Supervised By: Dr. Abdulhameed

Principles and steps

of Surgical Tooth

ExtractionDone by :

Dr. Muthanna Ibraheem

Surgical extraction is the method by which a tooth is removed from its socket, after creating a flap and removing part of the bone that surrounds the tooth. This technique is relatively simple and can be done by general Practitioner if the basic principles of the surgical technique are followed.

INDICATIONS1. Teeth of the maxilla or mandible that present unusual root morphology. In such cases, a surgical extraction is

performed preventively, because their removal is impossible with the simple technique without complications arising (e.g., root breaking, fracture of alveolar bone, etc.).

2. Teeth with hypercementosis of root and root tip, presenting large bulbous roots.

3.Teeth with dilaceration of root tips.

4. Teeth with ankylosed roots or with abnormalities, e.g., dens in dente.

5. Teeth fused with an adjacent tooth.

6. Broken root tips that have remained in the alveolar bone and are involved in osteolytic lesions.

7. Roots of teeth found below the gumline,

8. Deciduous molars whose roots embrace the crown of the subjacent premolar. If the simple extraction technique

were to be attempted, there is a great risk of concurrent luxation of the premolar.

CONTRAINDICATIONS

Asymptomatic fractured root tips, whose pulp was vital, located deep in the socket.

when there is a risk of serious local complications, such as the dislodging of a root tip into the maxillary sinus or injury of the inferior alveolar nerve, mental nerve, or lingual nerve.

A large part of the alveolar process needs to be removed.

There are serious health problems present.

STEPS OF SURGICAL EXTRACTION

IN GENERAL1. Creation of a flap.2. Removal of bone and exposure of an adequate part of the root.3. Extraction of the tooth or root with elevators or forceps.4. Postoperative care of wound and suturing.

A.single-rooted tooth

An L-shaped incision ismade and the flap is reflected. The buccal plate covering thesurface of the root is removed, the tooth is extractedusing forceps

1. Extraction 0f Tooth With Hypercimintosis at the root tip

B.Multi-rooted teeth • The envelope flap is

reflected, part of the buccal plate is removed,

• Extraction of the mesial portion of the tooth, which includes the crown and root

• and the tooth is sectioned buccolingually at the crown as far as the intraradicular bone

• Extraction of the distal portion of the tooth using forceps after creating a pathway for removal

• Suturing of the flap using interrupted sutures

• Widening of the alveolus with a round bur.

2. Extraction of Deciduous Molar that Embraces Crown of Permanent Tooth.

• Envelope flap created and bone removed as far as the root bifurcation.

• Roots of the molar sectioned with a perpendicular groove on the crown, which extends as far as the intraradicular bone.

• Removal of the mesial portion of the tooth, which includes the crown and root.

• Suturing of the flap with interrupted sutures.

• Removal of the distal portion of the tooth, which includes the crown and root, using forceps.

3. Extraction of Ankylosed Tooth

Radiograph and clinical photographof a maxillary canine with dens in dente

A trapezoidal flap is created, which extends fromthe lateral incisor as far as the distal aspect of the maxillaryfirst premolar.

Use of a chisel to remove the tooth, together with the ankylosed portion of the labial plate.

Operation site after placement of sutures.

4.Surgical Extraction of Retained Roots

A. Single rooted tooth

Radiograph and clinical photographof a maxillary 1st premolar.

Creation of an L-shaped incision, which extends from the mesial aspect of the canine as far as the distal aspectof the second premolar

Reflection of the flap.

Removal of the buccal plate along the length of the root using a round bur

luxation of the root in the outward direction using a straight elevator

Surgical field at the end of the operation

Smoothing of bone margins of the wound using a bone file

Operation site after suturing

B. Two rooted tooth

Creation of an envelope flap to exposethe roots

• the removal of the buccal plate as far as the root bifurcation.

• Roots are separated using a fissure bur in the buccolingual direction

Luxation of roots after sectioning

C. The Semilunar

Incision

• Creation of flap

• removal of the buccal plate and exposure of the root

Removal of the root from the osseous window using double-angled elevator.

• Stabilization of the flap in its initial position with placement of the first suture at the center of the semilunar incision.

Antibiotic coverage

The recommended Antibiotic for p.o. administration is :Ampicillin : 500–1000 mg every 6–8 h, Amoxicillin : 500 mg every 8 h,erythromycin : (Macrolides) every 12 or 24 h,Clindamycin : 300 mg every 8 h,Tetracyclines : 100 mg every 12 h.

Thank you