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TOOTH EXTRACTION: Dr.Mumena C.H Tooth extraction Topics to be covered; Introduction Indication of preoperative radiographs Indications of tooth extraction Contra-indications of tooth extraction Instruments and instrumentation Techniques of tooth extraction Complications of tooth extraction Tooth extraction introduction Divided into Exodontia Odontectomy Purpose of procedure: Carry out the procedure painlessly and removal of all tooth material with least trauma sothat healing can occur without complications. Soft tissues and bone involved in the procedure. Cross infection control very important at all times. Presence of lips, cheeks, the mobility of tongue and saliva flow complicate this procedure. Tooth extraction introduction cont…: Tooth extraction is a surgical procedure like all others. All basic principles applicable during surgery should be strictly adhered to during tooth extraction. Sometimes not only desirable but absolutely essential to take pre-operative x-rays of the tooth which is to be extracted., Preoperative radiographs Indications of pre-operative x-rays Hx of difficulty extracttions Difficulty extractions (Tooth does move during attempted removal) Operator decides odontectomy Tooth in unfavourable position with regard to anatomical structures (Maxillary sinuses, inferior alveolar nerve). Misplaced tooth (worry-dilacerations if frequent). Indications of pre-operative x-rays Wisdom teeth Heavily filled teeth Non-vital teeth Chronically inflamed gingiva with sclerosis of the bone. Traumatized teeth Lone standing maxillary molars Partially erupted teeth Indications of pre-operative x-rays Root fragments Teeth with abnormal crowns or delayed eruption (worry: dilaceration or ankylosis) Systemic conditions which may point to bone abnormalities e.g Osteitis deformans Cleido-cranial dysostosis Paget’s disease Indications of pre-operative x-rays X-rays are of cardinal importance. X-rays must be taken of edentulous areas, irrespective of how long ago the teeth were removed, Underlying bone pathology must be excluded (Remaining roots, unerupted teeth, foreign bodies e.t.c.) Indications for tooth extractions Indications for tooth extractions Extraction of tooth must be done selectively. Determine whether the tooth concerned should be extracted. The operator must use his/her professional and scientific judgement as to what is best for the particular pt under the current circumstances. The following are few guidelines when considering extraction: Indications for extraction Carious lesion Un-restorable teeth Endodontically /apicectomy not possible Rootless Periodontal disease Severe endo/perio lesions Little/or no bone support for teeth Indications for extraction Prosthetic reasons Single tooth in edentulous jaws Severely overerupted teeth Orthodontic reasons Extraction to create space Impactions Surgical reasons Impacted teeth Teeth in fracture line Indications for extraction Surgical reasons cont… Fractured roots Teeth related to cysts/tumors Teeth related to malignancies/radiotherapy Teeth related to severe infections Socio-economic reasons Severely mentally handicapped pt where conservative treatment not possible Indications for extraction Deciduous teeth Complete root resorption Incomplete root resorption (ectopic secondary tooth eruption) Note that there may be cases where the extraction of tooth may be indicated but where there certain contra-indications, It is imperative that thorough history of the and clinical examination be conducted before commencing extractions or any other surgical procedure. Contraindications for extraction Divided into systemic factors and local factors, Systemic factors include: Cardiac diseases; take history, examine the patient. Is history suggesting possibility of cardiac diseases, is the patient under physician’s care, Coronary artery diseases including HT and DM Artificial heart valves, Rheumatic fever,-danger of developing infective endocarditis, Certain blood dyscrasias e.g pt on anticoagulants Contraindications for extraction cont… Patient’s general health Malignant conditions and patients on radiotherapy Acute infections Rheumatic fever Thrombocypenia purpura-these patients usually present with petechiae (hemorrhage sports), spontaneous gingiva bleeding, etc. Anaemia – Hb as low as 8g/dl or below do not extract tooth. Contraindications for extraction cont… Leukemia- consult the physician or hematologist, before attempting anything to this patient, Jaundice – yellow discolouration of the mucous membrane, fingers, etc, and this can be due to liver cirrhosis, hepatitis. In this patient there is liver problem suggesting derangement of vit k dependent factors. Check for bleeding indeces. Contraindications for extraction cont… Pregnancy – three management phases Emergency Necessary but not emergency elective Treatment recommended at 2nd trimester, first trimester there is risk for abortions, while 3rd trimester size of the uterus makes patient uncomfortable, Emergency situation; Toothache, Bleeding tumor Contraindications for extraction cont… Necessary but not emergency Chronic Periapical abscess (I&D) Elective Impacted tooth Cosmetic prognathism Local contraindications All acute inflammatory process in the oral cavity, Ulcerative necrotizing gingivitis, Acute dental alveolar abscess, N.B – control the infection first before you carry out an extraction.