Teeth Extraction

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Teeth Extraction Important Notes

1. Uses Of Elevators:

  • To luxate the teeth by expanding the alveolar bone
  • To Remove broken or Surgically Sectioned roots from their sockets
  • Extraction of distal-most teeth in the arch

2. Types Of Elevators:

Extraction Types Of Elevators

3. Types Of Extractions:

  1. Intra-Alveolar Or Closed Technique: Extraction of the tooth by gaining direct access to the tooth to be extracted
  2. Trans Alveolar Or Open Technique: Access is gained by raising a mucoperiosteal flap or bone removal of the tooth

Read And Learn More: Oral and Maxillofacial Surgery Question and Answers

4. Contraindications Of Extractions:

Systemic contraindications Uncontrolled diabetes

  • Bleeding diathesis
  • Pregnancy
  • Cardiac conditions
  • Immunocompromised patients
  • Endocrine malformations
  • Local contraindications
  • Acute infections
  • Malignancy
  • Radiation therapy
  • Vascular lesions
  • Pericoronitis

Absolute contraindications Of Extraction:

  • Local hemangioma
  •  Arterioventral fistula associated with teeth
    • Principles Of The Elevator:
      • Lever principle
      • Wedge principle
      • Wheel and axle principle
    • Order of extraction: Maxillary teeth are extracted first & then mandibular

Sequence Of Extraction:

  • Third molar
  • Second molar
  • Second premolar
  • First molar
  • First premolar
  • Lateral & central incisors
  • Canines

Teeth Extraction

Extraction Long Essays

Question 1. Discuss objectives of tooth extraction
Answer:

Objectives Of Extractions:

  • Selection Of Proper Forceps Or Elevator:

Extraction Selection Of Proper Forcep Or Eleven

  • Efficient Grip Over Instrument: Cross-hatching over the handles & serrations on the interior of the surface provides grip to the instrument
  • Efficient Position Of Operator & Patient:
    • For maxillary extraction – the maxillary occlusal plane should be parallel to the floor.
    • The position of the patient should be 8 cm below the shoulder of the operator.
    • For mandibular extraction- The retro line position of the patient should be maintained.
    • Position of patient 16 cm below the elbow of the operator for mandibular extraction.
    • The operator stands front & side to the patient except for the 4th quadrant extraction in which operators must stand behind the patient.
  • Determine The Direction Of Displacement Of The Tooth:
  •  Differentiate Between Simple & Difficult Extraction:
    • Don’t hesitate to refer to the case
    • Assess clinically & radiographically the difficulty of extraction
  • Design Properly The Mucoperiosteal Flap:
    • The periosteal flap should provide proper exposure to the extraction site
    • It should not tear off the mucosa
  • Wound Closure:
    • Proper approximation of wound edges must be done
    • Debride the socket properly
  • Avoid Any Complications:
    • Complete the procedure traumatically
    • Avoid unnecessary damage to the site
  •  Post-Operative Instructions:
    • Bite on the gauze piece placed over the extraction socket for a minimum of half an hour
      • Reason: Stabilization of the clot in the socket
    • Not to rinse mouth vigorously for the next 24 hours
      • Reason: Causes dislodgement of the clot from the socket
    • Avoid Hot Beverages:
      • Causes vasodilation
    • Intake Of Soft Diet On The Day Of Extraction:
      • Hard food traumatizes the socket
    • Avoid Sucking Through Straws:
      • Creates negative pressure
    • Rinse With Warm Saline:
      • To prevent infection
    • Prescription Of Anti-Inflammatory Analgesics:
      • To relieve pain
    • Avoid Smoking:
      • It creates negative pressure
    • If bleeding is not stopped visit the dentist

Question 2. Discuss in detail indications, and principles in extractions. Note in complications.
Or
Indications of extractions
Answer:

Indications Of Extractions:

  • Unrestorable teeth
  • Periodontally weak teeth
  • Radiation therapy
  • Teeth in the line of fracture
  • Fractured teeth
  • Pathology associated with teeth
  • Malaligned teeth
  • Orthodontic extractions
  • Supernumerary teeth
  • Retained deciduous tooth
  • Extraction due to prosthetic reasons
  • Impacted teeth
  • Serial extraction
  • Teeth in line of osteotomy

Principles of Extractions:

1. Expansion Of Bony Socket:

  • The tooth is held at its occlusal end with the help of force
  • Move the forceps
  • This expands the bony socket
  • Makes easy removal of tooth

Extraction Expansion Of Bony Socket

2. Wedge Principle:

  • Place the beaks of forceps between the tooth & socket in the periodontal space
  • This displaces the tooth more occlusal
  • If required place the forceps more apically

Complications Of Extractions:

