Exodontia Principles and Techniques - Presented by Dr Billal and Group for the OMS weekly Presentation; Dhaka Dental College; Dhaka; Bangladesh

1. EXODONTIA
PRINCIPLES AND
TECHNIQUES
DR.BILLAL 49DDCH_2017

2. OUTLINE
• DEFINITION
• TYPES
• INDICATION OF INTRA-ALVEOLAR EXTRACTION
• CONTRA INDICATION OF EXTRACTION
• PRE OPERATIVE ASSESSMENT
• SURGEON PREPARATION
• PATIENTS PREPARATION
• TRAY SETUP
• POSTIONING OF THE PATIENTS
• SURGEON POSITON
• ANESTHESIA
• BASIC PRINCIPLES OF EXTRACTION FOR INDIVIDUAL TOOTH AND
• AFTER CARE
• POST OPERATIVE INSTRUCTION

3. DEFINATION & TYPES
1. DEFINATION: According to GEOFFREY L.HOWE –”The painless removal
of the whole tooth, or root, with minimal trauma to the investing tissues,
so that the wound heals uneventfully and no post operative prosthetic
problem is created”.
2. TYPES :
A. Intra-Alveolar extraction or conventional extraction or forcep
extraction
B. Trans Alveolar extraction or surgical extraction

4. INDICATION OF INTRA-ALVEOLAR EXTRACTION
1. SEVERE CARIES
2. SEVERE PERIODONTAL DISEASES
3. FAILURE OF ENDODONTIC TREATMENT
4. ORTHODONTIC PURPOSE
5. PROSTHODONTIC PURPOSE
6. TEETH FROM FACTURE LINE
7. ECONOMICALLY FAILURE TO PRESERVE THE TOOTH

5. CONTRA INDICATION OF EXTRACTION
A. SYSTEMIC CONTRA :
1. Severe uncontrolled DM
2. Severe MI
3. Uncontrolled leukemia and lymphoma
4. Bleeding disorder
5. Pregnancy (1st & 3rd trimester)
B. LOCAL CONTRA :
1. Tumor
2. Sever infection at the extraction site

6. PRE OPERATIVE ASSESSMENT
A. History Taking 1. Medical History :
(i) H/O Hypertension
(ii) H/O Jaundice
(iii) H/O Kidney diseases
(iv) H/O Rheumatoid arthritis
(v) H/O Cardiac diseases
(vi) H/O Asthma
(vii) H/O Bleeding disorder
2. Dental History
(i) H/O Extraction
(ii) H/O Uncontrolled bleeding
B. Clinical Examination :
(i)Accessibility (mouth opening)
(ii) Tooth mobility
(iii) Crown Condition of the tooth (G. Caries, large restoration, facture, cervical caries)
(iv) Oral hygiene status
(v) Presence of infection at the site of injection
CONT……………

7. C. Radio logical Examination :
i. Relation To Vital Structure (Maxillary Sinus, Inferior Dental Nerve)
ii. Root Configuration (Divergent, Convergent, Dilacerations,
Ankyloses, Hypercementosis, Periapical radiolucency)
iii. Condition of the bone of the jaw

8. SURGEON PREPARATION
1. Wear of Hand gloves
2. Mask
3. Eye Wear with sidesheild
4. Surgical Gown
5. Sterilization of above mentioned materials

9. PATIENTS PREPARATION
1. Prophylactic Antibiotics
2. Prophylactic Mouth cleansing
(i) Scaling
(ii) Polishing
(iii) Brushing
(iV) Rinsing with antiseptic mouth wash
(v) Placement of a towel on the patients chest
(vi) Eye wear

10. TRAY SETUP
Armamentarium
1. Mirror
2. Twizer
3. Caries probe
4. Elevator(Straight &angular)
5. Forcep(Upper& lower,Anterior,Premolar &Molar)
6. Cryer elevator/triangular elevator
7. Bayonet forcep
8. Root forcep

11. TRAY SETUP
9.Bone file
10.Ronger
11.Curettor
12.Local Anesthesia
13.Syringe
14.Cotton Pallet
15.Suture Material
16.Neddle Holding Forcep

12. POSTIONING OF THE PATIENTS
 For a maxillary extraction the chair
should be tipped backward and
maxillary occlusal plane is at 60
degrees to the floor.
The height of the dental chair
should be 8cm below the shoulder
level of the operator.
 For a maxillary extraction of
mandibular teeth, the patient
should be positioned the occlusal
plane is parallel to the floor.
The chair should be 16cm below
the level of operators elbow.

13. Surgeon Positon
 For all maxillary teeth ,
anterior mandibular teeth
& teeth of the 3rd
quadrant : Right front
position.
 For teeth of the 4th
quadrant : Right back
position.

14. BASIC PRINCIPLES OF EXTRACTION FOR INDIVIDUAL
TOOTH AND ROOT
Mechanics Principles for tooth extractions
1. Expansion of the bony socket.
2. The use of fulcrum and lever
3. Insertion of wedge of wedges
4. Wheel and axel.

