Simple dental extractions

Simple dental extractions

Plan

I. Introduction

II. Instruments required for performing dental extractions 

III. The different phases of simple dental extraction:

In adults

1. Preoperative phase

2. Intraoperative phase

Basic operating protocol for a simple dental extraction

• Exoetendoral disinfection
• Local or regional anesthesia
• Syndesmotomy
• Dislocation
• Avulsion
• Alveolar curettage ( if indicated )
• Hemostasis

3.Postoperative phase:

In children

IV. Difficult extractions:

VI.1. Separation of roots

VI.2. Alveolectomy

Conclusion

I. Introduction

Dental extraction is defined as the set of maneuvers allowing the tooth to be removed from its socket while respecting the integrity of the neighboring tissues. It can be very simple but, sometimes, very complicated.

It is a daily act for the dentist. It is a surgical intervention in the precise sense of the term, governed by conditions

and a well-codified protocol.

The causes of dental extractions can be multiple: periapical infection, tooth mobility, root fracture, orthodontic reason, impacted tooth, etc.

Problematic.

• Frequency of dental extractions
• Difficulties encountered

Goals :

• Know the basic protocol of a dental extraction 
• Successful dental extraction.

Definitions ;

• Simple dental extraction : Simple dental extraction is a surgical procedure which consists of performing the avulsion of a dental organ, without abnormality of structure, shape and deposition with a local and general context not likely to complicate the performance of the procedure.
• Surgical extraction (complex extraction or alveolectomy):

This is a less traumatic surgical technique which allows part or all of the root part of the tooth to be extracted to be exposed.

II. Instruments required for performing dental extractions:

The consultation platform:

• A mirror – A pair of tweezers – A probe

Oral and perioral disinfection equipment  :

• Antiseptic solution – Tweezers or clamps

Surgical suction  : Equipped with a single-use cup. Facilitates the operator’s work by avoiding annoying movements of the patient towards the spittoon. 

Anesthesia equipment :

• Metal syringe. – Disposable needles. – Anesthesia cartridge. 

Instruments for actual avulsion:

The instruments must be placed on a metal table 

1. Syndesmotomes (for syndesmotomy):

Functions : They allow the superficial desmodontal fibers to be cut all around the tooth, which prevents the gum from tearing during extraction.

– Syndesmotomes de Chompret

-Straight syndesmotome for the anterior teeth of the upper jaw. 

-Syndesmotome bent by the teeth of the lower jaw.

 – Sickle syndesmotome: used for all upper or lower teeth. 

• Bernard’s syndesmotomes  : Its end is lanceolate and its shape is multiple “straight or angled”, its use is rather that of an elevator for root extraction.

2. Elevators (For dislocation): Is done with elevators that are used to mobilize the tooth, these are very powerful instruments that must be handled with care. The appropriate elevator, held in the hand, is introduced into the space created by the syndesmotome by leaning on the alveolar bone, the tooth is mobilized until it moves in its socket. The most commonly encountered forms of elevators are:

 – The straight elevator: for the anterior teeth of the upper and lower jaw.

 – The bayonet elevator: for posterior teeth. 

– The crowbar: Only suitable for the successive extraction of the roots of a lower molar.

3. The davits: (For the extraction itself):

    We have a wide variety of forceps – (primary dentition – permanent dentition – maxilla – mandible – anterior sector – posterior sector…etc)

   They consist of two parts joined by a hinge: 

• The jaws: active part used to grip the tooth and give it the necessary movements, convex on the outside and concave on the inside, the internal concavity is generally striated in the lengthwise direction. 
• The branches: passive part that the operator holds in his hand to act.

Forceps for maxillary molars (permanent teeth)

Mandibular permanent denture forceps

Forceps for Molars and Wisdom Teeth

Mandibular

Forceps for deciduous teeth

4. Curettes ( alveolar curettage): 

 Their role is to explore the empty alveolus in order to remove any tissue debris, whether bone, dental, cystic or granulation. 

They consist of a thin handle and a spoon-shaped end. Varieties. We distinguish between straight and angled curettes. 

5. Gouge pliers : Functions. These are cutting pliers, which allow the regularization of protruding alveolar edges (regularization of inter-dental septa). 

6. Suture material:

It may be necessary to have suture material available to complete hemostasis that is difficult to achieve with simple compression.

(- Needle holder forceps – Cutting scissors – Suture thread)

III. The different phases of dental extractionSimple:

Different surgical techniques are used depending on the clinical situation encountered. In all cases, these are techniques using instrumentation whose design dates back to the end of the 19th century.

In adults

How is a tooth extraction performed?

1. Preoperative phase:

The psychological preparation of the patient begins as soon as he enters the waiting room.

It is obvious that attention and explanations generally allow the establishment of a climate of trust necessary for carrying out such an anxiety-provoking act.

Sedative premedication is only prescribed if the practitioner judges that his patient needs medicinal assistance.

Dress code

The practitioner must wear an Outfit.

block and hooves

.Long hair will be

tied and wearing a hairnet, mask, sterile gloves and protective glasses is recommended.

Hand washing & rubbing with hydroalcoholic gel

Preparation of materials: The instruments will be placed on a sterile field in the chronological order of their use, then the table will be covered with a second field, which will then be used to cover the patient’s body when he is installed in the chair.

2. Perioperative phase:

Patient position

• The semi-seated position. It is recommended that the back of the chair be tilted at an angle of 120° to the floor. for extractions of mandibular teeth.
• The cuoche position: It is recommended for extractions of maxillary teeth.

