Extrac 1

Extraction of teeth
Extraction of Teeth
★ Introduction
★ Indications
★ Contraindications
★ General principle
★ Essential skill
★ Instruments
★ Procedure
★ Healing of extraction wounds
★ Causes of delayed healing of extraction
wounds
★ Complications
1. Introduction
The extraction of teeth, however
accomplished, is a surgical operation involving
bony and soft tissues of the oral cavity,
access to which is restricted by the lips and
cheeks, and further complicated by the
movement of the tongue and mandible. It is
essential that this phase of oral surgery be
given the same careful study and application
of sound surgical principles as is given to surgery
in any other part of the human body.
1. Indications
Teeth are removed from the mouth for a
variety of reasons. Although the position of
modern dentistry is that all possible measures
should be taken to preserve and maintain teeth
in the oral cavity, it is still sometimes
necessary to remove some of them. This section
discusses a variety of general indications for
removing teeth. It must be remembered that
these indications are recommendations, and not
absolute rules.
★ Indications
for the extraction of teeth
1. Severe caries:
Perhaps the most common and widely
accepted reason to extract a tooth is that it is
so severely carious that it can not be
restored. The extent to which the tooth is
carious and is judged to be non-restorable is
a judgement call to be made between the
dentist and patient.
★ Indications
2. Pulpal necrosis:
A second, closed aligned rationale for removing
teeth is that there is pulp necrosis or irreversible
pulpitis that is not amenable to endodontics.
3. Severe periodontal disease:
A common reason for tooth removal is
severe and extensive periodontal disease. If
severe adult periodontitis has existed for some
time, there is excessive bone loss and irreversible
tooth mobility. In these situation the hypermobile
teeth should be extracted.
1. Indications
4. Orthodontic reasons:
Patients who are about to undergo orthodo-
ntic of crowded dentition frequently require
the extraction of teeth to provide space for
tooth alignment. The most commonly extra-
acted teeth are the maxillary or mandibular
first premolars, but second premolars or a
mandibular incisor may occasionally need
extraction for this same reason.
1. Indications
5. Malposed teeth:
Teeth that are malposed or malpositioned may be
indicated for removal in several situations. If they
traumatize soft tissue and can not be repositioned
by orthodontic treatment, they should be extracted.
6. Cracked teeth:
A clear but uncommon indication for extraction of
teeth is when the tooth is cracked or has a fractured
root. The cracked tooth can be painful and is
unmanageable by a more conservative technique.
1. Indications
7. Pre-prosthetic extraction:
Tooth occasionally interfere with the design
and proper placement of prosthetic appliances-
full dentures, partial dentures or fixed partial
dentures. When this happens, pre-prosthetic
extraction are necessary.
1. Indications
8. Impacted teeth:
Impacted teeth should always be considered
for removal. It is clear that an impacted
tooth is unable to erupt into a functional
occlusion because of inadequate space,
interference from adjacent teeth, or some
other reason. It should be scheduled for
surgical removal.
★ Indications
9. Supernumerary teeth:
Supernumerary teeth are usually impacted
and should be removal.
10.Teeth associated with pathologic lesions:

Teeth that are involved in pathologic
lesions may require removal.
1. Indications
11. Pre-radiation therapy:
Patients who are to receive radiative
therapy for a variety of oral tumors should
have serious consideration given to
removing teeth in the line of radiation therapy.
1. Indications
12. Teeth involved in jaw fractures:
Patients who sustain fractures of
the mandible or the alveolar process
occasionally need to have teeth
removed.
1. Indications
13. Esthetics:
Occasionally a patient requests
removal of teeth for esthetic reasons. In
these situations teeth may be severely
stained,as with tetracycline staining or
fluorosis, or may be severely malposed,
usually protruding.
1. Indications
14. Retained deciduous tooth:
When a permanent tooth is present, and in
normal position to erupt, the retained
deciduous tooth should be removed.
15. Focus of infections:
Cysts, chronic osteitis, Granulomatosis,
maxillary sinusitis, Rheumatic fever, Optic
disease.
2. Contraindications
for the extraction of the teeth
Even if a given tooth meets one of
the requirements for removal, in some
situations the tooth should not be removed
because of other factors, or
contraindications to extraction. These factors,
like the indications, are relative in there. In
some situations the contraindication can be
modified by the use of additional care or
treatment and the indicated extraction can be
performed; but in other situations the
contraindication may be so significant that the
tooth should not be removed until the severity
of the problem has been resolved.
The following are Contraindications for the extraction
of the teeth:
1. Heart diseases:
Patients with any of a variety of severe
uncontrolled cardial diseases should also have their
extractions deferred until the disease can be brought
under control.
Unstable angina pectoris,
A recent myocardial infarction,
Uncontrolled cardiac dysrhythmia,
Uncontrolled hypertension.
2. Blood diseases:
Patients who have blood diseases
should not have teeth removed.
● Aplastic anemia
● Iron deficiency anemia
● Hemolytic anemia
● Megaloblastic anemia
● Leuemia
● Lymphadenoma
● Idiopathic thrombocytopenic
purpura
● Hemophilia
3. Bleeding ● Von willebrand syndrome
diathesis: ● Severe platelet disorders
● Patients who take
anticonagulants
4. Diabetes:
Disease of the pancreas which
prevent sugar and starch being
absorbed(unless treated).
Blood sugar > 8.88mmol/L (160mg/dl)

