Exodontia

Dr V.RAMKUMARCONSULTANT DENTAL&FACIOMAXILLARY

SURGEONREG NO:4118 TAMILNADU-INDIA(ASIA)

There are three techniques available for removal of teeth.

The forceps technique (closed method)

Elevator technique,

Open method (transalveolar extraction)

Operator position

POSITION OF VARIOUS QUADRANT

Forceps

Forceps TechniqueIndications Fairly mobile teeth, Extraction of single tooth, Extraction of multiple teeth which are scattered.

Contraindications In complicated extractions, Deformed roots, Hard tissue pathology of roots like hyper-

cementosis etc. Badly destroyed teeth.

Advantages –

It causes the least amount of trauma.

Promotes retention of a satisfactory blood clot.

Favours rapid healing.

Various movement for extraction of individual tooth

Upper central, lateral, canine, first pre-molar, second pre-molar

First apical slight labial/buccal slight palatal rotation with traction

Upper molars First apical buccal palatal deliver the tooth buccaly

Lower central, lateral,canine, first pre-molar, second pre-molar

First apical slight labial/buccal slight lingual rotation with traction

Lower molars First apical buccal lingual deliver the tooth buccaly

Elevators

Elevator technique

Indications –

To luxate teeth which cannot be engaged by beaks of forceps ex: impacted, malposed or grossly destructed teeth.

To remove roots

Contraindications – Damaging of even extraction of adjacent tooth. Fracture of maxilla or mandible. Fracture of the alveolar process. Injuring the soft tissue if proper care is not taken. Penetrating into the maxillary sinus, during

extraction of maxillary posterior teeth. Forcing a maxillary root into the maxillary sinus or

forcing the apical third of the root of the lower third molar into the mandibular canal or into submaxillary or pterygomandibular space depending upon the position of the impacted third molar.

Rules to be followed when using an Elevator – Never use an adjacent tooth as a fulcrum unless

that tooth is also to be removed. Never use the buccal plate at the gingival line as

fulcrum except in third molars. Never use lingual plate as fulcrum at the gingival

line. Always use finger guards to protect the patient in

case the elevator slips. Use interseptal bone as fulcrum. Avoid using an elevator to laxate a tooth which has

a tooth distal to it.

According to use

1. Elevators designed to remove the entire tooth.

2. Elevators designed to remove roots broken off at the gingival line.

3. Elevators designed to remove roots broken off halfway to the apex.

4. Elevators designed to remove the apical third of the root (apical fragment ejectors).

5. Elevators designed to reflect to mucoperiosteum (periosteal elevators).

According to form

1. Straight

2. Angular (right and left)

3. Crossbar (right and left)

Transalveolar extractionSurgical / Open extraction

Indications - All teeth contraindicated for closed method. Grossly destructed or teeth devoid of crown. Teeth with large restorations. Teeth with fractured roots or root caries. Ankylosed teeth. Root canal treated teeth. Firm teeth in aged patients (because of sclerotic

bone). Teeth close to vital structures. Embedded roots.

Principles of incision & flap design for surgical extraction Incision must be made using a fresh sterile

sharp blade. Incision must be firm and made in a single

stroke. Multiple strokes to be avoided. Incision should be down to bone. Incision should not be close to vital structures. Incision should rest on sound bone (on

closure). Incision should be at right angle to epithelial

surface.

Contd.. Flap should provide adequate access to the

surgical area. Base of the flap must be broader than the

apex. Acute angulations while making incisions

avoided. Preferably the width of the flap should be

twice its height. Incisions should be raised in one sweep to

avoid button holes. Tissues should be handled gently. Adequate hemostasis is very essential.

Principles of surgical removal of roots Root has to be located either clinically or

radiographically

Incision

Bone removal (good vision and access to the root)

Chisel vs Bur techniquecriteria

chisel&mallet

Bur

technique difficult easy

Patient acceptance

Not tolerated Well tolerated

Chance of # bone

high less

Healing of bone

good delayed

Post op edema

less more

dry socket less more

Post op infection

less more

Thank You