Routine extraction
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This document outlines the process for routine tooth extraction. It discusses indications for extraction, preparation steps, needed armamentarium and techniques. Extractions can be done using forceps or surgically. Forceps involve using dental instruments to remove the tooth while surgery requires dissecting the tooth from its attachments. The document details positioning, different techniques for various tooth types, and potential complications like root fracture or alveolar bone fracture. Post-operative instructions are also included.
Routine extraction
- 1. Routine ExtractionRoutine Extraction OGUNLADE TIMOTHYOGUNLADE TIMOTHY
- 2. OutlineOutline • Introduction • Indications • preparative assessment • Armamentarium • Principles • complications • Post operative instructions
- 3. IntroductionIntroduction • Ideal extraction is the painless removal of the whole tooth or tooth- root with minimal trauma to the investing tissues so that the wound heals eventually and no post operative prosthetic problem is created
- 4. IntroductionIntroduction • Teeth extraction is an easy procedure but may be accompanied by various complications if adequate preparations and procedures are not ensured • The extraction of teeth is based primarily on an anatomical appreciation of their attachment in the jaw • Extraction can be achieved either by: Forceps extraction Surgical extraction
- 5. IntroductionIntroduction • Forceps extraction involves the use of dental forceps, elevator or both in removing the tooth or root. • In contrast, the surgical technique is employed only in cases where the tooth or root extraction is not possible with the simple technique. • The tooth or root to be removed is dissected from its attachments.
- 6. INDICATIONSINDICATIONS • Tooth extraction is the removal of a tooth from its socket Indications 1. Retained primary teeth 2. Retained roots 3. Caries 4. Pulpal lesion 5. Periodontal disease 6. Orthodontic plan
- 7. INDICATIONSINDICATIONS 7. Trauma 8. Periapical infection 9. Supernumerary teeth 10. Prosthetic plan 11. Hypoplasia/Hypocalcification 12. Therapeutic irradiation 13. Attrition 14. Erosion 15. Abrasion
- 8. ExtractionExtraction Steps involved in preparation for extraction • Consider the entire patient, do not focus only on the oral cavity • Obtain a good medical history • Obtain appropriate medical and dental consultations • Anticipating and preventing emergency situations
- 9. ExtractionExtraction Steps involved in preparation for extraction • Being fully capable of managing emergency situations if the need should arise • Appropriate periapical radiograph of tooth to be extracted must be taken • Future need for space maintenance should be considered in case of premature loss of a primary tooth • Oral hygiene must be good • Prepare both patient (psychologically)
- 10. Armamentarium forArmamentarium for extractionextraction • Dental mirror and probe • Anaesthesia (Topical, Infiltration or block) • Dental syringe and needle • Forceps • Elevators
- 11. Extraction PositionsExtraction Positions • Patient should be positioned in the chair with upper jaw at an angle of 45 degrees to the floor • For all maxillary teeth and posterior mandibular teeth, the dentist is to the front and right • For the extraction of anterior mandibular teeth the dentist should be positioned in front of the patient, or behind them and to their right
- 13. ForcepForcep
- 14. maxillary extraction forcepsmaxillary extraction forceps
- 16. ExtractionExtraction Extraction Positions • The forceps is held in the dominant hand • The nondominant hand performs the following roles: - control patient’s head - help to retract lip, cheek and tongue from surgical field - help to palpate the alveolar process and adjacent teeth during extraction
- 17. ExtractionExtraction Extraction Techniques • There are various techniques for the various teeth • Once anaesthesia is achieved and the operator well positioned • The beaks of the forceps are positioned at the cervical line of the tooth to have good grip on the tooth • A firm apical pressure should be applied to drive the blades along the root surface as far as possible
- 18. Extraction of maxillaryExtraction of maxillary anterior tooth(apical thrust)anterior tooth(apical thrust)
- 19. Extraction of maxillary anteriorExtraction of maxillary anterior tooth(exo movements)tooth(exo movements)
- 20. Extraction of upperExtraction of upper posterior toothposterior tooth
- 21. Extraction of upperExtraction of upper posterior toothposterior tooth
- 22. Extraction of lower anteriorExtraction of lower anterior toothtooth
- 23. Extraction of lower anteriorExtraction of lower anterior toothtooth
- 24. Extraction of lower posteriorExtraction of lower posterior toothtooth
- 25. Extraction of lower posteriorExtraction of lower posterior toothtooth
- 26. Anterior teethAnterior teeth • They are single rooted • Care must be taken not to place force on adjacent teeth • Rotational movements is involved in the extraction • Slow continuous force applied in alternating labial and lingual directions facilitates extraction in the mandible
- 27. Maxillary Posterior teethMaxillary Posterior teeth • Buccal movement is initiated first , followed by alternating buccal and palatal movements • The movements made are sustained to allow for expansion of the alveolar bone in the buccal aspect • The movements should be slow and continuous • This prevents fracture of the divergent roots
- 28. Mandibular Posterior teethMandibular Posterior teeth • Support the mandible with the nondominant hand to prevent injury to the temporomandibular joints • Place the forceps appropriately and make buccal and lingual movements • The movements should be slow and sustained to allow for expansion of the alveolar bone.
- 29. ExtractionExtraction • After extraction - Make sure the socket is clean - Compress the expanded alveolar bone with the digits - Put sterile guaze over the socket and ask patient to bite on it - Patient should continue to swallow saliva
- 30. ComplicationsComplications Root fracture • It is a common complication of tooth extraction • Aggressive removal should be avoided because the tooth can be damaged in the process(steady and slow) • Determine the size of what is left • If apical one third, leave in place. The succedaneous tooth will resorb it. (explain to parent and child) for primary teeth extraction • If visible, use elevators to remove it
- 31. ComplicationsComplications • Fracture of alveolar bone - Due to accidental inclusion of alveolar bone within the forceps blade or root configuration - Extraction of canines is often complicated by alveolar fracture. - Remove the fractured alveolar bone
- 32. Thanks for your time!!Thanks for your time!!
- 33. ReferenceReference • Fragiskos oral surgery textbook • Omishore segun Akanji presentation on routine extraction • Other online materials