This document discusses tooth extraction, including indications, contraindications, techniques, and complications. It provides details on: 1. Indications for tooth extraction such as non-restorable caries, pulpitis, periodontal disease, fractures, bony lesions, impacted teeth, and orthodontic reasons. 2. Contraindications including certain medical conditions, medications, pregnancy, infections, and uncooperative patients. 3. Techniques for simple extractions using forceps with different types for various tooth positions, and trans-alveolar extractions for difficult cases. 4. Potential complications from the procedure or analgesia like fracture, nerve damage, bleeding, pain, or displacement of the tooth

1. Exodontia

2. Tooth extraction
Indications:
1. Grossly carious tooth which cannot be restored
2. Acute/chronic pulpitis
– which can’t be restored by RCT
3. Periodontal diseases
– More than half of alveolar bone loss
4. Fracture of tooth
– Root
– Longitudinal
– If tooth lies on jaw # line

3. Indication cont..
5. Bony lesion lies over the tooth
– Cyst, Tumor,OM
6. Impacted tooth
7. Aesthetic indication
8. Orthodontic appliances
– Teeth crowding
9. Supernumerary and malposed teeth
10. Retained deciduous tooth if permanent successor is present
11. If tooth hurting the soft tissue
– Upper 3rd molar damaging the lower 3rd molar gum tissue

4. Contraindications:
General
1. Cardiac diseases - Valvular heart diseases, RHD, Hypertension,Patients on anticoagulation therapy
2. Blood disorders (Severe anemia, Leukemia, Hemophilia)
3. Liver disease (Vitamin K deficiency, Clotting factor deficiency)
4. DM
5. Pregnancy- 1st and 3rd trimester
6. Epilepsy patient
7. Allergic to local anesthesia
8. Psychiatric patient
9. Very old patient
10. Uncooperative patient/ Lack of consent
11. Patient on steroids
12. High grade fever

5. Contraindication :
Local
1. Acute gingivitis
2. Acute periodontitis
3. Acute pericoronitis
4. Acute cellulitis
5. Acute osteomyelitis
6. Malignancy
Any acute infection except Acute pulpitis is not contra indication of tooth
extraction but it is rather indication of extraction

6. Position

7. Surgeon’s position for extraction
with forceps

8. Principles of simple (closed)
extraction

9. Extraction movement
⦿ Primary movement: Along longitudinal axis of root
⦿ Secondary movement: Main extracting movement
● Rotatory
● Buccolingual or labiolingual
● Mesodistal
● Lifting the tooth

10. ■ Upper central and lateral incissor
– Rotation only
■ Upper canine
– Rotation initially, some labiolingual movement may be
needed
■ Upper premolar and molar
– Buccopalatal movement

11. ■ Lower central and lateral incissor
–Labiolingual movement
■ Lower canine
–Rotatory and labiolingual
■ Lower premolar
–Rotatory
■ Lower molar
–Buccolingual movement

16. Intra and Trans alveolar
extraction

17. ■ Dental forceps are used to
extract the majority of erupted
teeth
■ These instruments enable the
operator to grasp the root of a
tooth and exert force directly to
the root mass in order to
displace it from the surrounding
bone
Intra alveolar extraction

18. ■ Forceps are designed with short blades (beaks) to engage the tooth
root, and longer handles that offer a large mechanical advantage in both
gripping and moving the tooth

19. ■ Forceps are intended to grasp
the roots of teeth, not their
crowns
■ The shape of forceps blades
needs therefore to conform to
the shape of the root both
around its circumference and
along its length
The use of forceps

20. Cross-section of the blade
■ The blade should be more curved and narrower than the root with
two point contact
■ This arrangement supports the root across the full width of the blade
and is the best practical option

21. ■ If the blades wider than the root, there are
only a single point contact on each side
■ Force on the root is concentrated at this
point, therefore the risk of root fracture is
higher, and a less stable grip results

22. Application of forceps blades
■ Forceps blades should be aligned with the
long axis of the tooth for extraction:
1. To give maximum support
2. To distribute evenly the forces applied to
the root
■ Misalignment of the forceps may allow the
instrument to slip off the root, so increasing
likelihood of root fracture

23. 1. Teeth varying position in the mouth
2. Because of the varying anatomical
form of teeth
DIFFERENT TYPES OF FORCEPS

24. DIFFERENT TYPES OF FORCEPS
■ Upper forceps have their handles in line with
the blades, whilst the handles of lower forceps
are set at right angles to the blades

26. ■ Mandibular molar teeth
have mesial and distal
roots and therefore the
buccal and lingual
blades of lower molar
forceps are each
shaped to
accommodate two
roots

27. Upper molar forceps
■ Maxillary first and second
molar teeth have two buccal
roots and a single palatal root
■ The forceps are twin beaked
on the buccal side and have a
single blade palatally

28. Gripping the forceps
■ The role of left hand during extraction:
1. Support the alveolus at the extraction site. In
this way the jaw is stabilized so that
movements with the forceps do not move
the whole head or cause displacement or
even dislocation of the mandible
2. The fingers and thumb of the left hand retract
the lips, cheeks or tongue to allow free access
to the extraction site

