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Extraction 1

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Mohammed Elejeli
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32 views48 pages

Extraction 1

Uploaded by

Mohammed Elejeli
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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The ideal tooth extraction is the painless removal of the whole tooth or tooth root with minimal trauma

to the investing tissues so that the wound heals uneventfully and no post operative prosthetic problem
created.

“Geoffrey L Howe”
What are the indications of tooth extraction?

1-Gross caries (unrestorable tooth)


2-Peri apical pathology

• Non vital teeth with periapical pathology if the endodontic treatment


not an option
3-Very Advanced periodontal disease 3-
4-Extensive fractured heavily restored tooth
5-Severe crowding for orthodontic therapy
6-Impacted teeth and unerupted
7-Supernumerary teeth

• Supernumerary teeth may predispose adjacent teeth to periodontal disease


8-Retianed Decedious teeth
9-Pre radiotherapy for Oral/head and neck cancer
Contra Indications for Extraction

• Systemic Contra indications


• Local Contra indications
Systemic contraindications

•Cardiovascular problems

1-Uncontrolled hypertension
2-Unstable Angina pectoris
3-Recent myocardial infarction
4-Uncontrolled cardiac dysrhythmias

•Uncontrolled metabolic disease

•poorly controlled Diabetes


•Hyperthyroidism
•Osteoporosis
•End stage renal disease with severe uremia

•Malignant disease

Leukemia
Lymphoma
•Blood dyscrasias
Anemia

Hemophilia

Hemorrhagic purpura Polycythemia Platelet disorder.

•Patients on medication should be treated with caution


•Corticosteroid therapy

•Pregnancy is considered a relative


contraindication
Pregnancy is considered a relative contraindication

Avoid first trimester

More safe in the middle trimester


Local Contraindications

1-Absolute contraindication:

Teeth associated with central hemangiomas.


Central haemangioma
2-Relative contraindications

1-Severe pericoronitis around an impacted mandibular molar.

2-Teeth located within an area of tumor, especially a malignancy

3-History of therapeutic radiation for cancer

4-Acute dentoalveolar abscess


Acute dentoalveolar abscess
Haemangioma- Leukaemia-
Malignant lesion in Maxilla
Assessment
• Before considering extraction good history and clinical examination
with proper investigation
Presurgical assessment

Medical history
Dental history (history of difficult extraction , profuse Bleeding )

Patient’s emotional maturity: Level of anxiety


Clinical examination
a- Cardiovascular Problems
b- Pulmonary Problems
• Asthma
• COPD
c- Renal Problems : Renal Dialysis Renal Transplant

d- Hypertension

e-Hepatic Disorders

f- Endocrine Disorders
Diabetes Mellitus

g-Adrenal Insufficiency: Hyperthyroidism Hypothyroidism


h-Hematologic Problems

k-Hereditary Coagulopathies

L-Therapeutic Anticoagulation

M-Neurologic Seizure Disorders


Clinical examination

• ACCESS TO THE TOOTH


1-Mouth opening: First factor to be examined that is the extent to which the
patient can open mouth
.Any limitation to the mouth opening compromise the ability of surgeon to do
routine uncomplicated exodontia.

2-TOOTH ALIGNMENT IN THE ARCH


•Location and position of the tooth to be extracted within a dental arch should be
examined.

•Properly aligned tooth has normal access for forceps placement and elevators

•However crowded or malposed tooth present difficulty in placing proper forceps


MOBILITY OF TOOTH
• Greater than normal mobility-periodontal disease
Less-than-normal mobility- Hypercementosis, Ankylosis.
CONDITION OF CROWN

Assessment of crown before extraction is related to the presence of large caries or


restorations as the likelihood of crushing the crown during extraction is increased.
•It is critical to grasp the forceps as apically as possible.
•If the tooth has large accumulation of calculus, it should be removed with the
scaler before extraction as calculus interferes with placement of forceps and
fractured calculus contaminate the tooth socket.
Assess the condition of adjacent tooth important
RADIOGRAPHIC EXAMINATION
Radiographic examination provides information regarding:
1-The relationship of the tooth to be extracted to adjacent erupted and un
erupted teeth.

2-Primary teeth, the relationship of its roots to the underlying succedaneous


teeth.
3-Relationship of Associated Vital Structures
Maxillary sinus. ID Canal
Tooth factors

• Number of roots of tooth to be extracted.


• Curvature of the roots and the degree of divergence
• short conical roots easier to remove
• long roots with severe abrupt curves at apical end difficult to remove
• Size of the root bulbous or not
• Level of furcation Crown root ratio
CONDITION OF SURROUNDING BONE

Bone is more radiolucent, likely to be less dense which makes extraction easier.

If the bone appears radiographically opaque indicates increased density with the evidence of
condensing osteitis/ sclerosis. More difficult extraction

Periapical pathology.
Osteopetrosis
RELATIONSHIP OF ASSOCIATED VITAL STRUCTURES.

Proximity of the roots of maxillary molar to the floor of maxillary


sinus.
•Only a thin bone exists between the sinus and roots, the potential
for perforation increases chance of communication with maxillary
sinus
• MAXILLARY MOLARS:
• MANDIBULAR MOLARS.
Proximity to inferior alveolar canal.

• MANDIBULAR PREMOLARS. Mental foramen


Evidence of root caries
GENERAL ANXIETY CONTROL PROTOCOL DURING APPOINTMENT

.Non pharmacological
. Pharmacological
Non pharmacologic

• Frequent verbal assurances

• Distracting conversation

• No unnecessary noise

• Surgical instruments out of patient sight

. Relaxing background music


Pharmacologic

A-Local anesthesia of sufficient intensity and duration

B--Sedations:

1- Nitrous oxide

2 -IV anxiolytics (sedations)


Clinical steps in Extractions at the dental clinic
CHAIR POSITION FOR FORCEPS EXTRACTION
For extraction of any teeth Except right mandibular posteriors
The operator stands on the right side of the patient.
For extraction of mandibular right posteriors
-The operator stands behind the patient.
Height of chair
• For Maxillary teeth extraction:
• The chair adjusted -site of operation is about 8cm (3 inches) below the Shoulder level of the
operator.

• For Mandibular teeth extraction:


• The chair adjusted -the teeth to be extracted- 16cm(6 inch)below the level of the operator’s
Elbow.
Infection control

Surgeons prevent transmission of infection –patient themselves.


CONCEPT OF UNIVERSAL PRECAUTIONS -All patients must be
viewed as having blood-borne diseases -can be transmitted to the surgical
team.
Prevention of transmission- surgical gloves, surgical mask, and eyewear with
side shields , surgical gowns and surgical cap.
Before the surgical procedure-a minimal amount of draping - decrease the risk
of contamination.
Before the extraction-antiseptic mouth rinse-reduces the gross bacterial
contamination –reduces post operative infection
Thankyou

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