Exodontia /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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  • Exodontia /certified fixed orthodontic courses by Indian dental academy

    1. 1. EXODONTIA INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 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. www.indiandentalacademy.com
    3. 3. OBJECTIVES: •Severe the periodontal attachments carefully •Lever the tooth out of the alveolar socket without damaging adjoining structures and anatomical areas. www.indiandentalacademy.com
    4. 4. • • • • • • A good radiograph Adequate anesthesia Instruments Adequate illumination Efficient assistance Suction apparatus www.indiandentalacademy.com
    5. 5. • • • • To gain adequate access and to obtain secured grip on the tooth To apply controlled force in a predetermined direction To severe the dentoalveolar bondage with minimum trauma To safely deliver the tooth in-toto out of the socket through an uninterrupted path of removal with minimum pain and discomfort to the patient. www.indiandentalacademy.com
    6. 6. • • • • • • • • • • Severe caries or pulpal necrosis Severe periodontal disease Therapeutic extraction in orthodontic Rx Impacted,malposed or supernumerary teeth Teeth prior to irradiation Retained decidious teeth Preprosthetic extractions Teeth in line of fractures Infected teeth or teeth associated with pathologic lesions # tooth/root,teeth which are foci of sepsis www.indiandentalacademy.com
    7. 7. • •   ABSOLUTE RELATIVE SYSTEMIC LOCAL www.indiandentalacademy.com
    8. 8. • • • • • • Uncontrolled metabolic diseases like diabetes mellitus,end stage renal disease Bleeding disorders like hemophilia,platelet disorders,uncontrolled leukemias,lymphomas Severe MI,unstable angina pectoris,uncontrolled hypertension Acute adrenaline crisis,long term steroid therapy First and third trimester of pregnancy Toxic goitre,liver disorders www.indiandentalacademy.com
    9. 9. • • • • • Tooth in irradiated area Tooth in area of malignant tumour Third molars with severe pericoronitis Pathology like AV malformation of bone,central hemangioma Acute abscess www.indiandentalacademy.com
    10. 10. • CLOSED METHOD/FORCEPS EXTRACTION/INTRAALVEOLAR 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 www.indiandentalacademy.com
    11. 11. • • • • Access to the tooth Mobility of the tooth Condition of the crown of the tooth Condition of the adjacent tooth www.indiandentalacademy.com
    12. 12. • • • • IOPA with accurate and detailed information concerning the tooth,its roots,and surrounding tissues is preffered. Relationship of associated vital structures Configuration of roots Condition of the surrounding bone www.indiandentalacademy.com
    13. 13. EXTRACTION OF MAXILLARY TEETH www.indiandentalacademy.com
    15. 15. • • • • • • • • • In maxilla ,index finger and thumb of left hand is used to support the maxilla and rest 3 fingers to stabilize patient’s head In mandible,index and middle finger is used to retract and support intraorally ,while thumb supports the mandible.If dentist is standing behind the patient then thumb and index finger is used intraorally and rest 3 fingers support mandible. Retraction of lips,cheek and tongue Guiding beaks of forceps onto tooth Couteracting the pressure applied Prevention and protection against slipping of forceps Prevent broken fillings or tooth fragments before it reaches oropharynx Compressing buccal and lingual cortical plates Examination of surgical field for bony edges,undercuts www.indiandentalacademy.com
    16. 16. 1. LEVER PRINCIPLE OF FIRST ORDER: • 3 basic components-fulcrum,effort,load • Fulcrum is b/n effort and load • Maximum advantage is when effort arm is longer than load arm • Used in forceps along with wheel and axle and in elevators www.indiandentalacademy.com
    17. 17. 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/n bone and tooth • Forceps when inserted b/n mucoperiosteum and surface of tooth www.indiandentalacademy.com
    18. 18. 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 Forceps –applied in the form of arc www.indiandentalacademy.com
    19. 19. Forceps can be applied in five major motions. 1.Apical pressure 2.Buccal pressure 3.Lingual pressure 4.Rotational pressure 5.Tractional pressure www.indiandentalacademy.com
    20. 20. 1.Adequate anesthesia 2.Loosening of soft tissue attachment from the tooth -using woodson elevator or sharp end of no.9 periosteal elevator 3.Luxation of tooth with a dental elevator 4.Adaptation of forceps to the tooth 5.Luxation of tooth with forceps 6.Removal of tooth from the socket www.indiandentalacademy.com
