principles of exodontia

1. EXODONTIA
( Chapter One )
Principles of exodontia
DR. HAYDAR MUNIR SALIH ALNAMER
BDS. PHD (BOARD CERTIFIED)

2. Dental extraction has
always been
considered to be an
unpleasant procedure
for the patients due to
pain phobia.

3. The ideal tooth extraction is the painless removal
of the whole tooth, or tooth root, with minimal
trauma to the investing tissues, so that the wound
heals uneventfully and no post- operative
prosthetic problem is created.
Geoffrey L Howe

4. Extraction procedure can be:
1. Simple exodontia or closed method of
extraction or intraalveolar extraction
2. Complicated exodontia or open method of
extraction or transalveolar extraction

5. Simple Vs complex tooth extraction

6. In general, according to difficulty faced the
cases are classified into four types:
Type 1—easy patient easy case
Type 2—easy patient difficult case
Type 3—difficult patient easy case
Type 4—difficult patient difficult case

8. GENERAL PRINCIPLES INVOLVED IN
EXODONTIA
• Clinical evaluation
• Radiographic evaluation
• Patient and surgeon preparation
• Patient position
• Operator position
• Principles of extraction
• Principles of elevators
• Postoperative instructions

9. BASIC REQUIREMENTS
1. A good radiograph
2. Adequate anesthesia
3. Instruments
4. Adequate illumination
5. Efficient assistance
6. Suction apparatus

10. CLINICAL EVALUATION
In preoperative assessment period the tooth to be extracted should be
examined carefully to assess the difficulty of extraction

11. Access to the Tooth
 The first factor to be examined in preoperative assessment is
the extent to which the patient can open the mouth. Any
limitation of opening may compromise the ability of the
surgeon to give local anesthesia or perform a routine
extraction
 The location and position of the tooth to be extracted within a
dental arch should be examined.
 A properly aligned tooth has a normal access for placement of
elevators and forceps. However, crowded or otherwise
malposed teeth may present difficulty in positioning the
usually used forceps

12. Access to the Tooth

13. Mobility of the Tooth
 If the teeth are excessively mobile, uncomplicated tooth
removal should be expected, but soft tissue management
after the extraction may be more involved
 Teeth that have less-than-normal mobility should be
carefully assessed for the presence of hypercementosis or
ankylosis of the roots

14. Mobility of the Tooth

15. Condition of the Crown
 the presence of large caries or restorations in the crown.
If large portions of the crown have been destroyed by caries, the
likelihood of crushing the crown during the extraction is increased
 In addition, an endodontically treated tooth becomes desiccated and
typically becomes brittle and crumbles easily when force is applied.
 If the tooth to be extracted has a large accumulation of calculus, the
gross accumulation should be removed with a scaler or ultrasonic
cleaner before extraction
 If adjacent teeth have large restorations, the surgeon should use
elevators with extreme caution because fracture or displacement of
the restorations may occur

16. Condition of the Crown

17. Condition of the Crown
Dr. Haydar Munir Salih Dr. Haydar Munir Salih

18. RADIOGRAPHIC EXAMINATION
 It is essential that proper radiographs be taken of
any tooth to be removed.
 In general, periapical radiographs provide the
most accurate and detailed information
concerning the tooth, its roots, and the
surrounding tissue.
 Panoramic radiographs are used frequently, but
their greatest usefulness is for impacted teeth as
opposed to erupted teeth.

19. Relationship to Vital Structures

20. Configuration of Roots
1. The first factor to evaluate is the number of roots on the tooth to be
extracted
2. The surgeon must know the curvature of the roots and the degree
of root divergence to properly plan the extraction procedure.
3. The shape of the individual root must be taken into consideration
4. The size of the root must be assessed.
5. The surgeon should look for evidence of caries extending into the
roots.
6. The tooth should be evaluated for previous endodontic therapy

21. Number & curvature of Roots

22. Roots carries & endodontic therapy

23. Condition of Surrounding Bone
1. Careful examination of the periapical radiograph indicates the
density of bone surrounding the tooth to be extracted.
2. The surrounding bone should also be examined carefully for
evidence of any apical pathology.

25. PATIENT AND SURGEON PREPARATION
 The concept of universal precautions states that all patients
must be viewed as having blood borne diseases that can be
transmitted to the surgical team.
 Before extraction: Patients should vigorously rinse their
mouths with an antiseptic mouth rinse such as chlorhexidine.
 To prevent teeth or fragments of teeth from falling into the
mouth and potentially being swallowed or aspirated into the
lungs, it is preferable to place a 4 x 4 inch gauze loosely into
the back of the mouth. However, it should not make the
patient gag.

26. PATIENT AND SURGEON PREPARATION

27. CHAIR POSITION FOR FORCEPS
EXTRACTION ( MAXILLARY TEETH)

28. CHAIR POSITION FOR FORCEPS
EXTRACTION ( MANDIBULAR TEETH)

29. CHAIR POSITION FOR FORCEPS
EXTRACTION ( SITTING POSITION )