This document discusses different techniques for tooth extraction: forceps technique, elevator technique, and open/surgical extraction. It provides details on indications, contraindications, principles, and procedures for each technique. The forceps technique is preferred for mobile teeth and involves rotating and extracting the tooth. Elevators are used for impacted, malformed, or destroyed teeth by leveraging them out. Open extraction requires incisions and bone removal for grossly destroyed teeth or those near vital structures. Precise incisions and gentle tissue handling are emphasized for all extraction methods.

1. Exodontia
Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY
SURGEON
REG NO:4118 TAMILNADU-INDIA(ASIA)

2. There are three techniques available for
removal of teeth.
 The forceps technique (closed method)
 Elevator technique,
 Open method (transalveolar extraction)

3. Operator position

4. POSITION OF VARIOUS QUADRANT

5. Forceps

6. Forceps Technique
Indications
 Fairly mobile teeth,
 Extraction of single tooth,
 Extraction of multiple teeth which are scattered.
Contraindications
 In complicated extractions,
 Deformed roots,
 Hard tissue pathology of roots like hyper-cementosis
etc.
 Badly destroyed teeth.

7. Advantages –
 It causes the least amount of trauma.
 Promotes retention of a satisfactory blood clot.
 Favours rapid healing.

8. Various movement for
extraction of individual tooth
Upper central, lateral,
canine, first pre-molar,
second pre-molar
First apical slight labial/buccal
slight palatal rotation with
traction
Upper molars First apical buccal palatal
deliver the tooth buccaly
Lower central, lateral,
canine, first pre-molar,
second pre-molar
First apical slight labial/buccal
slight lingual rotation with
traction
Lower molars First apical buccal lingual
deliver the tooth buccaly

13. Elevators

14. Elevator technique
Indications –
 To luxate teeth which cannot be engaged by
beaks of forceps ex: impacted, malposed or
grossly destructed teeth.
 To remove roots

15. Contraindications –
 Damaging of even extraction of adjacent
tooth.
 Fracture of maxilla or mandible.
 Fracture of the alveolar process.
 Injuring the soft tissue if proper care is not
taken.
 Penetrating into the maxillary sinus, during
extraction of maxillary posterior teeth.
 Forcing a maxillary root into the maxillary
sinus or forcing the apical third of the root of
the lower third molar into the mandibular
canal or into submaxillary or
pterygomandibular space depending upon the
position of the impacted third molar.

16. Rules to be followed when using an Elevator –
 Never use an adjacent tooth as a fulcrum
unless that tooth is also to be removed.
 Never use the buccal plate at the gingival line
as fulcrum except in third molars.
 Never use lingual plate as fulcrum at the
gingival line.
 Always use finger guards to protect the
patient in case the elevator slips.
 Use interseptal bone as fulcrum.
 Avoid using an elevator to laxate a tooth
which has a tooth distal to it.

17. According to use
1. Elevators designed to remove the entire
tooth.
2. Elevators designed to remove roots broken
off at the gingival line.
3. Elevators designed to remove roots broken
off halfway to the apex.
4. Elevators designed to remove the apical
third of the root (apical fragment ejectors).
5. Elevators designed to reflect to
mucoperiosteum (periosteal elevators).

18. According to form
1. Straight
2. Angular (right and left)
3. Crossbar (right and left)

21. Transalveolar extraction
Surgical / Open extraction
Indications -
 All teeth contraindicated for closed method.
 Grossly destructed or teeth devoid of crown.
 Teeth with large restorations.
 Teeth with fractured roots or root caries.
 Ankylosed teeth.
 Root canal treated teeth.
 Firm teeth in aged patients (because of sclerotic
bone).
 Teeth close to vital structures.
 Embedded roots.

23. Principles of incision & flap
design for surgical extraction
 Incision must be made using a fresh sterile sharp
blade.
 Incision must be firm and made in a single
stroke.
 Multiple strokes to be avoided.
 Incision should be down to bone.
 Incision should not be close to vital structures.
 Incision should rest on sound bone (on closure).
 Incision should be at right angle to epithelial
surface.

25. Contd..
 Flap should provide adequate access to the
surgical area.
 Base of the flap must be broader than the apex.
 Acute angulations while making incisions
avoided.
 Preferably the width of the flap should be twice
its height.
 Incisions should be raised in one sweep to avoid
button holes.
 Tissues should be handled gently.
 Adequate hemostasis is very essential.

26. Principles of surgical removal
of roots
 Root has to be located either clinically or
radiographically
 Incision
 Bone removal (good vision and access to the
root)

27. Chisel vs Bur technique
criteria chisel&mallet Bur
technique difficult easy
Patient
acceptance
Not tolerated Well tolerated
Chance of #
bone
high less
Healing of
bone
good delayed
Post op edema less more
dry socket less more
Post op
less more
infection

29. Thank You