Tooth Extraction – Things to know about it

Definition

” Extraction is defined as complete, painless removal of tooth or tooth root with minimal trauma to surrounding investing structures, so that the wound heals uneventfully and there will be no post operative prosthetic problems”.

Indications 

  •  Severe cariesGROSSLY DECAYED TOOTH
  •  Pulpal necrosis PULPAL NECROSIS
  •  Severe periodontal disease ANUG
  •  Orthodontic reasons ORTHO EXTRACTION
  •  Malopposed teeth SUPER NUMERARY TEETH
  •  Cracked teeth cracked tooth
  •  Prosthetic reasons
  •  Impacted teeth impaction
  •  Supernumerary teeth supernumerary teeth
  •  Associated with pathologies  CYST
  •  Involved in fractures 91_X55-i100_L
  •  Esthetics & Economics

Contra-indications

Absolute

  1. Local
    1. Hemangiomas HEMANGIOMA
  2. Systemic
    1. Lymphomas LEUKEMIA
    2. Leukemia  leukemia
    3. Thyrotoxicosis

      RI280897/13

      RI280897/13

Relative

  1. Local
    • Acute infection infection
    • ANUG ANUG
    • Acute pericoronitis pericoronitis
  2. Systemic
    • Diabetes mellitus diabetes
    • Hypertension hypertension
    • Pregnancy pregnancy
    • Heart diseaseFun tooth
    • Epilepsy epilepsy

Evaluation of teeth removal

  1.  Access to Tooth
  2.  Mobility of Tooth
  3.  Condition of Crown

Radiographs 

Indications for radiograph

  •         Attempted extraction attempted extraction
  •         Grossly decayed GROSSLY DECAYED TOOTH
  •         Root canal treated cyst
  •         Supernumerary teeth supernumerary teeth
  •         Impacted Teeth impaction
  •         Root stumps root stumps
  •         Fractured Teeth fractured tooth

Radiographic evaluation

  •  Condition of the Tooth.
  •  Condition of the Bone.
  •  Relationship with associated Vital structures.

Types of Exodontia

  1.   Intra-alveolar extraction also called as Closed extraction. Where tooth is luxated and elevated out of socket with elevators and forceps. extraction
  2.   Trans-alveolar extraction in this method an incision is placed and mucoperiosteal flap is reflected for proper accessibility, bone cutting is done either with a chisel and mallet or a bur. Sutures are placed to approximate wound margins.

transalveolar extraction

Principles of Extraction

 Intra-alveolar or Closed method extraction

  1.  Forcep blade should be placed below the C.E. junction on sound root portion with apical thrust.
  2. Mechanical principles:
    1.    Expansion of bony socket expansion of bony socket
    2.     Use of lever and fulcrum to elevate the tooth. principles of extraction
    3.     Use of wedge or wedges within root or socket. wedge principle
  3. Traction towards least resistance.

Principles for deciduous teeth extraction

  1.  Gentle  and Judicious use of elevators
  2.   Beak of the forceps should be carefully placed, so that it should not injure the hidden permanent tooth bud.

child extraction

Order of extraction

  •  To prevent bleeding from socket of extracted teeth obscuring the field of operation distal most tooth is first extracted.
  •  Maxillary teeth should be extracted before mandibular to prevent falling of debris or totth material in to socket.
  •  Canine should not be left last as alveolus may get fractured due to its length.

Forces during extraction

  •  Apical force: to wedge the forceps firmly in the periodontal ligament space.this does not actually move the tooth but expands the bony socket
  •  Buccal force: Expands the buccal cortical plate.
  •  Lingual force: Expands the lingual cortical plate.
  •  Rotational force: Teeth with single conical roots can be extracted by this method.it causes internal expansion of the bony socket.
  •  Tractional force: These are forces applied finally to remove the tooth completeley out of socket.

Rules for application of forceps

  •  Correct forceps for particular tooth should be selected.
  •  Grasp the forceps at the far end of handles.
  •  Long axis of the beaks of the forceps should be parallel to the long axis of the tooth.
  •  Beaks should be firmly grasped on sound root structure, not on enamel of crown.
  •  Beaks should not impinge on adjacent teeth.

Forces applied for different teeth

MAXILLARY:

  •   Incisors: labial-lingual-labial with mesial rotation.
  •  Cuspids: labial-lingual-labial with mesial rotation.
  •  First premolar: buccal-palatal-removal in buccal direction.
  •  Second premolar: buccal-palatal-removal in buccal or palatal direction.
  •  Molars: buccal-slight palatal and distal rotation.

MANDIBULAR: 

  •  Anteriors: labial-lingual-slight mesial to distal force and removal in labial direction.
  •  Premolars: buccal with slight mesio-distal rotation.
  •  Molars: buccal-lingual and removal in buccal direction.
  •  Third molars: buccal pressure and removal in buccal or lingual direction.    

Complications of Exodontia

A complication is any deviation from normal expected pattern of events

Fracture of:

  •        Crown of tooth. crown fracture
  •        Roots of tooth. root fracture
  •        Alveolar bone. alveolar bone fracture
  •        Maxillary tuberosity.
  •        Adjacent or opposing tooth.

Dislocation of:

  •    Temporomandibular joint tmj dislocation

Displacement of root:  displacement of rrot into the sinus

  •     In to the soft tissues
  •     In to maxillary antrum

Excessive hemorrhage:  excessive hemorrhage

  •     During tooth removal
  •     On completion of extraction

Postoperatively

Damage to:

  •     soft tissues
  •     Inferior alveolar nerve and its branches IAN trauma
  •     Lingual nerve
  •     Tongue and floor of mouth

Post-operative pain due to:

  •     Damage to hard and soft tissues
  •     Dry socket drysocket
  •     Acute osteomyelitis osteomyelitis

Post operative swelling due to:

  •       Oedema
  •       Hematoma formation HEMATOMA FORMATION
  •       Infection

Trismus trismus

  • Oro-antral communication

oroantral communication

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