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Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
Principles of Exodontia
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Principles of Exodontia

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Anaesthesia & Exodontia …

Anaesthesia & Exodontia
Third Year

Published in: Education, Health & Medicine
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  • 1. According to American Society of Anesthesiology ((ASA Patients Classified into ASA I; ASA II; ASAIII ;ASA IV & ASA V 20/01/14
  • 2. ASA I Healthy, normal patient Physiologically able to tolerate the stress Without psychological problems No treatment modifications are indicated 20/01/14
  • 3. ASA II Mild systemic disease Can perform normal activity without experiencing distress Healthy patient with more extreme anxiety May need modification in treatment 20/01/14
  • 4. ASA III Severe systemic disease Limited activity but not incapacitated Need stress reduction method during dental treatment May need to alter treatment 20/01/14
  • 5. ASA IV Has an incapacitating disease that is life threatening Patient is in distress at rest No elective dental therapy Emergency treatment should be in hospital setting 20/01/14
  • 6. ASA V Moribund patient - not expected to live 24 hours with or without operation 20/01/14
  • 7. Uncomplicated Exodontia Simple Extraction Closed extraction Conventional extraction Intra-alveolar extraction 20/01/14
  • 8. Indications for removal of teeth • Sever caries • Pulpal necrosis not amenable to • • • • • • endodontic treatment Sever periodontal disease with excessive bone loss Orthodontic reasons Malopposed or malpositioned teeth Supernumerary teeth Cracked teeth Preprosthetic extractions 20/01/14
  • 9. Indications for removal of teeth • Impacted teeth • Teeth associated with • • • • pathologic lesions Preradiation therapy Teeth involved in jaw fractures Esthetics Economics 20/01/14
  • 10. 20/01/14
  • 11. Contraindications for the removal of teeth • Systemic contraindications • Local contraindications 20/01/14
  • 12. Systemic contraindications • Uncontrolled or poorly controlled medical conditions: diabetics, Leukemia , cardiac disease ;end stage renal disease • Severe bleeding diathesis as hemophilia ,or platelet disorder • Pregnancy is a relative contraindication? Safe in the second trimester • Patients on special medications: corticosteroids, immunosuppressive, or chemotherapy 20/01/14
  • 13. Local contraindications • Post-irradiation • Tooth in tumour mass • Tooth in Facture line • Sever pericoronitis • Acute infection and acute dento-alveolar abscess 20/01/14
  • 14. Patient assessment • Level of co-operation • Medical history • Choice of anaesthesia 20/01/14
  • 15. Level of co-operation • All patient to be consented for dental extraction and the procedure explained to them • Most patients are co-operative and can be treated under LA • Conscious sedation and GA should be considered in the following conditions: • Irreconcilable dental phobia • Handicapped patients • Young children below the age of reason • Long procedure • Contraindication to LA 20/01/14
  • 16. Medical history • Patient medical history has to be thoroughly evaluated e.g.: Bleeding problems Immunocompromised patients Ischemic heart disease, cardiac infarction Infective endocarditis Patients with previous radiotherapy to the jaws • Others • • • • • 20/01/14
  • 17. Choice of anaesthesia Judged by: Medical history and Level of co-operation a. Local anaesthesia( LA):  Simple procedures (30-45min)  Single operative site  Accessible areas b. General anaesthesia (GA):  Complicated procedures  Multiple operative sites  Difficult accessibility 20/01/14
  • 18. Clinical Examination .The tooth to be extracted is examined Teeth misplaced palatally or lingually , rotated , inclined or single standing teeth .in occlusion , are all potentially difficult Certain teeth have abnormal root formation, particularly the upper and lower third .molars . Heavily filled and dead teeth 20/01/14
  • 19. Clinical evaluation of teeth for removal • Mobility of tooth • Roots • Surrounding bone • Condition of the crown • Access to tooth • Neighboring vital structures • Radiographic examination 20/01/14
  • 20. Radiographic Examination The dental radiographs reveals the following : 1-Abnormal number, shape or pattern of roots 2-Caries extending into the roots 3-Fracture,resorption, ankylosis or hypercementosis of the roots 4-Approximation of maxillary sinuses; nasal cavity or neurovascular 20/01/14 canal
  • 21. Requirements of Pre-extraction Radiograph A-It should show the whole root structure B-It should show the bone investing C-It should show the relation to any important anatomical structure Types of Radiograph : A-Intra-oral radiograph B-Extra-oral radiograph 20/01/14
  • 22. • Mobility of the teeth • Roots configuration: • Numbers • length • width • ankylosis • hypercementosis • resorption • Surrounding bone: • Bone level • Bone density • Bone pathology 20/01/14

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