●Nervous systemic symptoms:

easy exciting, nervous
● A group symptoms
5. Throidism of high metabolism
● Thyroid edema
(Grave disease)
6. Pregnancy:
Pregnancy is a relative contraindication:
Patients who are in the first or last trimester
should have their extractions deferred if possible.
The latter part of the first trimester and the first
month of the last trimester may be as safe as the
middle trimester for a simple uncomplicated
extraction, but more extensive surgical
procedure should be deferred until after the child
has been delivered.
7. Renal diseases:
All kinds of
renal
diseases , we
should not
remove teeth.
8. Virus hepatitis:
Inflammation of
the liver.
9. Acute inflammation:
Patients who have severe
pericoronitis around an impacted
mandibular third molar should not have
the tooth extracted until the pericoronitis
has been treated. That is to say, the
infection should be controlled first.
10. Malignant tumor:

Teeth that are located within an
area of tumor, especially a malignant
tumor, should not be extracted. The
surgical procedure for extraction could
disseminate cells and thereby the
metastatic process. (Picture)
11. Long treatment with

suprarenoma
12. Nerve system diseases

● Cleidocranial
dysostosis
13.Theother
diseases: ● Osteitis deformans
● Osteopetrosis
3.General principle
1. Academic surgery: theory, skill, practice
2. Confidence:
3. Local anatomy: (picture)
4. The psychology of the patient:
5. The faith inspired by the operator in the
patient:
6. Postoperative treatment:
4.Local anatomy
Teeth
appearance
( Permanent
teeth)
4.Local anatomy
Teeth
appearance
( Deciduous
teeth)
5.Essential skill
● Asepsis
● Anesthesia
Success in the
operation of ● Dexterious technic
teeth extraction
is dependent on: ● Surgical judgement
6.Instruments
Chisels:
6. Instruments
Surgical
Mallet
6. Instruments
Dental
curettes
★ Instruments
Gingival
separator
★ Instruments
dental
elevator
dental
extracting
forceps
7. Procedure
1. To use gingival separator to separate
gingival from tooth.
2. To use elevator to make tooth loose in the
alveolar cavity.
3. To use forceps to pull out tooth from the
alveolar cavity.
4. To use dental curette to scratch the
alveolar cavity in order to clean the dental
or bony fragment, debris and granulation
tissue.
5. To put thumb and forefinger on either side
of the alveolar bone to replace them.
8. Healing
of extraction wounds
1. Formation of a blood clot filling the
socket.
2. Organization of the clot.
3. Formation of woven bone in the
connective.
4. Replacement of woven bone by
trabecular bone and remodeling of the
alveolus.
Causes of Delayed Healing
of Extraction wounds
1. Infection
2. Prolonged bleeding due to a clotting
defect.
3. Formation of an oro-antral fistula.
4. Proliferation of a malignant neoplasm.
5. Scurvy.
9 Complications
1.Loosening of adjacent teeth:
This is caused by unappropriate use of
forceps and elevators.
2. Fracture of adjacent teeth and restorations:

This occasionally occurs during a
routine extraction procedure. This most
commonly occurs with the unappropriate
use of elevators.
9 Complications
3. Fracture of the buccal or labial plate:
The surgeon who frequently fractures
the buccal or labial plate must
analyze his technique since this is
considered “heavy handed” surgery in
the light of more appropriate refined
techniques.
9 Complications
4. Teeth or roots into the maxillary sinus:
It is possible either during forceps
extraction or root retriveal. It is quite
easy to displace root of upper molar
teeth into the maxillary sinus.
9 Complications
5. Injury to the inferior alveolar nerve:
It may occur when the inferior
alveolar nerve is closely associated
With roots and sometimes with the
crown of the mandibular third molar.
Operations in this region can easily
damage the nerve.
9 Complications
6. Post-operation pain:
Post-operation pain which the
patient experiences after the second
and third postoperative day should
carefully examined, since this is not a
normal postoperative course. It is
caused by dry socket or sharp bone
spine.
9 Complications
7. Ecchymosis:
This generally is seen following flap
especially and is found most often in elder
patients, especially women, who have
decreased capillary resistance and poor
tissue tone. It is caused by continuous
postoperative subcutaneous oozing of
blood into the tissues.
9 Complications
8. Postoperative hemorrhage:
9. Local infection: such as dry socket.
10. Damage to soft tissues:
11. Fracture of the jaw.

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Extraction of teeth

10.Teeth associated with pathologic lesions:

Blood sugar > 8.88mmol/L (160mg/dl)

●Nervous systemic symptoms:

10. Malignant tumor:

11. Long treatment with

12. Nerve system diseases

2. Fracture of adjacent teeth and restorations:

9. Local infection: such as dry socket.

10. Damage to soft tissues:

11. Fracture of the jaw.

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