Tooth extraction
Indications/contraindications
Technique
I/ Definition :
Tooth extraction is a surgical procedure that involves separating the tooth from its socket.
I) INDICATIONS:
A – Local indications :
These are indications related to the condition of the tooth itself. A tooth may be deemed irrecoverable because of:
1°) significant coronal-radicular destruction, exceeding any possibility of recovery and reconstitution
2°) cases of advanced apical lesions, the healing of which cannot be achieved by endodontic treatments.
3°) cases of advanced periodontal lesions leading to significant vertical and axial mobility
B) Prosthetic indications
1°/ The extraction of one or more teeth, even those that can be preserved, is possible when they are of no functional value, or likely to harm the restoration of a balanced prosthetic system.
2°/ Sometimes it is indicated to extract an isolated tooth or a group of teeth with a view to a prosthetic replacement likely to provide an aesthetic or functional improvement.
C) Orthodontic indication:
Extraction of permanent (healthy) teeth is frequently indicated:
1°/ In case of number anomalies (supernumerary teeth)
2°/ To regularize the alignment of the teeth without modifying the shape of the arch (ectopic tooth)
3°/ To prevent or limit a future malocclusion by reducing the number of teeth. It is the first premolars which are most often sacrificed.
4°/Extraction of DDS responsible for dental overlaps.
5°/Extraction of non-rhizalysed temporary teeth
D) General indications :
1°/ This is the case of focal infections: these are remote manifestations of a dental infection by the phenomenon of bacteremia
(endocarditis, uveitis, nephritis, etc.)
2°/ In the case of general pathological conditions: cardiovascular, digestive, renal, and even neurological diseases, in these cases it is necessary to eliminate dental infectious foci.
3°/ Preparation for radiotherapy
II°) CONTRAINDICATIONS
A°) RELATIVE OR TRANSIENT CONTRAINDICATIONS:
This is the case where the extraction is postponed for various reasons.
1°/Local order:
cases of oral septicemia (cellulitis, abscess, desmodontitis)
2°/ Physiological :
a) cases of pregnancy:
– avoid extractions during the first 3 months of pregnancy, especially in primiparas (risk of abortion)
and the last 2 months (risk of premature delivery)
in case of emergency: you must seek the advice of the treating gynecologist, use anesthesia without vasoconstrictor in small quantities, and perform the extraction gently without extending the operation time
b)menstrual cycle :
causes a neuro-vegetative imbalance. Extraction can accentuate this imbalance: extraction should be postponed except in emergencies.
c) breastfeeding :
toxicity
3°/General :
Are found in patients who suffer from a general illness. The patient must be prepared (premedicated) in this case.
The risks in this type of patient are:
Infectious risk
Risk of bleeding
Risk of syncope
Toxic risk
B°) ABSOLUTE CONTRAINDICATIONS :
This is the case where extraction can be fatal (death)
1°/immuno-depressed patients (leukemia, advanced AIDS)
The subject’s resistance is reduced and an extraction can give a sudden awakening to the disease, which can lead to the death of the patient due to deficiency of resistance.
2°/Case of subjects having undergone radiotherapy: extraction risks triggering osteo-radio-necrosis
In emergency cases, extraction is carried out in a hospital environment under antibiotic coverage and with specific procedures to follow.
3°/ Patient having had a myocardial infarction (MI)
Or angina pectoris (ANGOR) (less than 01 month)
III/Techniques of dental extraction
II/ Stages of dental extraction 1- preparation of the patient/practitioner:
Psychic preparation
Adjusting the position of the chair according to the tooth to be extracted
Preparation of the operating field (disinfection using an antiseptic)
Protection of the practitioner by wearing a mask/gloves
2- anesthesia: The type of anesthesia will be chosen depending on the tooth to be extracted
3- Syndesmotomy:
Syndesmotomy involves cutting the gingival seam all around the tooth, which prevents the extraction from causing gingival tears.
the Syndesmotome:
– Description : it is characterized by
- A handle with a rectangular section
- A fine, lanceolate working part
- A rod
Use : it is introduced into the gingival sulcus at the level of one of the interdental papillae until it comes into contact with the crestal edge or even slightly below and travels in contact with the tooth to the opposite papilla, cutting the ligament.
