Exodontias (tooth extraction )

Dr.Dejen G.(MD)
2020
 Exodontias (tooth extraction )
Exodontias - is a minor surgical procedure in
involving taking out of tooth from its socket with
the use of instruments.
Indication for extraction
There are many reasons for which both
deciduous and permanent teeth have to be
extracted. But dental caries and periodontal
pathology account for 85%- 90% of extraction.
 Indications Of Extraction:

Indications advocated for dental extraction:

 -Unrestorable carious tooth.
 -Pulp necrosis and irreversible pulpitis;
 untreatable by endodontic therapy,
 calcified root canal
 patient refusal.
 Indications Of Extraction:

Indications advocated for dental extraction:

 -Severe periodontal disease; Bone

loss,grade 3 mobility.
 -Impacted teeth ;Mal-alligned,resorption of
roots of adjacent teeth.
 Indications Of Extraction:

Indications advocated for dental extraction:

 -Orthodontic treatment ; Crowding,Space

creation.Maxillary and Mandibular 1st Pre-
molar.
 -Mal-alligned teeth ; Tissue trauma
 mal-positioning.
 Indications Of Extraction:
Indications advocated for dental extraction:

 -Esthetics ;
 Stained teeth,
 excessively protruded teeth,mal-alligned.
 -Cracked and fractured tooth ;Tooth in
fracture line,pain, Dilaceration
 infection.
 Indications Of Extraction:

Indications advocated for dental extraction:

 -Pre-prosthetic extraction ; Unsuitable

abutments,interference with appliance
 -Super-numerary teeth ;
Impacted,resorption, displacement,failure
for erruption
 -serial extraction
 -tooth involved in cyst formation
Contraindications Of Extraction:

Contraindications for Dental Extraction

Systemic Local
Contraindication for extraction
These are either local or systemic factors.
a) Local factors
 Acute infection with an uncontrolled cellulites
 Acute pericoronitis (mandibular third molar)
 extraction of maxillary premolar and first molar in acute
sinusitis
 tooth embedded in a malignant growth because it leaves
non healing wound
 extraction of tooth from irradiated jaw. B/c osteo radio
necrosis since there is low vascularity
b) Systemic factor
 uncontrolled diabetic mellitus
 cardiac problems
e.g hypertension, coronary artery disease, ischemic
heart disease, valvular and septal defects.
 Pregnancy - second trimester is safe.
 Bleeding disorder
 Patients on steroids therapy
 Renal failure
 Patients with toxic goiter- problem of thyroid crisis
 Position of the operator
 The operator stands at right side in front of
the patient for extraction of left maxillary and
mandibular teeth as well as for anterior
tooth .
 For right mandibular tooth operator stands
on the right side and behind the patient.
Basic instruments used for exodontias
 For simple extraction
-Dental forceps
-Elevators
 For complex extraction
-Hand piece
-Diamond bur and the above.
General steps for tooth extraction
 Detached the gum from the crown part of the
tooth using elevator
 Put the beaks of the forceps below cemento-
enamel junction
 Fix the forceps
 Luxation ( dislocation of the tooth)
 Apply traction
Extraction technique
• There are two types of procedures
• Intra -alveolar
• Trance –alveolar
Intra- alveolar(forceps technique)
• Using elevators and forceps
I) For maxillary teeth
a) Central and lateral incisors- slight labial and
palatal pressure with mesial rotation followed by
slight traction.
b)Canines- these are difficult to remove. Labial
pressure then palatal pressure with mesial
rotation followed by traction.
c) First premolar- buccal pressure and palatal
pressure and extraction to buccal side .no
rotation is to be used.
 d) Second premolar- buccal and palatal pressure
with slight rotation.
e) First and second molar- buccal and palatal
rocking and buccal side removal.
f) Third molar- buccal pressure along with distal
and downward movement is used to luxate
the tooth out of the socket.
II) Mandibular teeth
a) Central and lateral incisors- labial and lingual
rocking and slight mesial and distal rotation
followed by removal to labial side.
b)Canine- labial pressure with mesial rotation and
vertical pull yield the desire result.
c) First and second premolar- buccal pressure with
slight mesio-distal rotation.
d)All mandibular molars- buccal and lingual rocking
with removal to buccal side.
Complications involved in extraction
Operative complication
a) Fracture of the tooth
b) Alveolar bone fracture
c) Maxillary tuberosity fracture
d) Mucosal tear
e) Oro- antral opening
f) Injury to soft tissue
g) Hemorrhage
h) Injuries to the adjoining teeth
Post operative complication
a)Post operative hemorrhage
b)Pain and swelling
c) Dry socket(alviolitis)
d)Osteomyelitis
e)bacterimia