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