Pedia exodontia

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Pediatric Dentistry I
Forth Year

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Pedia exodontia

  1. 1. Dr AZZA TAG ELDIN
  2. 2. EXTRACTION It is the painless removal of the whole tooth or tooth root with minimal trauma to the investing tissues, So that wounds heals uneventfully and no post operative prosthetic problems.
  3. 3. PRINCIPLES  Avoid injury to soft tissues such as the tongue lips, gingiva and cheeks .  Avoid injury to underlying developing permanent teeth and other hard tissues such as bone and adjacent or opposing teeth.  Use radiograph to determine:-  Size and shape of roots.  Amount and directions of root resorption.  Position and stage of development of underlying permanent tooth.  Any pathology.
  4. 4. DIFFERENCE BETWEEN PRIMARY & PERMANENT TEETH  Size:- Primary teeth are smaller in every dimensions compare to their permanent counterpart.  Shape:- Crown of primary teeth are more bulbous. The furcation of primary molar root is positioned more cervically than in the corresponding permanent teeth.  Physiology:- Root of primary teeth resorb naturally where as in the permanent dentition resorption is normally a sign of pathology.  Support:- The bone of alveolus is much more elastic in the younger patient.
  5. 5. These difference means that there are some modification to Extraction technique in children. 1. Type of forceps :-- the beaks & handles are smaller, & to accommodate more bulbous crown the beaks are more curved in forceps designed for removal of primary teeth. 2. The wide splaying of primary molars roots means that more expansion of the socket is required. 3. Due to relatively cervical position of the bifurcation in primary molars it is injudicious to use forceps with deeply plunging beaks. 4. Avoid blind investigation of primary socket. 5. Because of physiological resorption it is often preferable to leave small fragments in situ if root fractures.
  6. 6. PROBLEMS PECULIAR TO CHILD PATIENTS  Natal & Neonatal teeth.  Infra Occlusion of teeth.  Fusion Gemination of two teeth.  Damage to Permanent successor.  Dislocation of the Mandible.
  7. 7. Indication for extraction of deciduous teeth  Badly carious can not be restored.  Over retained primary teeth preventing eruption of permanent successor.  Infection of periapical area can not be treated without extraction.  For orthodontic purpose.  Supernumerary teeth if not needed in dental arch.  In traumatic injury to teeth if vertical fracture occur.  Ankylosed primary teeth that have permanent successor and fails to exfoliate normally.  Impacted teeth.  Ectopically positioned can not be brought into function.
  8. 8. Contraindications for Extractions of teeth in children  Child having bleeding disorder.  Acute infections like stomatitis and acute Vincent’s infections.  Herpetic stomatitis.  Acute pericementitis.  Acute dentoalveolar abscess.  Acute cellulitis.  Malignancy.  Teeth getting irradiation.  Acute or chronic heart disease, congenital heart disease and kidney disease.
  9. 9. PRE - OPERATIVE PREPARATION OF THE PARENT AND CHILD  PARENT- 1. PARENTAL CONSENT BEFORE THE PROCEDURE. 2. INSTRUCT THE PARENT NOT TO DICUSS WITH THE CHILD WHAT THE DENTIST WILL DO.  CHILD- 1. ARMAMENTARIUM SHOULD BE KEPT BEHIND THE CHAIR. 2. NEVER HOLD THE NEEDLE IN FRONT OF CHILD ALWAYS HIDDEN BY FINGERS. 3. BEFORE GIVING THE LA, EXPLAIN TO THE CHILD THAT SENSATION OF PINCHING OR AN ANT BITING MAY BE FELT. 4. CHILD REALIZES THE DIFFERENCE BETWEEN PRESSURE AND PAIN. 5. EXPLAIN THE SENSATION OF NUMBNESS TO CHILD.
  10. 10. Extraction Technique  Patient Position:- The child should be seated in dental chair reclined about 30° to the vertical for extraction under local anesthesia, under general anesthesia supine position.
  11. 11. Extraction Technique Operator position:- When removing upper teeth under LA the operator should stand in front of the patient with straight back and the patient mouth at a level just below the operator’s shoulder. A right handed operator removes lower left teeth from similar position in front of the patient except that the patient mouth is at height just below the operator’s elbow. When removing the teeth from the lower right , the right handed operator stand behind the patient with the chair as low as possible to allow good vision.
  12. 12.  The Non-working hand:- 1. It retract soft tissues to allow visibility and access. 2. It protects the tissues if the instruments slips. 3. It provide resistance to the extraction forces on the mandible to prevent dislocation. 4. It provides feel to the operator during the extraction and gives in formation about resistance to removal.
  13. 13. Upper primary & permanent anterior When these teeth are in normal position: forceps used for primary teeth – upper primary anterior OR upper primary root forceps. forceps used for permanent teeth – upper straight forceps force applied– applying the forceps beaks to the root & then Using clockwise & anticlockwise rotating about long axis.
