THE PAINLESS REMOVAL OF WHOLE TOOTH,OR ROOT,WITH MINIMAL TRAUMA TO THE INVESTING TISSUES,SO THAT THE WOUND HEALS UNEVENTUALLY AND NO POST- OPERATIVE PROSTHETIC PROBLEM IS CREATED .

1. By-Dr. Prathamesh Fulsundar

2. WHAT IS
EXODONTIA?
• THE PAINLESS REMOVAL OF WHOLE TOOTH,OR
ROOT,WITH MINIMAL TRAUMA TO THE
INVESTING TISSUES,SO THAT THE WOUND HEALS
UNEVENTUALLY AND NO POST- OPERATIVE
PROSTHETIC PROBLEM IS CREATED .
• BY GEOFFRAY .L.HOWE

3. TWO TYPES :
1. UNCOMPLICATED
2. COMPLICATED

4. PRINCIPLES AND
TECHNIQUES FOR
SURGICAL EXTRACTION
 Surgical extraction of an erupted tooth is a
technique that should not be reserved for
extreme situations.
 A prudently used open technique may be more
conservative and cause less morbidity than a
closed extraction.
 Forceps extraction techniques that require
greater force are at a higher risk than open
extraction techniques.

5.  Forceps extraction of these teeth resulted
in removal of bone and tooth, instead of just
tooth.

6. INDICATIONS FOR SURGICAL EXTRACTIONS
1. BRUXISM 2. HYPERCEMENTOSIS

7. 3.DILACERATION 4.FUSION

8. 5. WIDELY DIVERGENT
ROOTS
6. EXPANSION OF
MAXILLARY SINUS

9. 7. LARGE RESTORATIONS 8. IMPACTED TEETH

10. 9. RETAINED ROOTS
10. DENSE BONE:
The extraction of most teeth depends on the expansion of the buccocortical
plate. If this bone is heavy, adequate expansion is less likely to occur and
fracture is more likely.

11. PRINCIPLES OF COMPLICATED
EXODONTIA –surgical or
open method of tooth extraction
1. Surgical method of tooth extraction is used when there
are broken or fractured root tips or when tooth cant be
extracted by normal ways of extraction
2. Principles of flap design ,development and
management flap is a local section of soft tissue that
fallows following point -

12. DESIGN PARAMETERS OF SOFT
TISSUE FLAPS –

13. TYPES OF MUCOPERIOSTEAL FLAPS :
1.ENVELOP FLAP -
2.THREE CORNERED FLAP

14. 3) FOUR CORNERED FLAP –
•Flaps should avoid injury to vital
structures like nerves and vessels .

15. 4) SEMILUNAR FLAP-
5 Y-INCISION –

16. Technique for developing a
mucoperiosteal flap

17. TECHNIQUE FOR OPEN EXTRACTION OF
SINGLE -ROOTED TOOTH

18. If root is fractured at level of bone, buccal
beak of forceps can be used to remove small
portion of bone at same time that it grasps root.

19. The third option is to use the straight elevator as a
shoehorn elevator by forcing it down the periodontal
ligament space of the tooth.

20. A small wiggling motion Is used which expands
the periodontal ligament space which allows
the small straight elevator to enter and act as a
wedge to displace the root occlusally.

21. Removal of bone:
From the buccal surface,
mesiodistal width of the
bone removal should be
approximately the
mesiodistal dimension of
the tooth root
Bone should be removed
approximately one half or
two thirds the length of
the root.

22. Removal of the root

23. Purchase point is made in the root at the
most apical position when the tooth is
difficult to extract even after removal of
bone.

24. Crane’s pick elevator is used to elevate the
tooth .

25. Envelope incision is
made
Reflection of flap, crestal
bone is removed to expose
bifurcation
TECHNIQUE FOR SURGICAL REMOVAL OF
MANDIBULAR MOLARS

26. Tooth sectioning is done with a straight hand piece with
a straight bur, the no. 8 round bur, or with a fissure bur -
the no. 557 or no. 703 bur.

