1. The document discusses indications and contraindications for tooth extractions. Common indications include severe tooth decay, non-restorable pulpal necrosis, advanced periodontal disease, orthodontic reasons, malpositioned teeth, cracked teeth, impacted teeth, supernumerary teeth, and teeth involved in pathologic lesions or jaw fractures. 2. Absolute contraindications for extraction include uncontrolled metabolic disorders like diabetes, cardiac problems, leukemia, renal failure, and liver disorders. Relative contraindications include conditions where extraction should be deferred until the underlying condition is addressed. 3. Local contraindications include a history of radiation therapy in the extraction site, teeth located near a tumor, pericoronitis, and acute dent

1. EXODONTIA
Chapter two
Indications & Contraindications
SENIOR LECTURER DR. HAYDAR MUNIR SALIH ALNAMER
BDS, PHD (BOARD CERTIFIED)

2. “
”
Indications of exodontia
Teeth are extracted for a variety of reasons. This section discusses a
variety of general indications for removing teeth. These indications
are only guidelines, not absolute rules

3. 1. Caries
 Perhaps the most common and widely accepted reason to remove
a tooth is that it is so severely carious that it cannot be restored.
 The extent to which the tooth is carious and is considered non-
restorable is a judgment call to be made between the dentist and
the patient.
 Sometimes the complexity and cost required to salvage a severely
carious tooth also makes extraction a reasonable choice. This is
particularly true with the availability and success of reliable
implant-supported prostheses

4. 1. Caries
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Dr. Haydar Munir Salih

5. 1. Caries
Dr. Haydar Munir Salih Dr. Haydar Munir Salih

6. 1. Caries
Dr. Haydar Munir Salih Dr. Haydar Munir Salih

7. 1. Caries
Dr. Haydar Munir Salih

8. 2. Pulpal Necrosis
 A second, closely aligned rationale for removing a tooth is the
presence of pulpal necrosis or irreversible pulpitis that is not
amenable to endodontics.
 This may be the result of a patient declining endodontic
treatment or when a tooth has a root canal that is tortuous,
calcified, and untreatable by standard endodontic techniques.
Also included in this category of general indications is the case in
which endodontic treatment has been done but has failed to
relieve pain or provide drainage, and the patient does not desire
retreatment

9. 2. Pulpal Necrosis

10. 2. Pulpal Necrosis

11. 3.Periodontal Disease:
 A common reason for tooth removal is severe and extensive
periodontal disease.
 If severe adult periodontitis has existed for some time, excessive
bone loss and irreversible tooth mobility will be found.
 In these situations, the hypermobile teeth should be extracted. Also,
ongoing periodontal bone loss may jeopardize the chance for
straightforward implant placement, making extraction a sensible
step even before a tooth becomes moderately or severely mobile

12. 3.Periodontal Disease:

13. 3.Periodontal Disease:
Dr. Haydar Munir Salih

14. 3.Periodontal Disease:
Dr. Haydar Munir Salih

15. 3.Periodontal Disease:
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16. 3.Periodontal Disease:
Dr. Haydar Munir Salih

17. 3.Periodontal Disease:
Dr. Haydar Munir Salih

18. 3.Periodontal Disease:

19. 4. Orthodontic Reasons:
 Patients who are about to undergo orthodontic correction of
crowded dentition with insufficient arch length frequently require
the extraction of teeth to provide space for tooth alignment.
 The most commonly extracted teeth are the maxillary and
mandibular premolars, but a mandibular incisor may occasionally
need to be extracted for this same reason. Great care should be
taken to double-check that extraction is indeed necessary and that
the correct tooth or teeth are removed

20. ORTHODONTIC REASONS

21. 5. Malpositioned Teeth:
 Teeth that are malposed or malpositioned may be indicated
for removal in several situations. If they traumatize soft
tissue and cannot be repositioned by orthodontic
treatment, they should be extracted.
 A common example of this is the maxillary third molar,
which erupts in severe buccal version and causes ulceration
and soft tissue trauma of the cheek

22. 5. Malpositioned Teeth:

23. 6. Cracked Teeth:
 An uncommon indication for extraction of teeth is a
tooth with a cracked crown or a fractured root.
 The cracked tooth can be painful and be unmanageable
by a more conservative technique.
 Cracked teeth have often already undergone endodontic
therapy at some point in the past, which tends to make
the crown and root more brittle and difficult to remove.