  14. 14.  Labially placed upper lateral incisor & canine have vary little buccal support & are easily removed, either by using straight forceps . Applied mesially & distally & using a slight rotatory movement or By the use of elevator.  Most commonly used elevator are WARWICK JAMES & COUPLANDS elevator.  Palatally positioned lateral incisors & canine are usually not accessible with forceps & thus elevator are used.
  15. 15. Upper primary molars  These teeth display the most widely splayed roots so considerable  Expansion of socket is required.  Forceps used– upper primary molar forceps  Force applied– initially palatally to expand the socket then continous  Buccaly directed force.
  16. 16. Upper premolars  Forcep used – upper premolar forceps  Removed by the buccal expansion Upper permanent molars  Forceps– left & right upper molar forceps  Removed by expanding the socket in the buccal direction Lower primary anterior  Forceps– lower primary anterior or root forceps  Extracted same as upper anterior.
  17. 17. Lower permanent anterior Root of lower incisors are thin mesiodistally & rotation is likely to cause root fracture so the most effective method of removal:- Is to apply lower root forceps & expand the socket labially. Permanent lower canine may be delivered by rotatory movement or By buccal expansion.
  18. 18. Lower primary molars  Forceps– lower primary molar forcep.  Two pointed beaks which engage the bifurcation.  Buccolingual expansion of socket
  19. 19. Lower premolars Forcep– lower premolar forceps Removed by rotatory movement around the long axis of root Lower permanent molars Two designs of forceps used –1.lower molar forceps -2.forcep of cowhorn design Lower molar forcep have two pointed beaks which are applied in the Region of bifurcation buccally & lingually. Applied the forceps & move the tooth in buccal direction to expand the buccal cortical plate. When buccal expansion is not sufficient to deliver the tooth then the forceps should be moved In a figure –of –eight fashion to expand the Socket lingually as well as buccally.
  20. 20. Management of buried teeth  Buried teeth (including supernumeraries) are treated in children for several reasons - 1. Symptomatic (eg. pain) 2. Radiographic sign of pathology (eg.dentigerous cyst formation) 3. Part of an orthodontics treatment plan
  21. 21. Extraction Of Buried Teeth  Flap design Flap should:- 1. be muco-periosteol. 2. Be cut 90º to bone. 3. Have a good blood supply. 4. Avoid damage to imp. Structures 5. Allow atraumatic reflection. 6. Provide adequate access and visibility. 7. Permit re-apposition of the wound margins over sound bone.
  22. 22. Flap for buccaly placed teeth – 2 designs – Ist Design- Gingival margin as the horizontal component and a vertical relief incision into the depth of the buccal sulcus 2nd Design – Semilunar incision, at least 5 mm of attached gingiva should be maintained at the narrowest point to ensure a good blood supply to marginal gingiva.
  23. 23. Flap for palatally/lingually placed teeth – Palatally positioned teeth are best removed via an incision that follows the palatal gingival margin. Such an incision maintain the integrity of greater palatine nerve & vessels. In the lower jaw adequate access to the lingual side is obtained by raising the lingual gingiva & reflected mucosa via an incision run around the lingual gingival margin
  24. 24.  Bone Removal this may be carried out using a hand piece and bur or by the use of chisels.  Tooth Removal once sufficient bone has been removed to allow identification of the tooth to be extracted & exposure of the greatest diameter of its crown, the tooth should be elevated.  Suturing
  25. 25. POST OPERATIVE COMPLICATIONS  Dry Socket  Aspiration or swallowing of tooth.  Post-operative Bleeding.  Pain.  Swelling.  Infection.
  26. 26. POST OPERATIVE INSTRUCTION  FOR CHILD- 1. The child should not be dismissed until blood clot is formed. 2. Hold a small cotton roll between his teeth for half an hour . 3. Not to bite his lip. 4. Do not disturb the area where tooth was removed. 5. Do not rinse mouth for 24 hours after extraction.  FOR PARENT- 1. Reinforce the child for instructions that already given to him. 2. Light meal with no hard food. 3. Analgesics is prescribed if the extraction was traumatic and antibiotic coverage is done if the area was infected.
  27. 27. CONCLUSION For the young child who requires the removal of primary teeth, the dentist should recognize the proper sequence of all the procedures. The dentist prepares the child by using a sensitive approach through his selection of words that indicate to the child the nature of the procedure.

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