Uncomplicated Exodontia ( Simple Extraction)

Dr. Urpiana
Oral Surgery

Pain and Anxiety Control

Local Anesthesia
profound local anes results in loss of all pain,
temperature, and touch sensations, but it
does not anesthetize the proprioceptive fibers.
Thus the patient feels a sensation of pressure.

Sedation
oral, inhalation (nitrous oxide), IV sedation
Indications for Removal of Teeth
Severe Caries
Pulpal Necrosis
Severe Periodontal Disease
Orthodontic Reasons
Malposed Teeth
ex. Supaeruption of teeth , bucally positioned
max 3rd molars
Cracked Teeth
Preprosthetic Extraction
Impacted Teeth
Supernumerary Teeth
Teeth associated with pathologic lesions
Teeth involved in jaw fractures
Prepradiation Theraphy
Esthetics
Economics
Contraindications for Teeth Removal

Systemic Contraindications
severe
uncontrolled
metabolic
ds.
uncontrolled sys. ds, leukemias, unstabled
agina pectoris, sever MI, pregnancy, bleeding
disorders

Local Contraindications
ex. history of therapeutic radiation for cancer,
teeth located w/in an area of tumor
Clinical Evaluation of teeth for removal

access to tooth

limitation of mouth opening

location and position of the tooth

mobility of tooth

condition of crown
Radiographic Examination of tooth removal

periapical radiograph provides the most accurate

and detailed info

Criteria
must be properly exposed w/ good contrast
film should be properly positioned
must be properly processed w/ good fixation ,
drying and mounting

Relationship of Associated Vital Structures

proximity of the maxillary molar roots to the
floor of the maxillary sinus (NSA or w/ SA)
inferior alveolar canal may approximate the
roots of the mandibular molars

radiograph for mandibular premolars should

include the mental foramen
Configuration of Roots
number of roots to be extracted
curvature of the roots
shape of individual root
size of the root must be assessed
Condition of Surrounding Bone
density of the bone surrounding the tooth
more radiolucent is likely to be less dense,
more opaque indicates increased density
therefore more difficult to extract
check for evidence of apical pathology.
Periapical radiolucencies may represent a
granuloma or cyst

The removal of teeth employs the use of the

following mechanical principles and simple
machines
wedge
wheel and axle
lever

Wedge
can be used to expand, split and displace
portions of substance that receives it
Wheel and Axle
most closely identified with the pennantshaped elevator. Handle serves as the axle,
and the tip acts as a wheel and engages and
elevates the tooth root from the socket
Lever
is a mechanism for transmitting a modest
force into a small movement against great
resistance

o
-

Forceps
primary instrument used to remove a tooth
from the alveolar process
Goals
1. Expansion of the bony socket
2. Removal of the tooth from the
socket
Forceps can apply 5 major motions :
1. Apical Pressure
tooth socket is expanded by the insertion of
the beaks down into the periodontal space
center of rotation is displaced apically
2. Buccal Force
results in expansion of the buccal plate,
particularly at the crest of the ridge.
Also causes lingual apical pressure
3. Lingual Pressure
aimed at expanding the linguocrestal bone
and at the same time, avoiding excessive
pressure on the buccal apical bone
4. Rotational Pressure
rotates tooth which causes internal expansion
of the tooth socket
only used on teeth w/ single , conic roots
5. Tractional Force
useful for delivering tooth from socket once
adequate bony expansion is achieved

should be limited to the final portion of the

extraction process and should be gentle

Erupted tooth can be extracted using one of the

two major techniques :
1. Closed Technique
also known as the simple extraction or forceps
technique
2. Open Technique
also known as the surgical, or flap technique

3 Fundamental Requirements for a Good Extraction

:
1. Adequate access and visualization of the field
of surgery
2. An unimpeded pathway for the removal of
tooth
3. Use of controlled force to luxate and remove
the tooth

STEPS FOR CLOSED EXTRACTION TECHNIQUE:

Step 1 : Loosening of soft tissue attachment from the
tooth
woodson elevator or sharp end of molt #9
purpose is to ensure that profound anesthesia
has been achieved
soft tissue is loosened to allow the forceps to
be
positioned
more
apically,
without
interference from or impingement on the soft
tissue of gingival.
Step 2 : Luxation of tooth with a dental elevator.
expansion and dilation of the alveolar bone
and tearing of the periodontal ligament
require that the tooth be luxated in several
ways
the straight elevator is inserted perpendicular
to the tooth into the interdental space
Step 3 : Adaptation of the forceps to the tooth
beaks of the forceps should be shaped to
adapt anatomically to the tooth, apical to the
cervical line, that is to the tooth surface
lingual beak is usually seated first and then
the buccal beak
grasp the handles of the forceps at the very
ends to maximize mechanical advantage and
control

Step 4 : Luxation of tooth with the forceps

the major portion of the force is directed
toward the thinnest and therefore weakest
bone.
thus in the maxilla and all but the mandibular
molars, the major movement is labial and
buccal
for some teeth, rotational motions are then
used to help expand the tooth socket and tear
the periodontal ligament attachment
Step 5: Removal of the tooth from the socket
slight tractional force, usually directed
buccally, can be used.
Role of the opposite hand
responsible for reflecting the soft tissues of the
cheeks, lips, and tongue to provide adequate
visualization of the area of surgery
it helps protect other teeth from the forceps,
should it release suddenly from the tooth socket
supports the alveolar process and provides
tactile

SIMPLE TOOTH EXTRACTION PROCEDURES

let patient gargle w 1% povidone iodine for 1
minute
dry the area to be anesthetized
apply topical anesthesia then wait for 1-2 mins
Perform
(anes tech) using 2% lidocain w/
1:100,00 epi
check for profoundness of anesthesia using gum
separator
loosen soft tissue w/ gum separator
luxate tooth then elevate tooth using luxators and
elevators
remove tooth w/ forcep #___
curette socket
apply digital compression on socket
palpate the area for sharp bony edges. If present ,
remove sharp edges using bone file or rongeur.
copious irrigation w/ .9% NSS
let the patient bite on gauze to stop bleeding
once bleeding is controlled,suture if needed.
let patient bite again on moistened gauze