Operator position  : The practitioner can work sitting or standing .

• For right-handed patients, the operator stands in front and to the right of the patient between 6:00 and 9:00 in order to extract the maxillary and mandibular teeth, other than the right molars.

• He is placed between 9:00 a.m. and 12:00 p.m. in order to extract the right molars.
• For left-handed patients, the operator stands to the patient’s left.

Basic surgical protocol for simple tooth extraction 

Perfect lighting is recommended

1. Asepsis of the surgical field  :  Oral and perioral disinfection must be done with an antiseptic solution. With a compress. the lips are smeared first, then the inside of the mouth. Antisepsis can be done with a simple  mouthwash .

2. Syndesmotomy  :  This involves cutting the  epithelial and connective tissue attachments  surrounding the tooth. Section of the gingival setting. This is done with a  syndesmotome  which is held like a pen holder.

Subluxation: This consists of mobilizing the tooth with an elevator. The latter penetrates between the tooth and the alveolar bone on the mesial or distal vestibular side to move the tooth. The recommended movements are radiculo-coronary.

3. Avulsion itself : this is the removal of the dental organ. For this, we will use a forceps that will firmly grasp the tooth. The movements to be made with the forceps will vary depending on the type of teeth (respect the anatomy of the roots):
   1. If the tooth is bi- or tri-rooted, the recommended movements are versions with traction. This is the case for the upper and lower molars
   2. If the tooth has a single root, the movements are rotational and traction. This is the case for incisors and canines. It is imperative to check the extracted tooth

4. Alveolar curettage or verification.

Dental curettage is a step that consists of cleaning freshly extracted teeth. Its objective is to have a clean socket.

Dental curettage is not mandatory.

     Alveolar inspection is a way to detect alveolar fractures that may occur during tooth extraction.

5. Hemostasis:

This is a phase that allows the bleeding to stop. It occurs in two stages:

• Chemical using a hemostatic solution.
• Bidigital compression type mechanics.

NB: For maxillary teeth having close relationships with the maxillary sinus, so-called antral teeth (premolars and molars), the VALSALVA technique must be integrated .

3. Postoperative stage: 

3.1. Postoperative advice

 – Avoid mouthwashes during the first 24 hours which are always likely to eliminate a clot that has just formed. 

– Tobacco, alcohol and hot drinks should also be avoided on the first day.

 – Proper hygiene must be maintained. *There are surgical toothbrushes with very soft bristles that allow you to resume brushing the affected area very early.

 – To combat postoperative pain, avoid taking non-steroidal anti-inflammatory drugs and prefer paracetamol-based analgesics.

  – Adopt a semi-liquid and cold diet for the first 24 hours, then soft and lukewarm for a week. 

3.2. Clinical control  : Monitoring of healing and removal of sutures generally occurs between the 7th and 10th day after the operation. 

In children (temporary teeth)

• It does not present any particular operational difficulties. 
• The psychological approach is essential to be able to carry out the act in satisfactory conditions. 
• Sedative premedication can help the practitioner, but more generally it is the degree of cooperation of the young patient which will be the determining factor.  
• Tooth extraction must be preceded by an X-ray examination to ensure the presence of the germ, its location and its relationship with the temporary tooth.
• The technique must be quick and gentle at the same time. Extraction is easy in case of rhizalysis. 
• Dislocation and curettage should be avoided as this could cause damage to the underlying germ.

III. Extraction of difficult teeth.

III.1. Root separation:

It is a surgical technique which performs a coronal and interradicular section of multi-rooted teeth or only interradicular in the case of loss of coronal substance using a bur mounted by an instrument holder.

rotary.

III.2. Alveolectomy: This is an operative technique that allows partial or total exposure of the root(s) of the tooth to be extracted. It consists of an osteotomy of the external alveolar table.

Technique: 

• Local anesthesia is required. 
•  An intrasulcular incision with or without a mesial discharge line.
•  Detachment of the mucoperiosteal flap : is carried out starting from the mesial discharge line (if it is performed) and progresses along the dental necks, gradually sinking towards the back of the vestibule.
•  Alveolectomy proper: after detachment and loading of the flap using a retractor, the operator digs a groove in the vestibular alveolar bone using the rotating instrument equipped with the appropriate burr. He performs a true lateral osteotomy. 
•  Root separation may be necessary. 
• Avulsion, alveolar revision 
•  Closure of the site with hermetic sutures.

Conclusion

The performance of dental extractions requires compliance with a certain number of rules inherent in any surgical practice. The conditions

installation, knowledge of the

equipment and instruments and their uses

have elements that determine good operating practice.

Bibliographical References

1. P.LIMBOUR.Surgery.Simply.DesignManufactureEdition,Dental Information
   2017.
2. N.SCHWENZER.M.EHRENFELD.Dental Surgery.LavoisierMedicineSciences,2015.
3. Daniel PERRINetal..Manual of surgical procedure.Practical technique, mastery and rational exercise on a daily basis.Accredited collectionContinuing trainingJPIO.EditionsCdP,2012.
4. H.TARRAGANO etal..Lachirurgieorale.CollectionaccreditedContinuing trainingJPIO.EditionsCdP,
   2010.
5. Pr.M.BERKANE.Oral pathology.2nd year course.OfficedesPublicationsUniversitaires,
   2004.
6. H.-H.HORCH.Oral SurgeryTranslated from German by B.Kaess.Masson,paris,1996

Simple dental extractions

  Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.
 

Simple dental extractions