TEETH EXTRACTION
(EXODONTIA)
Dr. Shikha Adhikari
EXTRACTION (EXODONTIA)
The painless removal of the whole tooth, or root, with
minimal trauma to the investing tissues, so that the wound
heals uneventfully & no post-operative prosthetic
problem is created.
INDICATIONS OF EXODONTIA
[Link] with deep caries or severe abrasion, which can not
be treated by fillings and crowning.
[Link] with severe periodontal disease.
3. Teeth with non-vital pulps, or with acute or chronic
pulpitis when root canal treatment is not possible.
4. Teeth with periapical pathology such as abscess,
granuloma, or cyst; if other treatment can’t be performed.
5. Teeth interfering with the stability and fitness of
dentures and bridges.
6. Teeth traumatizing soft tissues. If no other
treatment will prevent this trauma.
7. Malposed and crowded teeth not responding to
orthodontic treatment as request of the orthodontist.
[Link] may be extracted to facilitate correction of
jaw deformities.
9. Impacted teeth and unerupted teeth or embedded
teeth.
10. Supernumerary teeth.
11 Retained deciduous teeth to facilitate eruption of
normally positioned permanent teeth.
12. Teeth with fractured roots.
13. Teeth involved in the fracture lines of the jaws.
14. Remaining fractured roots and fragments.
15. Teeth should be extracted and a very extensive
alveolectomy performed before radiation therapy for oral
malignancy
CONTRAINDICATIONS:
A. Absolute: Central Hemangioma: May cause
uncontrolled bleeding.
A-V malformation.
B. Relative: When some precautions have to be taken.
1. Local
Acute cellulitis
ANUG,
Acute pericornitis,
Acute osteomyelitis
CENTRAL HEMANGIOMA, A-V
MALFORMATION.
ACUTE CELLULITIS, ANUG
ACUTE PERICORNITIS,
OSTEOMYELITIS
2. Systemic:
Uncontrolled Diabetes Mellitus
Uncontrolled Hypertension.
Bleeding disorders.
Cardiovascular diseases.
Liver disorders.
Patients on long-term steroid therapy.
Teeth that have undergone radiation (6 months-1year)
LOCAL ANESTHESIA
Definition : loss of sensation in a circumscribed area in
the body, caused by a depression of excitation in nerve
endings or an inhibition of conduction process in
peripheral nerves after the administration of anesthetic
agents through local route.
Lidocaine+adrenaline (most commonly used)
PROCEDURES
A. maxillary anesthetic technique
1. local infiltration
2. field block
3. nerve block
B. mandibular anesthetic technique
1. local infiltration
2. field block
3. nerve block
MAXILLARY NERVE BLOCKS
Nerve block Area anesthetized
Anterior superior alveolar nerve block Upper central incisor, lateral incisors, canine
and surrounding soft tissues and alveolar bones
Middle superior alveolar nerve block 1st and 2nd premolars mesiobuccal root of 1st
molar and surrounding soft tissues and alveolar
bones
Posterior superior alveolar nerve block Upper 1st molar except mesiobuccal root, 2nd ,
3rd molar and surrounding soft tissues and
alveolar bones
Greater palatine nerve block Hard palate, mucosa, from molars to 1st
premolar
Nasopalatine block Mucosa and bones from anterior palate to
canine
Infraorbital nerve block lower eyelid, side of nose, and areas supplied
by middle and anterior superior alveolar nerves.
MANDIBULAR NERVE BLOCKS
Nerve block Area anesthesized
Inferior alveolar nerve block One side of tongue, teeth from
midline to molars and
supporting tissues
Buccal nerve block Buccal surface of molars and
supporting tissues
Incisive nerve block Incisors to canines teeth and
supporting tissues
CLINICAL EVALUATION OF
TEETH FOR REMOVAL
Mouth opening(incisal opening)
Adjacent teeth
Soft tissue inflammation and swelling
Access to tooth
Mobility of tooth
RADIOGRAPHIC EVALUATION
OF TEETH FOR REMOVAL
For determining:
1. roots: number, curvature and if root canal
treatment performed then teeth is very brittle
Bone height, density, apical pathology
Vital structures: inferior alveolar nerve, maxillary
sinus
SEPARATION AND REFLECTION OF
TOOTH FROM SOFT TISSUE
Severing Soft Tissue Attachment around the teeth by
periosteal elevator
TECHNIQUE OF EXODONTIA
Intraalveolar extraction(closed technique)
Transalveolar extraction(open method)
INTRAALVEOLAR
EXTRACTION(CLOSED TECHNIQUE)
Steps to carry out simple extraction
Step 1 ( severing/loosening the soft tissue attachment around the
tooth)
Seperating the tooth gingiva
Step 2 (luxation of tooth with dental elevator(optional step))
Step 3 (adaptation/application of forceps to the tooth)
Step : use forcep to luxate the teeth.
Step 5 : removal of tooth from the socket
Step 6 : compress the socket
POST EXTRACTION
INSTRUCTIONS
Day of surgery
Keep the gauze in your mouth for an hour or two, maintaining
firm pressure, and change them every half hour as needed.
Always keep your head up.
Apply ice to the cheek at regular intervals (20 minutes of ice
every hour).
If you are bleeding, take a lightly moistened gauze pad or tea
bag and bite down on the pad or tea bag for 20 minutes.
Blood flow and saliva staining are normal postoperative
effects.
Limit your physical efforts. Get some rest.
Do not dislodge the blood clot that has formed, as it helps
healing.
Do not eat anything until the bleeding has stopped.
Avoid drinking through a straw(dry socket)
Avoid rinsing your mouth or forceful spitting.
Do not smoke(dry socket ) or drink alcohol.
Do not eat hard foods from that operated side.
Eat lukewarm, soft foods only.
Avoid brushing your teeth near the extraction area for the
first 72 hours.
Pain
If you are bothered by pain, take the medication that has
been prescribed for you.
If you have antibiotics prescribed for this treatment,
continue to take them for the period of time indicated,
even if the symptoms disappear.
Diet
Eat only soft foods or warm liquids on the day of
extraction. Return to your regular diet as soon as you are
able.
From the next day until full recovery
Rinse your mouth three times a day with warm
water and salt (2 ml or 1/2 teaspoon of salt in 250
ml or 1 cup of water).
Brush and floss your teeth daily to remove plaque
and ensure better long-term results. Avoid brushing
the extraction area for the first 72 hours.
Avoid eating hard foods (nuts, candy, ice cream)
You may have difficulty with pronunciation and increased
saliva. This should settle down within a week.
Bruises may appear on the skin. They will disappear after
five to seven days.
You may have difficulty opening your mouth. This should
subside after four to five days.
If, after three days, the pain increases instead of
decreasing, call us.
INDICATION FOR FOLLOWUP
AFTER EXTRACTION
After 7 days of open extraction, recall for removal of
sutures
If continuous pain thatdoesnt relieve after taking
analgesic after 3to 7 days of extraction (dry socket ):
sedative dressing
If abscess present near the extraction sockets: irrigation
Followup if felt necessary
THANK YOU