– Varieties:
- Chompret syndesmotome: it cannot be dismantled
We distinguish:
*Right syndesmotome
*Sickle syndesmotome (Hamon)
Syndesmotome angled on the cutting edge
*Syndesmotome angled on the flat
Bernard’s syndesmotome:
4- Subluxation : After the syndesmotomy, the careful use of the elevator helps to mobilize the tooth. Its use is not mandatory, it helps to facilitate the action of the forceps and is sometimes sufficient to perform the dental extraction.
The Elevator:
– Description : consisting of
– the handle: can be an extension of the rod carrying the working part, or perpendicular to the rod.
– The stem
– The working part: dug by a gutter or oval.
– Use :
The instrument is introduced between the root and the alveolar bone, and acts as a lever.
The concavity adapting to the convexity of the root, we achieve a real cleavage of the tooth from its supporting tissue, the aim being to achieve the mobilization and elevation of the dental organ.
Varieties : The most commonly used forms are:
- Flohr Elevator :
- Roy’s elevator (bayonet)
- Winter Elevator
4- Avulsion:
After subluxation, the use of forceps allows the extra-alveolar luxation of the tooth to be completed.
The Davier:
– Description :
A davit is made up of 03 parts:
- The mores constitute the working part, they allow the tooth to be grasped thanks to the adequacy of their shape to the morphology of the tooth.
- Branches: generally symmetrical, slightly curved.
- Hinge: point of union of the two arms of the instrument.
- – Use :
- Allows you to grasp the tooth
– Varieties:
- In the upper jaw : the moras are in the extension of the handle
1- forceps for incisors and canines :
-general rectilinear shape.
2-Premolar forceps :
- General form in italic S.
3- Forceps for 1st and 2nd molars :
- General shape in stretched S.
Asymmetrical Mores: vestibularly the mores has a median spur which inserts into the interdental space
4- Wisdom tooth forceps :
Bayonet shape
5-Root davits:
- A The mandible : is distinguished by the orientation of the mors which form a right angle with the handles:
1- Forceps for incisors and canines :
2-Premolar forceps :
3- Forceps for 1 and 2 molars:
4- Wisdom tooth forceps :
5-Root davits :
5- Alveolar revision or curettage:
– Definition :
Consists of exploring and cleaning the bone socket emptied by the extraction and also serves to check the integrity of the alveolar walls. – Curettes:
– Description :
Consisting of a straight or bent handle, spoon-shaped end.
The grip is of the pen holder type.
The concave face of the active part is applied to all the walls of the cell .
Then it progresses from the depth to the surface, thus ensuring careful curettage of the cavity.
6-time gingival
- Bi-digital compression: pinch the edges of the alveolus firmly on both sides so as to bring them as close as possible
- Then ask the patient to bite on the cotton
G-post-operative advice
- do not rinse
- Do not remove the cotton before 1 hour.
- Semi-liquid food not too hot
- Do not touch the alveolus
- No anti-inflammatories (aspirin!!)
- If you have pain, take paracetamol.
- Avoid “grandma’s” remedies: alum, coffee, etc.
Tooth extraction
Impacted wisdom teeth may require surgery.
Zirconia crowns are durable and aesthetic.
Bleeding gums may indicate periodontitis.
Invisible orthodontic treatments are gaining popularity.
Invisible orthodontic treatments are gaining popularity.
Modern dental fillings are both durable and discreet.
Interdental brushes are ideal for narrow spaces.
Good dental hygiene reduces the risk of cardiovascular disease.
Impacted wisdom teeth may require surgery.
Zirconia crowns are durable and aesthetic.
Bleeding gums may indicate periodontitis.
Invisible orthodontic treatments are gaining popularity.
Invisible orthodontic treatments are gaining popularity.
Modern dental fillings are both durable and discreet.
Interdental brushes are ideal for narrow spaces.
Good dental hygiene reduces the risk of cardiovascular disease.