be positioned the occlusal plane is parallel to the floor. The chair should be 16cm below the level of operators elbow.

Surgeon Positon

For all maxillary teeth ,

anterior mandibular teeth

& teeth of the 3rd

quadrant : Right front

position.

For teeth of the 4th

quadrant : Right back

position.

BASIC PRINCIPLES OF EXTRACTION FOR INDIVIDUAL

TOOTH AND ROOT

Mechanics Principles for tooth extractions

1. Expansion of the bony socket.

2. The use of fulcrum and lever

3. Insertion of wedge of wedges

4. Wheel and axel.

EXPANSION OF THE BONY SOCKET

• Expansion of the bony socket by

use of the wedge-shaped breaks

of the forceps.

• The forceps should be seated with

strong apical pressure to expand

crystal bones and to displace

center of rotation as apically as

possible.

Continues…………….

Movement:

• Buccal or Labial : Pressure applied to tooth will expand the

buccal cortical plate towards the crestal bone with some lingual

expansion at apical end of the root.

• Lingual or palatal : Pressure will expand lingual contical plate at

crestal area and slightly expand buccal bone at apical area .

CONTINUES…………..

• The initial linguo-buccal

movement for extraction of lower

second mandibular molar.

• Initial rotational forces it is useful for

removal of teeth with conical

roots; such as maxillary central.

• Tractional forces are useful for final

removal of tooth from socket. They

should always be small forces,

because teeth are not "pulled."

CONTINUES………

1. The Final withdrawal movement for Most of the upper and lower teeth is an outward-

occlusal direction. Except the lower third molar which should be in a lingual- occlusal way

and maxillary 3rd molar should be disto-buccal.

The proper use of forcepsin luxation and removal of teeth

1. The extraction movements are essentially three movements whichare outward, inward, and rotatory movements.

2. Outward (buccal or labial) movement is the initial movement of allteeth except the lower second and third molar where the buccalplate of bone reinforced by the external oblique ridge.

3. Inward (lingual or palatal) movement is the initial movement duringthe extraction of the lower secondand third molars.

CONTINUES………

4. Primary Rotatory movement is the initial movement used in upper central incisor and lower second premolar.

5. If a resistance is felt in primary rotation, a bucco-lingual movement should be started.

6. If rotatory movement continued, a spiral fractured of the tooth root may occur.

CONTINUES………

•

• 7. Once the alveolar bone has expanded sufficiently and the tooth has been luxated, a slight traction force, usually directed buccally, can be used.

• 8. Final movement is the movement by which the tooth is removed from its bony socket. It should be always directed outward and occlusally to avoid traumatizing the opposing tooth,

• 9. The extraction forceps blade should be applied to the carious side first, and the first movement made toward the caries.

THE USE OF FULCRUM OR LEVER A lever is a mechanism for transmitting

a modest force with the mechanical

advantages of a long lever arm and a

short resistance arm into a small

movement against great resistance.

When an elevator is used for tooth

extraction, an acquired contact point

can be made on the root surface and

a liter can be applied by the handle of

the elevator to elevate the tooth or a

tooth root from the socket.

The wedge principle is useful for the

extraction of teeth in several different

ways.

1. By using the beaks of the extraction

forceps as a wedge.

2. When a straight elevator is used to

luxate a tooth from its socket.

THE USE OF FULCRUM OR LEVER

THE USE OF FULCRUM OR LEVER

WHEEL AND AXEL

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 toothroot from the socket

http://www.screencast.com/t/WT

ckiey4p

ROLE OF OPERATORS` HAND

The opposite hand plays animportant role in supportingand stabilizing the lower jawwhen mandibular teeth arebeing extracted.

The opposite hand supportsthe alveolar process andprovides tactile informationto the operator concerningthe expansion of thealveolar process during theluxation period.

AFTER CARE

1. Irrigation of the socket with

normal saline or the other

anticeptic solution .

2. Curettage of the socket to

remove bony fragment and

granulation tissues .

3. Break down of the bony sharp

edge at the socket world and

inter radicular bone.

4. Squeezing of the socket

5. Mouth rinsing with antiseptic

solution once .

6. Suturing (if required)

7. Moist gauze pack to prevent

hemorrhage

POST OPERATIVE INSTRUCTION

1. Remove the cotton/ gauze pack at least 1 hour later.

2. Take cool and soft diet for at least 24 hours.

3. Avoid hot and hard diet for at least 24 hours.

4. Do not rinse forcefully and do not brush of the site of

extraction for at least 24 hours .

5. Maintain the oral hygenie

6. If stitch is given ,come one week later to cut it.

REFERENCES

1. Peterson, L. J. Contemporary Oral and Maxillofacial Surgery, 4th ed.

Amsterdam Elsevier Science. 2002. ch.7

2. Neelima Anil Malik,Text Book Of Oral and Maxillofacial surgery,3rd

edi.

3. Vinod Kapur,Text book of oral surgery

4. Fragiskos D. Fragiskos Oral Surger. 2007

5.Carmen Scheller BASIC GUIDE TO DENTAL INSTRUMENTS