” 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”.
- Severe caries
- Pulpal necrosis
- Severe periodontal disease
- Orthodontic reasons
- Malopposed teeth
- Cracked teeth
- Prosthetic reasons
- Impacted teeth
- Supernumerary teeth
- Associated with pathologies
- Involved in fractures
- Esthetics & Economics
Evaluation of teeth removal
- Access to Tooth
- Mobility of Tooth
- Condition of Crown
Indications for radiograph
- Attempted extraction
- Grossly decayed
- Root canal treated
- Supernumerary teeth
- Impacted Teeth
- Root stumps
- Fractured Teeth
- Condition of the Tooth.
- Condition of the Bone.
- Relationship with associated Vital structures.
Types of Exodontia
- Intra-alveolar extraction also called as Closed extraction. Where tooth is luxated and elevated out of socket with elevators and forceps.
- 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.
Principles of Extraction
- Forcep blade should be placed below the C.E. junction on sound root portion with apical thrust.
- Mechanical principles:
- Traction towards least resistance.
Principles for deciduous teeth extraction
- Gentle and Judicious use of elevators
- Beak of the forceps should be carefully placed, so that it should not injure the hidden permanent tooth bud.
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
- 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.
- 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
- In to the soft tissues
- In to maxillary antrum
- During tooth removal
- On completion of extraction
Post-operative pain due to:
Post operative swelling due to:
- Oro-antral communication