1. Dr. Ashish Kr. Kushwaha
Maxillofacial Surgeon
SBB Dental College
EXODONTIA
2. EXTRACTION -
Is defined as the painless removal of the whole tooth or tooth root,
with minimal trauma to the investing tissues, so that the wound
heals uneventfully and no post-operative prosthetic problem is
created.
4. I. Absolute Contraindications
Haemangioma
A-V Malformation
II. Relative Contraindications
Acute Cellulitis
Uncontrolled Diabetes Mellitus
Hypertension
Bleeding Disorders
Cardiovascular Disease
Patients on long term Steroid therapy
Teeth that have undergone Radiation
5. • CLOSED METHOD / FORCEPS EXTRACTION /
INTRA-ALVEOLAR EXTRACTION - consists of
removing the tooth or root by use of forceps or elevators or
both
• OPEN METHOD / SURGICAL / TRANS-ALVEOLAR
EXTRACTION - consists of dissecting the tooth or root
from bony attachments by removal of some bone investing
the tooth / roots, which are then delivered by use of elevators
and or forceps
6. 1. LEVER & FULCRUM PRINCIPLE :
• 3 basic components- Fulcrum, Effort,
Load
• Fulcrum is present in b/w effort and
load
• Maximum advantage is when effort
arm is longer than load arm.
• Mechanical Advantage - 3
7. 2. WEDGE PRINCIPLE:
• Here 2 movable inclined planes with a base on one end and
blade on other end
• Effort is applied to the base of the plane and resistance has
its effect on slant side
• Used to split, expand or displace the portion that receives it.
• Elevators to luxate tooth when applied b/w bone and tooth.
• Mechanical Advantage – 2.5
8. 3. WHEEL AND AXLE PRINCIPLE:
• Effort is applied to circumference of
wheel which turns the axle so as to
raise the weight
• Greater the diameter of wheel more is
the mechanical advantage
• Used in crossbar elevators for removal
of mandibular roots
• Mechanical Advantage – 4.6
9. 1. Expansion of bony socket by use of wedge shaped beaks of the forceps
& the movement of the tooth itself with the forceps.
2. Removal of tooth from socket
11. Presurgical assessment
Medical history
Dental history (history of difficult extraction)
Clinical examination
Radiographic examination
12. Clinical examination
Presence of infection
Restriction of mouth opening
Condition of the crown of the tooth
Tooth mobility
Tooth alignment in the arch
13. Indications for a preoperative radiograph
History of difficult or attempted extraction
Tooth abnormally resistant to forceps extraction
If a transalveolar approach is going to be used
Teeth or roots in close relationship to maxillary sinus
or inferior dental & mental nerves
14. Heavily restored or pulpless teeth
Tooth subjected to trauma
Isolated maxillary molar
Partially or unerupted tooth
Retained root
15. If only a thin layer of
bone is present between
the sinus & the molar
teeth, there is increased
potential for perforation
of the maxillary sinus
during extraction
17. Basic steps in Forceps extraction
Grasping the tooth – engaging the beaks 1-2 mm
beyond the CEJ
Expansion of the bony socket
Mobilization of the tooth
Delivery of the tooth
19. Basic forces used to mobilize the tooth
Apical pressure
Buccal force
Lingual force
Rotational force
Traction force
20. Application of force related to tooth morphology
Maxillary Anteriors
• Have conical roots
• Lateral incisors being slightly longer & slender
• Canine usually the longest
• Alveolar bone thin on the labial side
• Initial movement in labial direction, a less vigorous palatal
force is then used, followed by rotational force
22. Application of force related to tooth morphology
Maxillary first premolar
◦ Bifurcated usually in the apical 1/3 to ½
◦ Roots extremely thin & subject to fracture
◦ Buccal pressures should be greater than palatal pressures
◦ Rotational force should be avoided
24. Maxillary 1st & 2nd molars
• Have 3 large roots
• buccal roots are relatively close together strong buccal force is used
with minimal palatal forces
28. Mandibular Premolars
• Have tapered roots and their apices may be distally inclined
• Extracted with lateral movements
• Only in the case of the 2nd premolar can initial movements be
rotatory
Mandibular molars
• Have 2 roots flattened mesiodistally
• Strong buccal and lingual motion is used to expand the socket
& the tooth is delivered in the buccoocclusal direction
30. Policy for leaving root fragments
• 3 conditions must exist for a tooth to be left in the
alveolar process
• Root fragment must be small
• Root deeply embedded in bone
• Root must not be infected
31. Immediate complication
• Failure to secure LA
• Failure to remove the tooth
• Fracture of the tooth
• # of the alveolus and max. tuberosity
• Oroantral communication
• Displacement of the tooth or root into the adjacent tissues
• Aspiration of the tooth
32. • # or subluxation of an adjacent tooth.
• Collateral damage to the surrounding soft tissues
• Thermal injuries
• Bleeding
• Dislocation of the TMJ
• # of mandible
• Damage to branches of the TN
33. Delayed complications
Excessive pain , swelling & trismus
Hemorrage
Localized alveolar osteitis (dry socket)
Oroantral fistula
Infection of soft tissues
Nerve damage
Failures of the socket to heal
35. References
• Some early dental extraction instruments including the pelican, bird or axe?
Australian Dental Journal 2002; 47:2
• Fonseca Oral & Maxillofacial Surgery Vol:1
• Contemporary Oral & Maxillofacial Surgery Peterson . Ellis . Hupp . Tucker
2nd Edition
• Textbook of Practical Oral & Maxillofacial Surgery . Daniel E Waite 3rd
Edition
• Minor Oral Surgery Geoffrey Howe 3rd edition
• The extraction of teeth Geoffrey Howe 3rd edition
• The Dental Clinics of North America : Basic procedures in Oral Surgery Apr
1994 38:2
36. • Oral & Maxillofacial Surgery Jonathan Pedlar
• Principles of Oral & Maxillofacial Surgery U J Moore 5th edition
• A synopsis of Minor Oral Surgery G Dimitroulis
• Killey and Kays outline of Oral Surgery Part 1
• Laskin Vol:2
• Dentistry an illustrated history Melvin Ring
• British Journal of Oral and Maxillofacial Surgery, Volume 40, Issue 3, June 2002,
Pages 248-252 I. L. Evans et al
• New England Journal of Medicine May 22 1997