  • Fracture of tooth
  • Fracture of the alveolar process
  • Fracture of maxillary tuberosity
  • Fracture of jaw
  • Damage
    • To adjacent tooth:
    • Soft tissues
    • Nerve
  • Displacement
    • Into fascial spaces
  • Hemorrhage
  • Dislocation
    • TMJ: Due to excessive mouth opening
    • Jaw
  • Postoperative Complication
    • Hemorrhage
    • Pain
    • Swelling
    • Dry socket
    • Trismus
    • Infections
  • Miscellaneous
    •  Oro antral fistula

Question 3. Describe in detail the complications of extractions, their prevention & management.
Answer:

Complications Of Extractions:

  1. Fracture Of Tooth:
    • Causes:
      • Wrong forceps selection
      • Improper force application
      • Improper placement of forceps
      • Grossly carious tooth
    • Prevention:
      • Selection of proper forceps Firm grip on forceps
      • Apical wedging of forceps
      • Use of root forceps in grossly carious tooth
    • Management:
      • If a small toothpiece remains, it gets resorbed
      • If the root is fractured at the apical third, It is removed by the apexoelevator
      • Transalveolar extraction done
  2. Fracture Of The Alveolar Process:
    • Cause:
      • Excessive force application
    • Prevention:
      • Minimal force application to luxate the tooth
    • Management:
      • Small pieces are removed along the tooth Large pieces are replaced
  3. Fracture Of Maxillary Tuberosity:
    • Cause:
      • Excessive forces
    • Prevention:
      • Correct application of forces
    • Management:
      • Replace it
      • Suture it
      • It heals in 4 weeks
  4. Fracture Of The Jaw:
    • Causes:
      • Improper selection of forceps Atropic mandible
    • Prevention:
      • Controlled force on instruments
      • Estimate the difficulty of extraction before extraction
    • Management:
      • Reduction of fragments
      • IMF done

Damage Of Extractions:

  1.  To Adjacent Tooth:
    • Causes:
      • Large restorations
      • Grossly carious tooth
    • Prevention:
      • Correct placement of forceps interdentally avoids the application of forces close to adjacent teeth
    • Management:
      • Temporary restoration was given over the adjacent tooth.
      • Replace it with a permanent restoration.
  2.  Soft Tissues:
    • Causes:
      • Slipping of instrument
      • Placement of forceps over tissue rather than on tooth
    • Prevention:
      • Use of controlled forces
      • Retract the tissues
      • Plan the incision properly
    • Management:
      • Allow to heal the tissues
      • Maintain oral hygiene
      • Analgesics prescription
      • Saline mouth rinses
  3. Nerve:
    • Prevention:
      • Assessment of pre-extraction radiograph
    • Management:
      • It regenerates

Displacement of  Extractions:

  1.  Into Fascial Spaces:
    • Causes:
      • Excessive forces
      • Fracture of cortical plates
    • Prevention:
      • Support the alveolus during extraction Application of controlled forces
    • Management:
      • Bringing the tooth back into the oral cavity If it is placed below the muscle then a reflection of the flap is done
      • If it is uninfected, it is not treated
  2. Hemorrhage:
    • Causes:
      • Hypertension
      • Damage to vessels
    • Prevention:
      • Atraumatic extraction
      • Avoid damage to extraction
      • Control the blood pressure before extraction
      • Planning of incisions
      • Avoid damage to nerves
    • Management:
      • Small bleeding, by application of pressure
      • Anticoagulants are prescribed.
      • Local anesthetic packs
      • Suturing
      • Cauterization of the spot Ligation of the artery
      • Hemostatic agents

Dislocation Of Extractions:

  • TMJ: due to excessive mouth opening
  • Jaw:
  • Management:
    • Manual reduction
    • Restriction of movement
  • Post-Operative Complication:
      • Hemorrhage:
        1. Small bleeding, by application of pressure
        2. Anticoagulants
        3. Local anesthetic packs
        4. Suturing
        5. Cauterization of the spot
        6. Ligation of the artery
        7. Hemostatic agents
        8. Locate the bleeding at the point & stop it
      • Pain: Anti-inflammatory and analgesic drugs

Swelling Of Extractions:

  1. Causes:
    • Edema
    • Hematoma
    • Infection
  2. Management:
    • Resolves on its own
    • Resolves on its own
    • Drain the pus if there is drainage
  3. Dry socket:
    • Analgesic
    • Irrigate the socket
    • Placement of abundant
  4. Trismus:
    • May resolve on its own
    • Manipulation of the jaw by jaw stretcher
  5. Infections:
    • Anti-inflammatory drugs
  6. Miscellaneous:
    • Oro antral fistula

Extraction Short Essays

Question 1. Transalveolar extraction.
Or
Open method of extraction.
Answer:

Transalveolar Extraction

  • Transalveolar Extraction is an open method of extraction
  • Also called the surgical method
  • Transalveolar Extraction is indicated when forceps extraction is difficult

Indications Of Transalveolar Extraction:

  • Teeth resisting forceps extraction
  • Sclerotic bone
  • Unfavorable roots
  • Hypercementosis
  • Proximity to anatomic structures
  • Grossly destroyed tooth
  • Heavily restored tooth
  • Root stumps
  • Impacted tooth

Steps Of Transalveolar Extraction:

Extraction Steps Of Translveolar Extraction

Question 2. Contraindications of extractions.
Answer:

Contraindications Of Extractions

  • Systemic contraindications
  • Uncontrolled diabetes
  • Bleeding diathesis
  • Pregnancy
  • Cardiac conditions
  • Immunocompromised patients Endocrine malformations Local
  • contraindications
  • Acute infections
  • Malignancy
  • Radiation therapy
  • Vascular lesions
  • Pericoronitis

Question 3. Etiology and management of post-extraction bleeding.
Answer:

Post-Extraction Bleeding

Post-extraction bleeding can be of three types

  • Primary Bleeding:
    • Causes:
      • Hypertensive patients
      • When a blood vessel has been severed
    • Management:
      • Atraumatic extraction should be carried out
      • Plan the incision properly
      • Usually stops by application of pressure
  • Reactionary Bleeding:
    • Cause
      • Increase in blood pressure leading to opening up small divided vessels
    • Management:
      • Seat the patient
      • Clean the oral cavity of all the clots
      • Visualize the problem
      • Locate the exact point of bleeding
      • Stop the bleeding by applying pressure of
      • At home, instruct the patient to place a clean handkerchief moist with cold water on the bleeding site and bite it on firmly
      • Place a cold wet tea bag on the site
      • The tannic acid in tea helps to precipitate protein and cause clot formation
  • Secondary Bleeding:
    • It occurs 7 days post-operatively
  • Cause:
    • Infections destroying the clot
  • Management:
    • Use of antibiotics to control infection

Extraction Short Question And Answer

Question 1. Absolute contraindications of extraction.
Answer:

Absolute Contraindications Of Extraction

  • Local hemangioma.
    • Due to injury to the vessels
    • Extravasations of blood into the tissue planes
  • Arterioventral fistula associated with teeth

Question 2. Order of extraction.
(or)
Sequencing in full mouth extraction
Answer:

Order Of Extraction

Maxillary teeth are extracted first & then mandibular

Sequence Of Order Of Extraction:

  • Third molar
  • Second molar
  • Second premolar
  • First molar
  • First premolar
  • Lateral & central incisors
  • Canines

Question 3. Reactionary Haemorrhage.
Answer:

Reactionary Haemorrhage

Hemorrhage occurring within 8 hours of surgery

Causes Of Reactionary Haemorrhag:

  • Hypertension
  • Postoperative sneezing
  • Coughing
  • Retching
  • Example: Ligature slippage from superior thyroid artery

Question 4. Bone wax.
Answer:

Bone Wax

Bone Wax is a mechanical hemostatic agent

Composition Of Bone Wax:

  • Benzoin
  • Storax
  • Balsam of tolu
  • iodoform
  • Solvent ether

Technique Of Bone Wax:

  • Place the bone wax on the bleeding spot
  • Wait for half an hour

Mechanism Of Bone Wax:

  • It occludes the blood vessel

Extraction Viva Voce

  1. The two teeth that are most difficult to remove are the first molar and canine
  2. In multiple extractions, maxillary teeth should be removed before mandibular teeth and posterior teeth before anterior teeth
  3. A dry socket is most common in the mandibular molar area
  4. According to Nitzan’s theory, the organism that is responsible for dry sockets is treponema denticola
  5. The extraction of the first molar to create space for the eruption of the third molar is called Wilkinson’s extraction
  6. For extraction of maxillary teeth, the occlusal plane is kept at 60° to the floor
  7. For extraction of mandibular teeth, the occlusal plane is parallel to the floor
  8. Cryer’s elevator works on wheel and axle and wedge principle
  9. Since the maxillary 1″ premolar has two roots which are curved and divergent, fracture occurs readily during extraction
  10. Extraction of tooth associated with central hemangioma results in profuse bleeding and death of the patient
  11. Cowhorn forceps are used for the removal of grossly decayed teeth
  12. Elevators are used for the extraction of distal-most teeth in the arch and the luxation of adjacent teeth
  13. The mandibular second premolar needs primarily rotatory movement to extract
  14. The elevators used in exodontia are functionally Class 1 and 2 levers
  15. To extract a tooth the whole of the inner surface of the forceps blade should fit the root surface
  16. The mechanical advantage would be maximum for an elevator when the effort arm is greater than the resistance arm
  17. The beaks of the extraction forceps should be placed on the root surface as far apically as possible
  18. The most common cause of post-extraction bleeding is the failure of the patient to follow post-extraction instructions
  19. Rongeur is commonly used to cut bone
  20. The best time of extraction in pregnancy is the second trimester.

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