Exodontia, Extraction, tooth Extraction, Indications of Extraction, Contraindications of Extraction, principles of elevators, principles of forceps, dry socket, complications of extraction, movement for extraction, haemorrhage, stobie's technique, maxilla, mandible, upper canine, lower canine, upper pemolar, lower premolar

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.

3.  Grossly Carious
 Pulpal Necrosis
 Severe Periodontal Disease
 Orthodontic Purpose
 Malopposed Teeth
 Fracture Teeth
 Preprosthetic Extracion
 Impacted Teeth
 Supernumerary Teeth
 Teeth Associated with Pathologic
Lesion
 Preradiation Therapy
 Tooth In Fracture Line
 Esthetics
 Economical Condition

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

10. SOCKET EXPANSION
WEDGE

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

16. Configuration of roots
 First evaluate number
 Then
• Curvature
• Shape
• Size
• length

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

18. APPLICATION OF FORCEP BLADES

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

21. INCISOR
CANINE
FORCEP APPLICATION

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

23. Maxillary premolar

24. Maxillary 1st & 2nd molars
• Have 3 large roots
• buccal roots are relatively close together strong buccal force is used
with minimal palatal forces

25. Maxillary 3rd molars

26.  Mandibular anteriors
◦ have fine roots with
flattened sides

27. Stobie’s technique

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

29. PREMOLAR
MANDIBULAR 1 & 2 MOLAR MANDIBULAR 3 MOLAR

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

34. Late complications
 Chronic osteomyelitis
 Osteoradionecrosis

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