prof. hee-eun kimcontents.kocw.net/kocw/document/2016/gachon/kimheeeun1/9.pdfindications of...
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![Page 1: Prof. Hee-Eun Kimcontents.kocw.net/KOCW/document/2016/gachon/kimheeeun1/9.pdfIndications of Extraction 1. Caries » 심한 치아우식증으로 근관치료가 불가능하거나](https://reader033.vdocuments.mx/reader033/viewer/2022041905/5e631d3ed98f3c3a4d39c1e4/html5/thumbnails/1.jpg)
Department of Dental hygiene, Gachon University College of Health Science
Prof. Hee-Eun Kim
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Key point
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Indications of Extraction
1. Caries
» 심한 치아우식증으로 근관치료가 불가능하거나 치조골 아래로 깊게 우식
이 진행된 경우
2. Trauma / Cracked teeth
» Teeth involved in jaw fractures
» 이로 인한 심각한 감염의 위험성이 존재 시
3. Periodontal disease
» 중증의 치주질환으로 광범위한 수평적, 수직적 골파괴가 있는 경우
4. Impactions
» Impacted & supernumerary teeth
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Indications of Extraction
5. Orthodontics
» 상하악 제1소구치, 교정과 의사의 진료의뢰서
6. Endo Tx. & Pulpal necrosis
» 근관치료 실패 시 (예, 측면 천공 발생한 만곡치의 경우), 근관치료 후 보
철수복이 불가능한 경우 (치관 및 치근 비율 낮음)
7. Cancer & Radiation therapy
» 구강암으로 인해 방사선 치료를 받는 환자는 방사선 치료로 인한 방사선
골괴사증 등을 예방하기 위해 방사선 치료 전 차아 발거 고려
8. Teeth associated with pathologic lesion
9. Malposed teeth
10. Financial issues
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Contraindications of Extraction
General
① 중증의 비조절성 당뇨 환자 (단, 조절 시 가능)
② 말기의 신장질환자
③ 백혈병 환자 및 혈소판 감소 환자 (감염 위험)
④ 심장질환자, 특히 심근경색질환
⑤ 뇌혈관 기능 장애 및 뇌혈관 질환자
⑥ 임신 초기와 말기
⑦ 혈우병 및 혈소판 이상을 지닌 출혈성 소인이 있는 환자
⑧ 내과의사 컨펌 요
‣ 스테로이드 투여 환자, 항암치료제 투여 환자, 면역억제제 투여 환자
Severe uncontrolled metabolic diseases
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Contraindications of Extraction
Local
» 급성 염증, 특히 급성 치주 및 치근단 농양과 안면 부위의 농양이 있는 환
자 (감염 조절 후 발치)
» 방사선 조사 경력이 있거나 조사 중인 환자
» 종양
» 급성 지치 주위염 환자 (감염 조절 후 발치)
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Mechanical principles involved in tooth extraction
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A. Elevator (발치기자)
특히, 우식이 심하게 진행된 치아, 외상으로 치관이 파절된 치아
발거에 유용
» 치근이 치조점막 하에 위치하여 겸자에 의한 발거가 불가능한 경우
1) Lever action (지렛대 작용)
2) Wedge action(쐐기 작용)
3) Wheel & axle action (윤축작용)
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1. Lever action (지렛대 작용)
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2. Wedge action(쐐기 작용)
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3. Wheel & axle action (윤축/회전작용)
발치기자를 삽입 부위에 위치시킨 후, 술자의 손을 회전시키면
» 가자의 작용점 및 치근부 회전운동과 접촉부의 직선운동으로 치아가 탈구
되고 발거됨
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Extraction forceps (발치겸자)
Expansion of the bony socket
Removal of the tooth
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Instrument
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Simple Ex.
OE set
Chlorhexidine solution
Irrigation syringe
Anaesthesia instrument
Elevator & forceps
Surgical curette
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Complex Ex.
OE set
Chlorhexidine solution
Irrigation syringe
Anaesthesia instrument
Surgical blade and blade holder
Elevator & forceps
Periosteal elevator
Suture set
Retractor
Surgical curette
Bone roungeur & bone file
Handpiece & Surgical bur
Gauze
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Process of Ex.
1. 치아상태 확인
» 파노라마 방사선 사진
2. 치료계획
3. 환자의 준비
» 전신상태 확인 및 생징후 체크
» 클로르헥시딘 가글
» 구강 외 소독(painting) 후 draping
» 마취
4. 피판 형성 및 거상
» Periosteal elevator 또는 Minnesota
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Process of Ex.
5. 치관 및 치근 삭제
6. 피판 봉합
» 발치와 내 충분한 세척, 이물질 제거
» 술 후 출혈 예방을 위해 흡인기의 흡입력을 약간 낮춤
7. 구강 내 세척 및 압박지혈
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Risk assessment in tooth extraction
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Clinical evaluation of teeth for removal
1. Access to the tooth
2. Mobility of the tooth
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3. Condition of the crown
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Radiographic examination of the tooth for removal
1. Relationship to vital structures
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2. Configuration of roots
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3. Condition of surrounding bone
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Complications of extractions
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발치 중 합병증
치아파절
치조골의 파절
연조직의 손상
인접치의 손상
상악동의 천공, 치아 및 기구의 전위
영구치배의 손상
기관 내 흡입
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발치 후 합병증
지연 출혈
발치 후 감염
부종
동통
개구장애
화농성 육아종
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Impacted tooth
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Indication
치관주위염, 치성 낭종 및 종양 발생 시
감염 존재 시
치주학적인 이유로 제2대구치 원심면 부위의 깊은 치주낭 존재
시
보철 및 보존적 근거로 원심면 수복 시
교정학적 이유
뚜렷한 근거 없는 동통이 존재하여 이를 감별하기 위한 진단 시
악골 골절의 예방 및 핀에 의한 내고정 시
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Contraindication
환자가 발치를 원하지 않을 때
발치로 인해 주위의 구조물 손상이 예상될 때
고령의 환자나 정신적 지체 등의 이유로 환자가 외과적 시술을
견디지 못할 때
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