    21. 21. First is the apical force. • Central incisors-labial pressure,lingual,then labial with mesial rotation • Lateral incisors-labial with mesial rotation • Cuspids-labial,lingual,labial with mesial rotation • 1st PM-Buccal,lingual,removal in buccal direction • 2nd PM-Buccal,lingual,removal in lingual or buccal direction • 1st &2nd molar-buccal,lingual & removal in buccal direction • 3rd molar-buccal & distal rotation www.indiandentalacademy.com
    22. 22. First is the apical force. • Central & lateral incisors-labial,lingual,slight mesio-distal & removal in labial direction • Cuspids-labial pressure with mesial rotation • 1st & 2nd PM-Buccal pressure with slight mesio-distal rotation • 1st,2nd & 3rd molar-buccal,lingual & removal in buccal direction www.indiandentalacademy.com
    23. 23. • • • • • • Saline or betadine irrigation Thorough curettage in case of periapical lesion Compress bucco-lingual plates with finger pressure In case of severe periodontitis excessive granulation tissue must be removed Sharp bony projections if any must be smoothened with bone file Gauze pressure pack for control of bleeding www.indiandentalacademy.com
    24. 24. • • • • • • • • • Explain the patient effects of LA Hold the gauze in mouth for atleat half an hour Avoid spitting and gargling for the day Warm saline rinses after 24hrs Not to disturb the area with finger or tongue Avoid hot,spicy and hard food Analgesics ,antiinflammatory for 3 days Antibiotics if patient is immunocompromised Avoid brushing in the area for 24hrs www.indiandentalacademy.com
    25. 25. 1.Operator’s fault-application of incorrect instrument and force -improper technique of application -improper motions 2.Structural abnormality of tooth-excessively curved roots -RC treated nonvital tooth -teeth with gross filling -extensively carious teeth -ankylosis or hypercementosis 3.Surrounding bone-sclerosis or condensing osteitis 4.Unco-operative patient www.indiandentalacademy.com
    26. 26. • • • • • Retained roots might prove as a source of infection,chronic irritation giving rise to neuralgic pain or might interfere with proper functioning of denture Excellent light and suction Closed technique when tooth is well luxated and mobile before fracture Root tip pick,small elevator,forceps with slender beaks,reamers If not then open method should be attempted www.indiandentalacademy.com
    27. 27. • • • First is usually maxillary teeth as they get anesthetized earlier and prevents fall of enamel or amalgam/debris into mandibular socket Most posterior teeth is extracted first The order is 3rd molar,2nd molar,2nd premolar,1st molar,1st premolar,lateral incisor,canine,central incisor. www.indiandentalacademy.com
    28. 28. • • Indications-gross caries involving pulp -retained primary teeth interfering with normal eruption of permanent successor -periapical pathology/root fracture Technique -smaller forceps -for U/L anteriors labial pressure with mesial rotation and removed to labial side -for U/L molars buccal pressure ,lingual pressure and removed to lingual side -force applied is less and forcep need not be inserted too deep along the root -care should be taken not to damage permanent successor www.indiandentalacademy.com
    29. 29. INDICATIONS: • Any tooth which resists attempt at closed extraction • Heavy/dense bone,short clinical crown due to attrition • Hypercementosis,ankylosis,geminated & dilacerated roots • Impacted tooth • Retained fractured tooth/roots which cannot be grasped with forceps or elevators • Roots in close proximity with vital structures like nerve or sinus • Grossly destructed,heavily restored,RCTreated • Prosthetic considerations www.indiandentalacademy.com
    30. 30. • • • • • • • • • Anesthesia-LA,plan for incision Elevation of mucoperiosteal flap Removal of bone-chisel mallet or bur Division of tooth if required Removal of tooth and roots Control of bleeding Alveoloplasty if required Toileting of the alveolar socket Suturing of flap www.indiandentalacademy.com
    31. 31. The term local flap indicates a section of soft tissue that • Is outlined by a surgical incision • Carries its own blood supply • Allows surgical access to underlying tissues • Can be replaced in the original position • Can be maintained with sutures and is expected to heal www.indiandentalacademy.com
