This document outlines the principles and steps of surgical tooth extraction. It describes the indications for surgical extraction, including teeth with unusual root morphology, hypercementosis, dilacerated roots, ankylosed roots, fused teeth, retained root tips, and deciduous molars that embrace permanent teeth. Contraindications include asymptomatic root tips and situations with risk of local complications. The steps described include flap creation, bone removal, tooth extraction using forceps or elevators, and wound closure. Specific techniques are described for single-rooted, multi-rooted, ankylosed, and retained root extraction cases. Postoperative antibiotic recommendations are also provided.

1. Principles and steps
of
Surgical Tooth
Extraction
Done by :
Dr. Muthanna Ibraheem

2. Surgical extraction is the method by
which a tooth is removed from its
socket, after creating a flap and
removing part of the bone that
surrounds the tooth.
This technique is relatively simple and
can be done by general Practitioner if
the basic principles of the surgical
technique are followed.

3. INDICATIONS
1. Teeth of the maxilla or mandible that present
unusual root morphology.
 In such cases, a surgical extraction is performed
preventively, because their removal is impossible
with the simple technique without complications
arising (e.g., root breaking, fracture of alveolar
bone, etc.).

4. 2. Teeth with hypercementosis of root and
root tip, presenting large bulbous roots.

5. 3.Teeth with dilaceration of root tips.

6. 4. Teeth with ankylosed roots or with
abnormalities, e.g., dens in dente.

7. 5. Teeth fused with an adjacent tooth.

8. 6. Broken root tips that have remained in the
alveolar bone and are involved in osteolytic
lesions.

9. 7. Roots of teeth found below the gumline,

10. 8. Deciduous molars whose roots embrace
the crown of the subjacent premolar.
 If the simple extraction technique were to
be attempted, there is a great risk of
concurrent luxation of the premolar.

11. CONTRAINDICATIONS
 Asymptomatic fractured root tips, whose pulp
was vital, located deep in the socket.
 when there is a risk of serious local
complications, such as the dislodging of a root
tip into the maxillary sinus or injury of the
inferior alveolar nerve, mental nerve, or
lingual nerve.
 A large part of the alveolar process needs to
be removed.
 There are serious health problems present.

12. STEPS OF SURGICAL
EXTRACTION

13. IN GENERAL
1. Creation of a flap.
2. Removal of bone and exposure of an
adequate part of the root.
3. Extraction of the tooth or root with elevators
or forceps.
4. Postoperative care of wound and suturing.

14. A.single-rooted tooth
 An L-shaped incision is
made and the flap is reflected.
 The buccal plate covering the
surface of the root is removed,
 the tooth is extracted
using forceps
1. Extraction 0f Tooth With
Hypercimintosis at the root tip

15. B.Multi-rooted teeth
• The envelope flap is
reflected, part of the buccal
plate is removed,
• Extraction of the mesial
portion of the tooth, which
includes the crown and root
• and the tooth is sectioned
buccolingually at the crown
as far as the intraradicular
bone

16. • Extraction of the distal portion of
the tooth using forceps after
creating a pathway for removal
• Suturing of the flap using
interrupted sutures
• Widening of the alveolus
with a round bur.

17. 2. Extraction of Deciduous
Molar that Embraces
Crown of Permanent
Tooth.
• Envelope flap created and
bone removed as far as the
root bifurcation.
• Roots of the molar sectioned with a
perpendicular groove on the crown,
which extends as far as the
intraradicular bone.

18. • Removal of the mesial portion
of the tooth, which includes the
crown and root.
• Suturing of the flap with
interrupted sutures.
• Removal of the distal
portion of the tooth, which
includes the crown and
root, using forceps.

19. 3. Extraction of Ankylosed Tooth
Radiograph and clinical photograph
of a maxillary canine with dens in dente

20. A trapezoidal flap is created,
which extends from
the lateral incisor as far as the
distal aspect of the maxillary
first premolar.
Use of a chisel to remove the
tooth, together with the ankylosed
portion of the labial plate.
Operation site after
placement of sutures.

21. 4.Surgical Extraction of Retained Roots
A. Single rooted
tooth
Radiograph and clinical photograph
of a maxillary 1st premolar.

22. Creation of an L-shaped incision, which
extends from the mesial aspect of the
canine as far as the distal aspect
of the second premolar

23. Reflection of the flap.

24. Removal of the buccal plate along the
length of the root using a round bur

25. luxation of the root in the outward
direction using a straight elevator

26. Surgical field at the end
of the operation
Smoothing of bone
margins of the wound
using a bone file

27. Operation site after suturing

28. B. Two rooted tooth

29. Creation of an envelope
flap to expose
the roots

30. • the removal of the buccal plate as far
as the root bifurcation.
• Roots are separated using a fissure
bur in the buccolingual direction

31. Luxation of roots after sectioning

32. C. The Semilunar
Incision

33. • Creation of flap
• removal of the
buccal plate and
exposure of the root

34. Removal of the root from the osseous window
using double-angled elevator.

35. • Stabilization of the flap in its initial position
with placement of the first suture at the
center of the semilunar incision.

36. Antibiotic coverage
The recommended Antibiotic for p.o. administration is :
Ampicillin : 500–1000 mg every 6–8 h,
Amoxicillin : 500 mg every 8 h,
erythromycin : (Macrolides) every 12 or 24 h,
Clindamycin : 300 mg every 8 h,
Tetracyclines : 100 mg every 12 h.

37. Thank you