27. Straight elevator Is used to luxate the roots

28. No 151 forceps is then used to extract the tooth.

29. Alternative method of sectioning is to use bur to
remove mesial root from first molar.

30. WHEN CROWN OF LOWER MOLAR IS LOST

32. TECHNIQUE FOR SURGICAL REMOVAL OF
MAXILLARY MOLARS

33. The bur is used to section the mesio buccal and the
distobuccal roots. With the help of molar forceps the
crown along with the palatal root is removed in the
bucco occlusal direction.

34. WHEN THE CROWN IS LOST

35. REMOVAL OF FRACTURED
ROOT TIPS AND FRAGMENTS
FRACTURE OF APICAL 1/3 OF THE ROOT CAN
OCCUR AND IS REMOVED BY –
• IRRIGATION-
Vigorous irrigation and suction
with small tip (antral lavage).
• CLOSED TECHNIQUE-
By using root tip pick inserted in
PDL space and teased out of the socket.

36. • If the irrigation –suction technique is
unsuccessful ,the next step is to tease the loose root
apex from the socket with a root tip pick.
• A root tip pick is a delicate instrument .
The root tip pick is inserted into the PDL space and the
root is teased out of the socket.

37. ROOT TIP PICK USED TO RETRIEVE ROOT TIP GENTLY
FROM THE SOCKET.

38. • Excessive apical force could result in displacement of
root tip into other anatomic locations such as
maxillary sinus .

39. The root tip can also be removed with a small straight
elevator .This technique is indicated for the removal
of larger root fragments than root tips .
If the closed technique is unsuccessful the surgeon should switch
without delay to open technique.

41. A. Three cornered flap is reflected to expose area overlying apex of root fragment being
recovered .
B. Bur is used to uncover apex of root and allow sufficient access for insertion of straight
elevator.
C. Small straight elevator is then used to displace tooth out of tooth socket.

42. POLICY FOR LEAVING ROOT
FRAGMENTS
• When a root tip has fractured , when
closed approaches of removal have
been unsuccessful ,& when the open
extraction is extremely traumatic,
the surgeon may consider leaving
the root in place.
• As with any surgical approach the
surgeon must balance the benefits
of surgery, against the risk of surgery
.

43. • The root fragments must be small
• The root should be deeply embedded in
bone and not superficial.
• The tooth involved must not be infected
,& there must be no radiolucency around
the root apex.

45. If the surgeon elects to leave a root piece in place
a strict protocol is observed -
• The patient must be informed
that, in the surgeons
judgement leaving the root in
its position will do less harm
than surgery.
• In addition, radiographic
documentation of the root tips
presence and position must
be obtained and retained in
the patients record.

46.  FUNCTIONS OF SUTURES :
 To Coat wound margins.
 Sutures also aid in
hemostasis.
 Sutures help hold a soft
tissue flap over bone.
PRINCIPLES OF SUTURING

47. Sutures may aid in maintaining a blood clot in the
alveolar socket (by a special stitch called figure-
eight) .

48. ARMAMENTARIUM :
NEEDLE HOLDER
A SUTURE NEEDLE
SUTURE MATERIAL

49. TECHNIQUE OF SUTURING

50. PASSAGE OF NEEDLE THROUGH SOFT
TISSUE MUCOSA

51. SUTURING BY INSTRUMENT TIE
TECHNIQUE :

54. WHEN THREE-CORNERED FLAP
IS USED :

55. Simple interrupted
suture

56. HORIZONTAL SUTURE

57.  Sutures are left in place for approximately
5 to 7 days.
 After this time they play no useful role
and, in fact, probably increase the
contamination of the underlying sub-
mucosa .
 When the sutures are removed , the
surface debris that has collected on them
should be cleaned off with a cotton-tipped
applicator stick soaked in peroxide ,
chlorhexidine , iodophor , or other
antiseptic solution.
 The suture is cut with sharp, pointed
suture scissors and removed by pulling it

58. CLOSURE OF OPERATING FIELD WITH
SURGICAL DRESSING
SUTURE REMOVAL

59. THANKYOU