Riyadh College of Dentistry and Pharmacy

Principles of Exodontia(Techniques)

Course ContributorDr. Nedal Abu Mostafa. BDS.MSc in Oral and Maxillofacial Surgery

Surgeon Preparation

Surgical team should wear surgical gloves, surgical mask, and eyewear with side shields .Additionally they should wear long-sleeved gowns that can be changed when they become visibly soiled.

If the surgeon has long hair, it is essential that the hair be held in position or to be covered with a surgical cap.

Patient Preparation

A sterile drape should be put across the patient's chest to decrease the risk of contamination.

Before the extraction, patients should rinse their mouths with an antiseptic mouth rinse, such as chlorhexidine.

1. The patient’s mouth must be at the same height as the dentist’s shoulder.

2. The angle between the dental chair and the horizontal (floor) must be approximately 120°.

3. The occlusal surface of the maxillary teeth must be at a 45°-60° angle compared to horizontal when the mouth is open.

4. The patient's head should be turned substantially toward the operator, so that adequate access and visualization can be achieved except the extraction anterior portion of the arch, the patient should be looking straight ahead.

For Extraction Of Maxillary Teeth

Patient position:

Dentists usually stand during extractions

Right-handed dentists during extraction using forceps is in front of and to the right of the patient ( 8 o'clock)Left-handed dentists should be in front of and to the left of the patient.

Surgeon Position:

1. The chair is positioned lower than the upper extraction.2. The level of the mandible about the level of the elbow.3. The angle between the chair and the horizontal is about 110°4. The occlusal surface of the mandibular teeth must be parallel to

the horizontal when the patient’s mouth is open.5. A bite block should be used to stabilize the mandible when the

extraction forceps is used.

For extraction of mandibular teeth

Patient position:

Right-handed dentists during extraction of anterior and left side teeth using forceps, is in front of and to the right of the patient ( 8 o'clock).

Right-handed dentists during extraction of right side teeth using forceps, is in behind to and to the right of the patient (11 o'clock).

Position of the surgeon:

Extraction

An erupted tooth can be extracted using one of two major techniques: 1. Closed simple, or forceps technique. 2. Open surgical, or flap, technique.

MECHANICAL PRINCIPLES INVOLVED IN TOOTH EXTRACTION

The removal of teeth from the alveolar process employs the use of the following mechanical principles and simple machines: The lever.Wedge.Wheel and axle.

The lever

Wheel and axle

Wedge

Steps for closed-extraction procedure

loosening of soft tissue attachment from the tooth.With a sharp instrument, such as elevator or the sharp end of periosteal elevator.

1. It allows the surgeon to ensure that profound anesthesia has been achieved..

2. To allow the tooth-extraction forceps to be positioned more apically, without interference from the soft tissue of the gingiva.

3. To avoid soft tissue laceration during removal of the tooth.

Adaptation of the forceps to the tooth. The lingual beak is usually seated first and then the buccal beak. The beaks of the forceps must be held parallel to the long axis of the tooth

Luxation of the tooth with the forceps. The major portion of the force is directed toward the thinnest and therefore weakest bone.The surgeon uses slow, steady, gradually increase force to displace the tooth buccally. As the alveolar bone begins to expand, the forceps is apically reseated which displace the center of the rotation apically. The force should be held for several seconds to allow the bone time to expand.

Removal of the tooth from the socket. Once the Alveolar bone has expanded sufficiently and the tooth has been luxated, a slight tractional force, usually directed buccally, can be used. Tractional forces should be minimized.

For upper teeth:The left index finger of the surgeon should reflect the lip and cheek tissue; the thumb should rest on the palatal alveolar process.

For lower teeth:The left index finger should reflects the cheek, the middle finger retracts the tongue, while the thumb finger supports the mandible

Role of Opposite Hand

In this way the left hand is able to:1. Reflect the soft tissue of the cheek.2. Stabilize the patient's head.3. Support the alveolar process.4. Provide tactile information to the surgeon.5. Stabilize the lower jaw to avoid injury to the TMJ.

Maxillary incisor teeth.

The maxillary central incisors generally have conic roots.The lateral incisors being slightly longer and more slender and more likely to have a distal curvature on the apical one third of the root, so this must be checked radio-graphically before the tooth is extracted. The alveolar bone is thin on the labial side and heavier on the palatal side.

Extraction of Maxillary Teeth

The initial movement is slow in the labial direction . A less palatal force is then used, followed by a slow, firm, rotational force. Rotational movement should be minimized for the lateral incisor, especially if a curvature exists on the tooth. The tooth is delivered in the labial-incisal direction with a small amount of tractional force

Maxillary canine

The initial movement is to the buccal aspect, with return pressure to the palatal.After the tooth has been well luxated, it is delivered from the socket in a labial-incisal direction with labial fractional forces

Maxillary premolars and molars

•Buccal pressures should be greater than palatal pressures.•Any rotational force should be avoided.•Final delivery of the tooth from the tooth socket is with tractional force in the occlusal direction and slightly buccal .

The extraction movements are generally in the labial and lingual directions, with equal pressures both ways.The tooth is removed from the socket with fractional forces in a labial-incisal direction

Extraction of Mandibular Teeth

Mandibular anterior teeth

Mandibular premolars

The roots tend to be straight and conic.The over-lying alveolar bone is thin on the buccal aspect and somewhat heavier on the lingual side. The basic movements being toward the buccal aspect, returning to the lingual aspect, and, finally, rotating. The tooth is then delivered in the occluso-buccal direction

Mandibular molars

Strong buccolingual motion is then used to expand the tooth socket and allow the tooth to be delivered in the bucco-occlusal direction.