Extraction Of Teeth

Extraction of teeth

Extraction of Teeth

★ Introduction ★ Indications ★ Contraindications ★ General principle ★ Essential skill ★ Instruments ★ Procedure ★ Healing of extraction wounds ★ Causes of delayed healing of extraction wounds ★ Complications

1. Introduction The extraction of teeth, however accomplished, is a surgical operation involving bony and soft tissues of the oral cavity, access to which is restricted by the lips and cheeks, and further complicated by the movement of the tongue and mandible. It is essential that this phase of oral surgery be given the same careful study and application of sound surgical principles as is given to surgery in any other part of the human body.

1. Indications Teeth are removed from the mouth for a variety of reasons. Although the position of modern dentistry is that all possible measures should be taken to preserve and maintain teeth in the oral cavity, it is still sometimes necessary to remove some of them. This section discusses a variety of general indications for removing teeth. It must be remembered that these indications are recommendations, and not absolute rules.

★ Indications for the extraction of teeth 1. Severe caries: Perhaps the most common and widely accepted reason to extract a tooth is that it is so severely carious that it can not be restored. The extent to which the tooth is carious and is judged to be non-restorable is a judgement call to be made between the dentist and patient.

★ Indications for the extraction of teeth 2. Pulpal necrosis: A second, closed aligned rationale for removing teeth is that there is pulp necrosis or irreversible pulpitis that is not amenable to endodontics. 3. Severe periodontal disease: A common reason for tooth removal is severe and extensive periodontal disease. If severe adult periodontitis has existed for some time, there is excessive bone loss and irreversible tooth mobility. In these situation the hypermobile teeth should be extracted.

1. Indications 4.

Orthodontic reasons: Patients who are about to undergo orthodontic of crowded dentition frequently require the extraction of teeth to provide space for tooth alignment. The most commonly extraacted teeth are the maxillary or mandibular first premolars, but second premolars or a mandibular incisor may occasionally need extraction for this same reason.

1. Indications 5. Malposed teeth: Teeth that are malposed or malpositioned may be indicated for removal in several situations. If they traumatize soft tissue and can not be repositioned by orthodontic treatment, they should be extracted. 6. Cracked teeth: A clear but uncommon indication for extraction of teeth is when the tooth is cracked or has a fractured root. The cracked tooth can be painful and is unmanageable by a more conservative technique.

1. Indications 7. Pre-prosthetic extraction: Tooth occasionally interfere with the design and proper placement of prosthetic appliancesfull dentures, partial dentures or fixed partial dentures. When this happens, pre-prosthetic extraction are necessary.

1. Indications 8. Impacted teeth: Impacted teeth should always be considered for removal. It is clear that an impacted tooth is unable to erupt into a functional occlusion because of inadequate space, interference from adjacent teeth, or some other reason. It should be scheduled for surgical removal.

★ Indications for the extraction of teeth 9. Supernumerary teeth: Supernumerary teeth are usually impacted and should be removal. 10.Teeth associated with pathologic lesions:

Teeth that are involved in pathologic lesions may require removal.

1. Indications 11. Pre-radiation therapy:

Patients who are to receive radiative therapy for a variety of oral tumors should have serious consideration given to removing teeth in the line of radiation therapy.

1. Indications 12. Teeth involved in jaw fractures:

Patients who sustain fractures of the mandible or the alveolar process occasionally need to have teeth removed.

1. Indications 13. Esthetics: Occasionally a patient requests removal of teeth for esthetic reasons. In these situations teeth may be severely stained,as with tetracycline staining or fluorosis, or may be severely malposed, usually protruding.

1. Indications 14. Retained deciduous tooth: When a permanent tooth is present, and in normal position to erupt, the retained deciduous tooth should be removed. 15. Focus of infections: Cysts, chronic osteitis, Granulomatosis, maxillary sinusitis, Rheumatic fever, Optic disease.

2. Contraindications for the extraction of the teeth Even if a given tooth meets one of the requirements for removal, in some situations the tooth should not be removed because of other factors, or contraindications to extraction. These factors, like the indications, are relative in there. In some situations the contraindication can be modified by the use of additional care or treatment and the indicated extraction can be performed; but in other situations the contraindication may be so significant that the tooth should not be removed until the severity of the problem has been resolved.

2. Contraindications The following are Contraindications for the extraction of the teeth: 1. Heart diseases: Patients with any of a variety of severe uncontrolled cardial diseases should also have their extractions deferred until the disease can be brought under control.

Unstable angina pectoris, A recent myocardial infarction, Uncontrolled cardiac dysrhythmia, Uncontrolled hypertension.