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    33. 33. 1. ENVELOPE FLAP:most common flap -2 teeth anterior and one teeth posterior to area of surgery -releasing incision 1 tooth ant and 1 tooth post -3 cornered or 4 cornered 2. SEMILUNAR :to approach root apex -avoids trauma to papilla & gingival margin -limited access,used in periapical surgery -should not cross canine eminence 3. Y INCISION:palatal tori,preserves greater palatine artery www.indiandentalacademy.com
    34. 34. -no.15 blade is used on a no.3 scalpel handle and held in a pen grasp -blade is held at an angle & incision is made posteriorly to anterior in gingival sulcus -smooth,continuous stroke with blade in contact with bone -if vertical incision is to be placed ,tissue is apically reflected,with opp hand tensing the alveolar mucosa www.indiandentalacademy.com
    35. 35. -start reflecting from papilla using woodson elevator or sharp end of no.9 periosteal elevator -carried out in pushing stroke,posteriorly and apically -once reflected flap is held with seldin or minnesota or austin retractor retsing firmly on sound bone. www.indiandentalacademy.com
    36. 36. Bone removal must be limited carried out with dental burs or chisel with hand or mallet pressure CHISEL & MALLET: • Quicker and cleaner • Maxillary buccal and lingual plates can be removed • Limiting cuts are placed vertically and then joined by horizontal cut • If force is not controlled it might lead to fracture of basal bone or adjacent teeth DENTAL BURS: • Used for dense mandibular bone • Round bur no.8 or rose head burs are used,cut efficiently,do not clog,easier to control. • www.indiandentalacademy.com
    37. 37. • • • • • flap must be held away from the site with a retractor Bur must not be allowed to overheat during bone removal,frequent irrigations with sterile normal saline should be used to prevent this and also removes debris and prevent bur from clogging Bone might be removed by either simply cutting it away or by bone guttering. A row of small holes is made with small bur along buccal crest and joined with fissure bur or chisel cuts.A gutter is formed.This is called postage stamp method. In case of lower PM,bone removal should be maximal medial to 1st PM and distal to 2nd PM to minimize damage to nerve & vessels traversing mental foramen www.indiandentalacademy.com
    38. 38. • • Accomplished with a straight hand piece with a straight bur such as no.8 round bur or fissure bur no.557 or no.703 Sectioning is done from below upwards so that operator knows when the roots are completely divided www.indiandentalacademy.com
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    45. 45. Root fragment must be small,not more than 3-4mm • It must be deeply embedded in bone,to prevent subsequent bone resorption from exposing tooth root & interfering with prosthesis. • Must not be infected & no radiolucency around root apex than The risk of surgery must be greater than benefit such as: • Removal causes excessive destruction of surroundin tissue,bone or gingiva • Endangers vital structures like inf alveolar nerve • There are chances of displacing root into tissue spaces or into maxillary sinus Patient must be informed about the judgement and consent must be obtained. • www.indiandentalacademy.com
    46. 46. • • • • • • Check for sharp bony edges and filng has to be done. Currettage if there is periapical lesion Thorough irrigation with normal saline/betadine. Most inferior portion of flap is common place for debris to settle especially in mandibular extractions which causes delayed healing or even small subperiosteal abscess in 3-4 days Flap is then set in original position & sutured in place with 3-0 black silk sutures Pressure pack is placed www.indiandentalacademy.com
    47. 47. Similar to that for closed method • Inform the patient about swelling • Antibiotics & analgesics • Cold pack application may be advised Recall the patient after 5 days for suture removal and access the healing. • www.indiandentalacademy.com
    48. 48. • • Presurgical assessment of the patient includes evaluation of level of anxiety,determination of health status and necessary modifications of routine procedures,evaluation of clinical presentation of tooth to be removed,and radiographic evaluation of tooth root and bone. All four factors must be weighed when estimating difficulty of extraction and least traumatic and efficient tooth removal should be performed. www.indiandentalacademy.com
    50. 50. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com