29. Moving the tooth
■ Once the blades of the forceps are
in the correct plane between the
root and bone, force is directed
parallel to the long axis of the root
to drive as far apically as can be
achieved
■ The root is gripped firmly but not
crushed
■ Then movements to begin tooth
displacement can start

30. Moving the tooth
■ The tooth is displaced by
progressively expanding
its bony socket with
controlled smooth but
positive effort
■ Rapid, jerky movement is
more likely to fracture the
tooth than to loosen its
root

31. Maxillary teeth
■ The alveolar bone in the
maxilla is thinner on its buccal
or labial surface by comparison
with the thicker palatal side
■ Therefore the normal direction
of tooth displacement is
buccally

32. Direction of movement of maxillary teeth

33. Mandibular teeth
■ The mandible has a higher ratio of cortical to cancellous
bone than the maxilla. Consequently the alveolar bone
supporting lower teeth is more dense and less readily
deformed, making the displacement of mandibular teeth
more difficult, particularly the molars
■ Buccal and lingual cortices tend to be of similar thickness in
the anterior mandible
■ Distally, in the second and third molar regions, the buccal
plate of bone is thickened by the external oblique ridge

34. Direction of movement of mandibular teeth

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TRANS-ALVEOLAR EXTRACTION
■ The operator gains direct access to the
alveolar bone and tooth roots after
raising the overlying soft tissues
■ Bone removal and sectioning of the
tooth or its roots under direct vision are
possible in order to expedite the
extraction

36. INDICATIONS FOR TRANS-ALVEOLAR EXTRACTION
■ Any tooth resistant to intra-alveolar
extraction
■ Teeth with abnormalities of shape or size,
e.g. gemination or dilaceration of the root

37. ■ Teeth having multiple or unfavourable roots
with conflicting paths of withdrawal

38. ■ Hypercementosed or ankylosed teeth

39. ■ Impacted teeth
■ History of difficult extractions in such patients

40. ■Retained roots that cannot be grasped
with forceps

46. Physics forceps

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Complications of
extraction
Classification
1. Complications due to analgesia.
2. Complications due to procedure.

51. Complications due to analgesia
■ Broken needle .
■ Infection .
■ Trismus .

52. Complications due to procedure
■ Fracture of :
-tooth being extracted
-alveolar bone
-maxillary tuberosity
-adjacent teeth
-mandible

53. ■ Dislocation of TMJ
■ Displacement of the tooth into:
-soft tissues
-maxillary sinus
-beyond the pharynx

55. ■ Damage to:
- gum , lips , tongue ,
palate , floor of the mouth.
- inferior dental nerve.

57. ■ Excessive bleeding:
- during extraction.
- postoperatively.

58. ■ Postoperative :
Pain
edema
ecchymosis

59. Diagnosis and Management of
Hemorrhage in Oral Surgery What is meant by Hemorrhage ?
Prolonged or uncontrolled bleeding is often
referred to as hemorrhage.
The amount of blood lost as a result of
hemorrhage can range from minimal to
significant quantities.

60. Hemorrhage in Surgery
Hemorrhage can occur to a greater or lesser
degree during all surgical procedures and it’s
management depends upon whether the
patient is hematologically normal or suffers
from some disturbance in the normal clotting
mechanism.

61. Normal Mechanism of Hemostasis
■ Hemostasis is a complicated process.
■ It involves a number of events
Hemostasis - Normal Mechanism
■ 1. VASCULAR PHASE
■ 2. PLATELET PHASE
■ 3. COAGULATION PHASE

62. VASCULAR PHASE
When a blood vessel is damaged,
vasoconstriction results.
!!!

63. PLATELET PHASE
Platelets adhere to the damaged
surface and
form a temporary plug.

64. Through two separate pathways, the
Intrinsic and Extrinsic, the conversion
of fibrinogen to fibrin is complete.
Fibrin tightly binds the platelets to
form a clot
!COAGULATION PHASE
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THE CLOTTING MECHANISM
INTRINSIC! EXTRINSic
PROTHROMBIN THROMBIN
FIBRINOGEN
FIBRIN
"##$ "###$
"#$
%
&
Tissue Thromboplastin
'())*+,-
%##
&##
&#
#&
%###

65. HEMOSTASIS
DEPENDENT UPON:
Vessel Wall Integrity
Adequate Numbers of Platelets
Proper Functioning Platelets
Adequate Levels of Clotting Factors
Proper Function of Fibrinolytic Pathway
Local Measures: Surgicel (Oxidised
Regenerated Cellulose)

66. Local measures: Gelfoam with activated
thrombin
Local Measures: Avitene (Microfibrillar
Collagen)

67. Local Measures:
Etik Collagen (Packed collagen)
Local Measures: Tranexamic acid 5%

68. Local Measures: Tranexamic acid 5% in
Syringe
Local Measures: Irrigation of wound with
Tranexamic acid

69. Local Measures: Suturing the wound Local Measures: Pressure with oral packs

70. LABORATORY EVALUATION
■ PLATELET COUNT
■ BLEEDING TIME (BT)
■ PROTHROMBIN TIME (PT)
■ PARTIAL THROMBOPLASTIN TIME (PTT)
■ THROMBIN TIME (TT)

71. Autotransplantation

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