Routine Exodontia

1. ROUTINE EXODONTIA
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
• Routine vs. Complex Exodontia
• Indications for Routine Exodontia
• Contraindications for Routine Exodontia
• Clinical and Radiographic Evaluation for teeth to be extracted.
• Pre-Operative Management
• Extraction Position
• Extraction Sequence
• References

3. ROUTINE VS. COMPLEX
• Routine: Normal daily extraction of teeth without the need to raise a flap.
• Complex: Surgical extraction with flaps and suture.

4. TOOTH EXTRACTION IS IT A MATTER OF
FORCE?
• Extraction of a tooth is a procedure that combines the principles of surgery and
elementary physical mechanics.
• Removal of an erupted tooth does not require large amount of strength instead it
involves the use of controlled force
• The tooth is not pulled from bone, it is gently lifted from its socket.

5. INDICATIONS
• Caries [Every carious tooth?]
• Pulpal Necrosis [When?]
• Periodontal Disease [When?]
• Orthodontic reasons [Caution!]
• Malposed teeth.
• Supernumerary teeth
• Cracked teeth.
• Impacted teeth.
• Teeth associated with Pathology
• Radiation therapy
• Teeth involved in jaw fractures [But?]
• Financial issues

7. CONTRAINDICATIONS
Systemic
• Poor Medical status. Examples: Poorly
controlled DM or HTN or Leukemia
• Pregnancy [Relative]
• Medications.
• IV Bisphosphonates patients are
contraindicated for Exodontia.
Local
• History of Therapeutic Radiation of
cancer.
• Tumors [Why?]
• Severe Pericoronitis
• Acute Infection [MYTH.]

8. CLINICAL EVALUATION OF TEETH FOR REMOVAL
• Access to the tooth. [Mouth Opening]
• Mobility of the tooth.
• Condition of the crown.

9. RADIOGRAPHIC EVALUATION OF TEETH FOR
REMOVAL
• Condition of the crown
• Condition of surrounding bone
• Root Length
• Roots closure
• Distance to vital structures
• Relationship with adjacent teeth
• Relationship with adjacent bone
• Associated Pathology
• Presence of unerupted or impacted teeth

10. WHICH IS EASIER TO EXTRACT?

11. CONDITION OF THE CROWN

12. DISTANCE TO VITAL STRUCTURES

13. ABNORMAL CONFIGURATIONS

14. PREVIOUS TREATMENT

15. ASSOCIATED PATHOLOGY

16. ARE THESE TEETH INDICATED FOR EXTRACTION?

17. PRE-OPERATIVE MANAGEMENT
• Universal Precautions
• Antiseptic Mouthwash ?
• Lung Protection  Loose 4 * 4 inch gauze in the posterior part of the mouth

18. CHAIR POSITION FOR EXTRACTION
• For Maxillary extraction:
• The chair should be tipped backward so that the maxillary occlusal plane is at an angle of
about 60 degrees to the floor.
• The height of the chair should be such that the patient’s mouth is at or slightly below the
operator’s elbow level.
• For Mandibular extraction:
• The patient should be positioned in a more upright position so that when the mouth is
opened wide, the occlusal plane is parallel to the floor
• SURGEON IS ALWAYS WORKING INFRONT OF THE PATIENT EXCEPT IN THE
MANDIBULAR RIGHT QUADRANT THE SURGEON WORKS FROM BEHIND THE
PATIENT

19. MAXILLARY EXTRACTION

20. MANDIBULAR EXTRACTION

21. EXTRACTION SEQUENCE
• UPPER BEFORE LOWER
• POSTERIOR BEFORE ANTERIOR
• Third Molar  Second Molar  Second Premolar  First Molar  First Premolar 
Lateral Incisor  Canine  Central Incisor
• Elevators
• Forceps
• Post-Operative care.

22. ELEVATORS – LUXATION

23. FORCEPS – WIDENING THE TOOTH SOCKET

24. MAXILLARY CENTRAL AND LATERAL INCISORS

25. MAXILLARY CANINE

26. MAXILLARY FIRST PREMOLAR

27. MAXILLARY SECOND PREMOLAR

28. MAXILLARY MOLARS

29. MANDIBULAR INCISORS

30. MANDIBULAR CANINE
•IDENTICAL TO MAXILLARY
CANINE EXTRACTION

31. MANDIBULAR PREMOLARS

32. MANDIBULAR MOLARS

33. POST-EXTRACTION SOCKET CARE
• The socket should be debrided only if necessary.
• The expanded Buccolingual plates should be compressed back to their original
configuration; Finger pressure is usually enough
• The bone should be palpated through the overlying mucosa to check for any
sharpness.
• Initial control of hemorrhage is achieved by use of a moistened 2 × 2 inch gauze
placed over the extraction socket.
• Post-Operative Instructions?
• Drugs?

38. REFERENCES
• Chapter 7: Principles of
Routine Exodontia

39. THANK YOU