Routine Extraction in dentistry

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

15. mandibular extractionmandibular extraction
forcepsforceps

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