2. Contraindications 2. Blood diseases: Patients who have blood diseases should not have teeth removed. ● Aplastic anemia ● Iron deficiency anemia ● Hemolytic anemia ● Megaloblastic anemia ● Leuemia ● Lymphadenoma

2. Contraindications Idiopathic thrombocytopenic purpura ● Hemophilia 3. Bleeding ● Von willebrand syndrome diathesis: ● Severe platelet disorders ● Patients who take anticonagulants ●

2. Contraindications 4. Diabetes: Disease of the pancreas which prevent sugar and starch being absorbed(unless treated). Blood sugar > 8.88mmol/L (160mg/dl)

2. Contraindications ●Nervous systemic symptoms:

5. Throidism

(Grave disease)

easy exciting, nervous ● A group symptoms of high metabolism ● Thyroid edema

2. Contraindications 6. Pregnancy: Pregnancy is a relative contraindication: Patients who are in the first or last trimester should have their extractions deferred if possible. The latter part of the first trimester and the first month of the last trimester may be as safe as the middle trimester for a simple uncomplicated extraction, but more extensive surgical procedure should be deferred until after the child has been delivered.

2. Contraindications 7. Renal

diseases:

All kinds of renal diseases , we should not remove teeth.

2. Contraindications 8. Virus

hepatitis:

Inflammation of the liver.

2. Contraindications 9. Acute inflammation: Patients who have severe pericoronitis around an impacted mandibular third molar should not have the tooth extracted until the pericoronitis has been treated. That is to say, the infection should be controlled first.

2. Contraindications 10. Malignant tumor: Teeth that are located within an area of tumor, especially a malignant tumor, should not be extracted. The surgical procedure for extraction could disseminate cells and thereby the metastatic process. (Picture)

2. Contraindications

11. Long treatment with

suprarenoma 12. Nerve system diseases

2. Contraindications ● Cleidocranial

dysostosis 13.The

other diseases:

● Osteitis deformans ● Osteopetrosis

3.General principle 1. 2. 3. 4. 5.

Academic surgery: theory, skill, practice Confidence: Local anatomy: (picture) The psychology of the patient: The faith inspired by the operator in the patient: 6. Postoperative treatment:

4.Local anatomy

Teeth appearance ( Permanent teeth)

4.Local anatomy

Teeth appearance ( Deciduous teeth)

5.Essential skill ● Asepsis ● Anesthesia

Success in the operation of teeth extraction is dependent on:

● Dexterious technic ● Surgical judgement

6.Instruments

Chisels:

6. Instruments

Surgical Mallet

6. Instruments

Dental curettes

★ Instruments

Gingival separator

★ Instruments dental elevator dental extracting forceps

7.

Procedure

1. To use gingival separator to separate 2. 3. 4.

5.

gingival from tooth. To use elevator to make tooth loose in the alveolar cavity. To use forceps to pull out tooth from the alveolar cavity. To use dental curette to scratch the alveolar cavity in order to clean the dental or bony fragment, debris and granulation tissue. To put thumb and forefinger on either side of the alveolar bone to replace them.

8. Healing of extraction wounds 1. Formation of a blood clot filling the socket. 2. Organization of the clot. 3. Formation of woven bone in the connective. 4. Replacement of woven bone by trabecular bone and remodeling of the alveolus.

Causes of Delayed Healing of Extraction wounds 1. Infection 2. Prolonged bleeding due to a clotting defect. 3. Formation of an oro-antral fistula. 4. Proliferation of a malignant neoplasm. 5. Scurvy.

9 Complications 1.Loosening of adjacent teeth: This is caused by unappropriate use of forceps and elevators. 2. Fracture of adjacent teeth and restorations: This occasionally occurs during a routine extraction procedure. This most commonly occurs with the unappropriate use of elevators.

9

Complications

3. Fracture of the buccal or labial plate: The surgeon who frequently fractures the buccal or labial plate must analyze his technique since this is considered “heavy handed” surgery in the light of more appropriate refined techniques.

9 Complications 4. Teeth or roots into the maxillary sinus: It is possible either during forceps extraction or root retriveal. It is quite easy to displace root of upper molar teeth into the maxillary sinus.

9

Complications

5. Injury to the inferior alveolar nerve: It may occur when the inferior alveolar nerve is closely associated With roots and sometimes with the crown of the mandibular third molar. Operations in this region can easily damage the nerve.

9 Complications 6. Post-operation pain: Post-operation pain which the patient experiences after the second and third postoperative day should carefully examined, since this is not a normal postoperative course. It is caused by dry socket or sharp bone spine.

9 Complications 7. Ecchymosis: This generally is seen following flap especially and is found most often in elder patients, especially women, who have decreased capillary resistance and poor tissue tone. It is caused by continuous postoperative subcutaneous oozing of blood into the tissues.

9

Complications

8. Postoperative hemorrhage: 9.

Local infection: such as dry socket.

10. Damage to soft tissues: 11. Fracture of the jaw.