15. EXPANSION OF THE BONY SOCKET
• Expansion of the bony socket by
use of the wedge-shaped breaks
of the forceps.
• The forceps should be seated with
strong apical pressure to expand
crystal bones and to displace
center of rotation as apically as
possible.

16. Continues…………….
Movement:
• Buccal or Labial : Pressure applied to tooth will expand the
buccal cortical plate towards the crestal bone with some lingual
expansion at apical end of the root.
• Lingual or palatal : Pressure will expand lingual contical plate at
crestal area and slightly expand buccal bone at apical area .

17. CONTINUES…………..
• The initial linguo-buccal
movement for extraction of lower
second mandibular molar.
• Initial rotational forces it is useful for
removal of teeth with conical
roots; such as maxillary central.
• Tractional forces are useful for final
removal of tooth from socket. They
should always be small forces,
because teeth are not "pulled."

18. CONTINUES………
1. The Final withdrawal movement for Most of the upper and lower teeth is an outward-
occlusal direction. Except the lower third molar which should be in a lingual- occlusal way
and maxillary 3rd molar should be disto-buccal.

19. The proper use of forceps
in luxation and removal of teeth
1. The extraction movements are essentially three movements which
are outward, inward, and rotatory movements.
2. Outward (buccal or labial) movement is the initial movement of all
teeth except the lower second and third molar where the buccal
plate of bone reinforced by the external oblique ridge.
3. Inward (lingual or palatal) movement is the initial movement during
the extraction of the lower second
and third molars.

20. CONTINUES………
4. Primary Rotatory movement is the initial
movement used in upper central incisor and
lower second premolar.
5. If a resistance is felt in primary rotation, a bucco-
lingual movement should be started.
6. If rotatory movement continued, a spiral
fractured of the tooth root may occur.

21. CONTINUES………
•
• 7. Once the alveolar bone has
expanded sufficiently and the
tooth has been luxated, a slight
traction force, usually directed
buccally, can be used.
• 8. Final movement is the
movement by which the tooth is
removed from its bony socket. It
should be always directed
outward and occlusally to avoid
traumatizing the opposing tooth,
• 9. The extraction forceps blade
should be applied to the carious
side first, and the first movement
made toward the caries.

22. THE USE OF FULCRUM OR LEVER
 A lever is a mechanism for transmitting
a modest force with the mechanical
advantages of a long lever arm and a
short resistance arm into a small
movement against great resistance.
 When an elevator is used for tooth
extraction, an acquired contact point
can be made on the root surface and
a liter can be applied by the handle of
the elevator to elevate the tooth or a
tooth root from the socket.
 The wedge principle is useful for the
extraction of teeth in several different
ways.
1. By using the beaks of the extraction
forceps as a wedge.
2. When a straight elevator is used to
luxate a tooth from its socket.

23. THE USE OF FULCRUM OR LEVER

24. THE USE OF FULCRUM OR LEVER









25. WHEEL AND AXEL
 When one root of a multiple-
rooted tooth is let in the alveolar
process, the pennant-shaped
elevator is positioned in the socket
and turned
 The handle then serves as the axle
and the tip of the triangular
elevator acts as a wheel and
engages and elevates the tooth
root from the socket
 http://www.screencast.com/t/WT
ckiey4p

26. ROLE OF OPERATORS` HAND
 The opposite hand plays an
important role in supporting
and stabilizing the lower jaw
when mandibular teeth are
being extracted.
 The opposite hand supports
the alveolar process and
provides tactile information
to the operator concerning
the expansion of the
alveolar process during the
luxation period.

27. AFTER CARE
1. Irrigation of the socket with
normal saline or the other
anticeptic solution .
2. Curettage of the socket to
remove bony fragment and
granulation tissues .
3. Break down of the bony sharp
edge at the socket world and
inter radicular bone.
4. Squeezing of the socket
5. Mouth rinsing with antiseptic
solution once .
6. Suturing (if required)
7. Moist gauze pack to prevent
hemorrhage

28. POST OPERATIVE INSTRUCTION
1. Remove the cotton/ gauze pack at least 1 hour later.
2. Take cool and soft diet for at least 24 hours.
3. Avoid hot and hard diet for at least 24 hours.
4. Do not rinse forcefully and do not brush of the site of
extraction for at least 24 hours .
5. Maintain the oral hygenie
6. If stitch is given ,come one week later to cut it.

29. REFERENCES
1. Peterson, L. J. Contemporary Oral and Maxillofacial Surgery, 4th ed.
Amsterdam Elsevier Science. 2002. ch.7
2. Neelima Anil Malik,Text Book Of Oral and Maxillofacial surgery,3rd
edi.
3. Vinod Kapur,Text book of oral surgery
4. Fragiskos D. Fragiskos Oral Surger. 2007
5.Carmen Scheller BASIC GUIDE TO DENTAL INSTRUMENTS