24. 6. Cracked Teeth:

25. 6. Cracked Teeth:

26. 6. Cracked Teeth:

27. 6. Cracked Teeth:

28. 7. Impacted Teeth:
 Impacted teeth should be considered for removal.
 If it is clear that a partially impacted tooth is unable
to erupt into a functional occlusion because of
inadequate space, interference from adjacent teeth,
or some other reason, it should be considered for
surgical removal.

29. 7. Impacted Teeth:
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Dr. Haydar Munir Salih

30. 8. Supernumerary Teeth:
 Supernumerary teeth are usually impacted and
should be removed.
 A supernumerary tooth may interfere with the
eruption of succedaneous teeth and has the
potential for causing their resorption and
displacement

31. 8. Supernumerary Teeth:

32. 9.Teeth Associated With Pathologic Lesions:
 Teeth involved in pathologic lesions may require removal. This is
often seen with odontogenic cysts.
 In some situations, the tooth or teeth can be retained and
endodontic therapy performed. However, if maintaining the tooth
compromises the complete surgical removal of the lesion when
complete removal is critical, the tooth should be removed.

33. Impacted mandibular canines:
Removal
Dr. Haydar Munir Salih

34. Impacted mandibular canines: Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

35. Impacted mandibular canines: Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

36. Impacted mandibular canines: Removal
Dr. Haydar Munir Salih
Dr. Haydar Munir Salih

37. Impacted mandibular canines: Removal
Dr. Haydar Munir Salih

38. 10.Teeth Involved in Jaw Fractures:
Patients who sustain fractures of the mandible or the alveolar
process sometimes must have teeth removed.
In some situations, the tooth involved in the line of fracture can be
maintained, but if the tooth is injured, infected, or severely luxated
from the surrounding bony tissue or interferes with proper
reduction and fixation of the fracture, its removal is usually
indicated

39. TOOTH IN THE LINE OF FRACTURE

40. Financial Issues:
 All of the indications for extraction already mentioned
may become stronger if the patient is unwilling or unable
to financially support the decision to maintain the tooth.
 The inability of the patient to pay for the procedure may
require that the tooth be removed. Also, implant dentistry
is often more cost effective for a patient than maintaining
a compromised tooth

41. “
”
Contra-indications of
exodontia

42. Absolute Contra-indications
 there are a few conditions which are absolute
contraindications. These factors will be the impediments for
extraction, even if care is taken.
 If extraction is carried out in the presence of such absolute
contraindications, the outcome may be even fatal
 No attempt should be made by the dental surgeon to thrust
extraction on such patients. By doing so the clinician will be
inviting disaster

43. Absolute Contra-indications
(a) metabolic disorders like uncontrolled
diabetes,
(b) uncontrolled cardiac problems,
(c) leukemia
(d) renal failure and
(e) liver disorders like cirrhosis of liver.

44. Relative Contra-indications
 That means, extraction is to be deferred until the
underlying conditions deserve attention to make the
patient fit to undergo extraction.
 In such patients, the underlying condition is to be treated
by way of precautions so that; complications can be
avoided due to extraction

45. Systemic Contraindications
1. DIABETES AND HYPERTENSION
2. PATIENTS ON STEROIDTHERAPY
3. PREGNANCY
4. BLEEDING DISORDERS
5. MEDICALLY COMPROMISED PATIENTS

46. Local Contraindications
1. The most important and most critical is a history of therapeutic
radiation for cancer.
2. Teeth that are located within an area of tumor, especially a
malignant tumor, should not be extracted.
3. Patients who have severe Pericoronitis around an impacted
mandibular third molar should not have the tooth extracted until the
Pericoronitis has been treated
4. Finally, the acute dentoalveolar abscess must be mentioned