Chp 7 - Principles of Uncomplicated Exodontia (95-126)

1. Pain and Anxiety Control

Local Anesthesia:
-loss of pain, temp, and touch
“NOT” - proprioceptive fibers (pressure) of involved nerves

Group 1 = 10-20
Group 2 = 50-60
Group 3 = 60-90
-mand teeth longer

-Bupivicaine = long lasting/acting 12 hours

-After appropriate anesthesia a patient may experience sharp pain in pulpits or soft
tissue inflammation

Maximum amounts:
1. recommended max dose
2. number of cartridges that can be used on healthy 154 lb adults

Sedation:
-inhalation of nitrous oxide
-via intravenous by anxiolytic drugs
-diazepam or midazolam

2. Presurgical Medical assessment:

3. Indications for Removal of Teeth

-Questions: hypercementosis surgical extraction = True

1. Caries
-most common reason
2. Pulpal Necrosis
3. Periodontal Disease
4. Orthodontic Reasons
-premolars
5. Malposed teeth
-tramatized soft tissue, ortho won’t work
6. Cracked teeth
-uncommon
7. Impacted teeth
8. Supernumerary
9. Teeth Associated with Pathologic Lesions
-if endo doesn’t work
10. Radiation therapy
11. Teeth involved with Jaw fracture
 12. Financial issues

4. Contradindications for removal of teeth

-Question: teeth should “NOT” be pulled out = True

1. Systemic Contraindications
-severe uncontrolled metabolic disease
-diabetes
-end stage renal
-lukemia/lymphoma
-severe myocardial ischemia
-malignant hypertension
-preganancy is “relative”
-middle trimester
-severe bleeding diathesis
-drugs:
-corticosteroids
-immunosuprrosive agents
-bisphosphonates
-cancer chemotherapeutic agents
2. Local Contraindications
-theraputic radiation for cancer
-tumor
-severe perioconontits
-acute dentoalveolar abscess (use antibiotic therapy first)

5. Clinical Evaluation of teeth for removal

1. access to the tooth

2. Mobility of tooth
3. Condition of the crown
-remove calculus first

6. Radiographic Examination of tooth for removal

-must be within 1 year

1. Relationship to vital structures

2. Configuration of roots
-number, curvature, shape, caries, resorption, edno
3. Condition of Surrounding Bone

7. Patient and Surgeon Preparation

8. Chair position for Extractions

max - chair tipped back, occlusal plane 60 degrees
mandibular - in a more upright position, use biteblock
-pt head turned toward surgeon
 -surgeon’s elbow should be at or below the patient’s mouth and shoulder’s relaxed

9. Mechanical Principles Involved in tooth extraction

1. Lever
-elevators
2. Wedge
-beaks of forceps
-small elvator
3. Wheel and Axle
-triangular, pennant shaped (Cryer)

10. Principles of Elevator and Forceps Uses

1. Elevator = luxation
-Do “NOT” use hard lingual pressure during luxation
-ex: triangular elevator = cryer
2. Forceps = continue bone expansion and disruption of the pdl attachments

1. Expansion of the bone socket by use of the wedge-shaped beaks

2. Movement of the tooth from socket

5 major motions:
1. Apical pressure
1.Expands,
2. center of rotation displace
2. Buccal force
-Luxate, then buccal force = True
3. Lingual/palatal pressure
4. Rotational pressure
-If center of rotation is too high, then fx of root apex
5. Tractional forces
-Final removal of tooth = True
-Strong pressures used = False

11. Procedure for Closed Extraction

closed = routine
open = surgical, flap

3 fundamental requirements for good extraction:

1. Adequate access and visualization of the field of surgery
2. Unimpeded pathway for the removal of the tooth
3. Use of controlled force to luxe and remove the tooth

5 Steps of “closed” extraction procedure:

1. Loosening of the soft tissue attachment from the cervical portion of the tooth
2. Luxation of the tooth with a dental elevator
3. Adaption of the forceps to the tooth
4. Luxation of the tooth with forceps
A. Forceps must be apically seated as far as possible and reseated
periodically during the extraction
 B. The forces applied in the buccal and lingual directions should be slow,
deliberate pressures and not jerky wiggles
C. Force should be held for several seconds to allow the bone time to
expand
-Dr. Braly’s 30 sec rule = true

5. Removal of the tooth from the socket

A. Role of Opposite hand

B. Role of the Assistant During Extraction

-visulaization
-suction
-protect teeth
-support mandible
-pschological and emotional support

12. Specific Techniques for Removal of Each tooth

A. Maxillary teeth

1. Incisor
2. Canine
3. First Premolar
4. Second Premolar
5. Molar
-53

B. Mandibular teeth

1. Anterior Teeth
2. Pre-molars
3. Molars

C. Modification for extraction of primary teeth

13. Postextraction tooth socket care

Other:

Most common root fx = max 1st premolar

If center of rotation is too high -= fx of root apex