about Trans alveolar extraction

1. Dr. REVATHY MOHAN
Lecturer
Malabar Dental College & Research Centre

2. INTRODUCTION
 Comprises the dissection of a tooth or root from its
bony attachments
 Method used for recovering the root,that are fractured
during the routine extraction.
 Open or surgical method
 Mucoperiosteal flap is elevated & tooth is extracted
surgically

3. INDICATIONS
 Failed intra alveolar attempt
 Retained root
 Endodontically restored tooth
 Extensively curved or dilacerated root
 Hypercementosed or ankylosed
teeth

4.  when desired to insert a denture soon after
extraction
 Sclerosis of bone
 Impacted teeth or embedded teeth
 Teeth associated with pathology

5. PRINCIPLES OF ELEVATORS
Lever principle:
 Most commonly used principle.
 The elevator is a lever of the first order.
 In this fulcrum is in between the effort and the resistance.

6.  Wedge principle:
 Elevator is forced between the root and the
bone,parallel to the long axis of tooth.
 The wedge is a movable inclined plane which
overcomes a large resistance at right angles to the
applied effort.
 It is usually used in conjuction with the lever principle.

7. Wheel and axle principle:
 Modified form of lever principle.
 The effort is applied to the circumference of a wheel
which turns the axle so as to raise the weight.
 This is applicable to cross bar elevators.

8. PRE EXTRACTION CLINICAL
ASSESSMENT
 Presence of infection
 Access to tooth
 Hypomobility of tooth
 Condition of crown
 Tooth alignment in arch
 Age of patient
 Embedded roots

9. PRE EXTRACTION RADIOLOGICAL
EVALUATION
 Relationship with associated vital structures.
 Configuration of roots.
 Condition of surrounding bone.

10. TECHNIQUE
ELEVATION OF MUCOPERIOSTEAL FLAP
REMOVAL OF OVERLYING BONE
DIVISION OF TOOTH
REMOVAL OF TOOTH
TOILET OF SOCKET
SUTURING

11. ELEVATION OF MUCOPERIOSTEAL
FLAP
 To expose the bone covering the tooth to be retrieved
 Provide adequate access to site of operation
 Base should be wide to have an unimpaired blood
supply
 Avoid major structures
 Can be buccal ,lingual or palatal
 Extended upto a tooth distance on both side
 Should not extend deep into sulcus

12. INCISIONS
 Incise in one continuous stroke through the bone at right
angles to surface mucosa
 Base should be wider
 Dental papilla included wholly
 Flap should be handled gently
 Edges should lie on sound bone
 One relieving incision is sufficient,

16. REMOVAL OF OVERLYING BONE
 Overlying alveolar bone removed to
expose part of the roots of tooth
 Creates pathway to deliver the
tooth
 Should be restricted
 Must be just enough to insert an
elevator or forceps and create a
space into which tooth or root can
be moved
 Bur or chisel used
 Rongeur forceps – for trimming
bone edges after extraction

17. Postage Stamp Method
 Row of small holes made with small bur (No.3)
 Joined together with either bur or chisel
 Minimizes risk of damage to nerves and vessels

19. DIVISION OF TOOTH
 Lines of withdrawal is different for different roots
 Root mass divided
 Seperated roots removed along their path of removal
 Make space for application of forcep / elevator
 Osteotome , chisel ,burs are used

20. REMOVAL OF TOOTH
 Engage the elevator in notch on side of root
 If notch not present then create it with round bur
directed at 45 degrees to long axis of root

21. SOCKET TOILET
 Unwanted bony prominences removed- Rongeur
forceps, chisels,burs
 Smoothening of sharp edges- bone files, vulcanite burs
 Wound irrigated with warm normal saline
 Bone debris & infected granulation tissue removed –
Mitchell trimmer, Cumine scaler

22. SUTURING
 To hold the cut edges to promote healing
 Minimize wound contamination
 Arrest haemorrhage

25. COMPLICATIONS
DURING SURGICAL PROCEDURE:
• Fracture of jaw
• Mucosal lacerations.
• Punture wounds on the surrounding tooth.
• Extraction of wrong teeth.
• Fracture of alveolus.
• Fracture of tuberosity.
• Displacement of tooth into maxillary sinus.

26.  Creation of oro-antral fistula.
 Fracture of mandible.
 fracture of mandible.
 Breakage of instrument.
 Luxation of adjacent tooth.
 Injury to inferior alveolar nerve.
 Injury to lingual nerve.
 Swallowing of teeth.

27. COMPLICATIONS AFTER THE SURGICAL
PROCEDURES:
 Presence of bony spicule.
 Haemorage.
 Infection.

28. REFERENCES
 The Extraction of tooth –Geoffrey .L. Howe
 Textbook of Oral & Maxillofacial Surgery – S.M Balaji
 Textbook of Oral and Maxillofacial Surgery- Neelima
Anil Malik-3rd edition