Transcript Tooth extraction

TOOTH EXTRACTION:
Dr.Mumena C.H
Tooth extraction
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Topics to be covered;
 Introduction
 Indication
of preoperative radiographs
 Indications of tooth extraction
 Contra-indications of tooth extraction
 Instruments and instrumentation
 Techniques of tooth extraction
 Complications of tooth extraction
Tooth extraction introduction
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Divided into
 Exodontia
 Odontectomy
Purpose of procedure:
 Carry out the procedure painlessly and removal of all tooth
material with least trauma sothat healing can occur without
complications.
Soft tissues and bone involved in the procedure.
Cross infection control very important at all times.
Presence of lips, cheeks, the mobility of tongue and saliva flow
complicate this procedure.
Tooth extraction introduction cont…:
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Tooth extraction is a surgical procedure like all
others.
All basic principles applicable during surgery
should be strictly adhered to during tooth
extraction.
Sometimes not only desirable but absolutely
essential to take pre-operative x-rays of the tooth
which is to be extracted.,
Preoperative radiographs
Indications of pre-operative x-rays
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Hx of difficulty extracttions
Difficulty extractions (Tooth does move during
attempted removal)
Operator decides odontectomy
Tooth in unfavourable position with regard to
anatomical structures (Maxillary sinuses, inferior
alveolar nerve).
Misplaced tooth (worry-dilacerations if frequent).
Indications of pre-operative x-rays
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Wisdom teeth
Heavily filled teeth
Non-vital teeth
Chronically inflamed gingiva with sclerosis of the
bone.
Traumatized teeth
Lone standing maxillary molars
Partially erupted teeth
Indications of pre-operative x-rays
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Root fragments
Teeth with abnormal crowns or delayed eruption
(worry: dilaceration or ankylosis)
Systemic conditions which may point to bone
abnormalities e.g
 Osteitis
deformans
 Cleido-cranial dysostosis
 Paget’s disease
Indications of pre-operative x-rays
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X-rays are of cardinal importance.
X-rays must be taken of edentulous areas,
irrespective of how long ago the teeth were
removed,
Underlying bone pathology must be excluded
(Remaining roots, unerupted teeth, foreign bodies
e.t.c.)
Indications for tooth extractions
Indications for tooth extractions
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Extraction of tooth must be done selectively.
Determine whether the tooth concerned should be
extracted.
The operator must use his/her professional and
scientific judgement as to what is best for the
particular pt under the current circumstances.
The following are few guidelines when considering
extraction:
Indications for extraction
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Carious lesion
 Un-restorable
teeth
 Endodontically /apicectomy not possible
 Rootless
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Periodontal disease
 Severe
endo/perio lesions
 Little/or no bone support for teeth
Indications for extraction
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Prosthetic reasons
 Single
tooth in edentulous jaws
 Severely overerupted teeth
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Orthodontic reasons
 Extraction
to create space
 Impactions
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Surgical reasons
 Impacted
teeth
 Teeth in fracture line
Indications for extraction
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Surgical reasons cont…
 Fractured
roots
 Teeth related to cysts/tumors
 Teeth related to malignancies/radiotherapy
 Teeth related to severe infections
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Socio-economic reasons
 Severely
mentally handicapped pt where conservative
treatment not possible
Indications for extraction
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Deciduous teeth
Complete root resorption
 Incomplete root resorption (ectopic secondary tooth
eruption)
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Note that there may be cases where the extraction of
tooth may be indicated but where there certain
contra-indications,
It is imperative that thorough history of the and
clinical examination be conducted before commencing
extractions or any other surgical procedure.
Contraindications for extraction
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Divided into systemic factors and local factors,
Systemic factors include:
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Cardiac diseases; take history, examine the patient. Is
history suggesting possibility of cardiac diseases, is the
patient under physician’s care,
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Coronary artery diseases including HT and DM
Artificial heart valves,
Rheumatic fever,-danger of developing infective
endocarditis,
Certain blood dyscrasias e.g pt on anticoagulants
Contraindications for extraction cont…
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Patient’s general health
Malignant conditions and patients on radiotherapy
Acute infections
Rheumatic fever
Thrombocypenia purpura-these patients usually
present with petechiae (hemorrhage sports),
spontaneous gingiva bleeding, etc.
Anaemia – Hb as low as 8g/dl or below do not
extract tooth.
Contraindications for extraction cont…
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Leukemia- consult the physician or hematologist,
before attempting anything to this patient,
Jaundice – yellow discolouration of the mucous
membrane, fingers, etc, and this can be due to liver
cirrhosis, hepatitis. In this patient there is liver
problem suggesting derangement of vit k
dependent factors. Check for bleeding indeces.
Contraindications for extraction cont…
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Pregnancy – three management phases
Emergency
 Necessary but not emergency
 elective
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Treatment recommended at 2nd trimester, first
trimester there is risk for abortions, while 3rd trimester
size of the uterus makes patient uncomfortable,
Emergency situation;
Toothache,
 Bleeding tumor
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Contraindications for extraction cont…
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Necessary but not emergency
 Chronic
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Periapical abscess (I&D)
Elective
 Impacted
tooth
 Cosmetic prognathism
Local contraindications
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All acute inflammatory process in the oral cavity,
Ulcerative necrotizing gingivitis,
Acute dental alveolar abscess,
N.B – control the infection first before you carry out
an extraction.