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Tooth Extraction Ngoma.pdf

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Lawrenceshamboko

This document provides an overview of tooth extraction procedures. It discusses the indications for tooth extraction including non-restorable cavities, periodontal disease, fractures, and impacted or crowded teeth. Contraindications like certain medical conditions are also outlined. The key equipment, positions, extraction techniques, complications, and post-operative instructions are described in detail. Local anesthesia methods like inferior alveolar nerve blocks and supraperiosteal infiltration are explained.

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NGOMA 1
OVERVIEW A Dental extraction (also referred to as tooth extraction, exodontia, exodontics or informally, tooth pulling) is the removal of teeth from the dental alveolus in the alveolar bone 2
Tooth extraction Indications: 1. Grossly carious tooth which cannot be restored 2. Acute/chronic pulpitis which cant be restored by Root Canal Treatment 3. Periodontal diseases More than half of alveolar bone loss 4. Fracture of tooth Root Longitudinal If tooth lies on jaw # line 3
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Indication cont.. 5. Bony lesion lies over the tooth Cyst, Tumor,Osteomyelitis 6. Impacted tooth 7. Aesthetic indication 8. Orthodontic appliances Teeth crowding 9. Supernumerary and malposed teeth 10. Retained deciduous tooth if permanent successor is present 11. If tooth hurting the soft tissue Upper 3rd molar damaging the lower 3rd molar gum tissue 6
Contraindications: General 1. Cardiac diseases - Valvular heart diseases, RHD, Hypertension,Patients on anticoagulation therapy 2. Blood disorders (Severe anemia, Leukemia, Hemophilia) 3. Liver disease (Vitamin K deficiency, Clotting factor deficiency) 4. DM 5. Pregnancy- 1st and 3rd trimester 6. Epilepsy patient 7. Allergic to local anesthesia 8. Psychiatric patient 9. Very old patient 10. Uncooperative patient/ Lack of consent 7
Contraindication : Local 1. Acute gingivitis 2. Acute periodontitis 3. Acute pericoronitis 4. Acute cellulitis 5. Acute osteomyelitis 6. Malignancy 8
EQUIPMENT Dental chair Operating light Dental forceps Scalpel Needle holder Dean scissors Curved hemostat Minnesota retractor Right angle Austin retractor Weilder tongue ratractor 9
Seldin retractor Molt periosteal elevator Suction tip Adson tissue forceps Allis tissue forceps Double ended curette Small half circle needle Suturing kit 10
Blumenthal rongeur forceps Bone file Burs Handpiece Hall drill Rubber bite block 11
Post extraction instructions: 1. Bite on cotton or gauge for half an hour 2. Dont spit or rinse as far as possible 3. Dont take hot water or food at least for 12 hour 4. No physical activity for 24 hours 5. Soft lukewarm comfortable foods 6. Intake of antibiotics and analgesics as prescribed by dentist 7. Cold compress with ice packs 8. No smoking / Alcohol / Tobacco 9. If any bleeding, pain or complications contact hospital or dentist immediately 10. Warm saline wash after 24 hrs for next 2 or 3 days 12
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Complications 1. Fracture of Crown, Root, Alveolar bone, Adjacent tooth 2. Dislocation of TMJ 3. Trauma to Gingiva, Lips, Tongue, Palate 4. Intraoperative and post operative hemorrhage 5. Trismus 6. Infection : local /systemic 7. Anesthesia related complication 14
Antibiotic prophylaxis: Under L.A Amoxycillin 3gm 1 hour before surgery,If allergic to Amoxycillin then give Clindamycin 600mg Under G.A Amoxycillin IV + oral 1gm at induction and 0.5 gm 6 hours later,If allergic then Vancomycin IV infusion1gm over 1 hour+Gentamycin120mg IV 15
Position 16
The surgeon and patient should be positioned in such a way that patient is comfortable and the surgeon can stand or sit in front of the patient without undue strain. Instruments should be placed out of the patients sight but close to the surgeon 17
Mandibular Extraction CHAIR AXIS- The chair is positioned so that the mandibular occlusal plane is parallel to the floor CHAIR HEIGHT- The chair is lowered to afford the surgeon the leverage and control needed for extraction PATIENT HEAD- the patient is asked to turn the head towards the operator OPERATOR- The operator is 9 oclock position relative to the patient SECOND HAND OPERATOR- The second operator is at 3 oclock position to help the operator in retracting the cheek, lip and tongue and stabilizing the jaw 18
ASSISTANT- The assistant places the suction tip in one hand and the soft tissue retractor in the other hand 19
Maxillary Extraction CHAIR AXIS- the chair is tipped backward so that the maxillary occlusal plane is at an angle of about 60 to the floor CHAIR HEIGHT- the chair is lowered to the height of the operators elbow PATIENT HEAD- the patient is asked to lift the head and turn toward the operator for access and visualization OPERATOR- is at the 9 oclock position relative to the patient SECOND OPERATOR- is at the 3 oclock position and helps with retraction suctioning irrigation and jaw stabilisation 20
Extraction movement Primary movement: Along longitudinal axis of root Secondary movement: Main extracting movement Rotatory Buccolingual or labiolingual Mesodistal Lifting the tooth 21
Upper central and lateral incissor Rotation only Upper canine Rotation initially, some labiolingual movement may be needed Upper premolar and molar Buccopalatal movement 22
Lower central and lateral incissor Labiolingual movement Lower canine Rotatory and labiolingual Lower premolar Rotatory Lower molar Buccolingual movement 23
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Nerve supply: Maxilla Posterior superior alveolar nerve: Molars Middle superior alveolar nerve: Premolars Anterior superior alveolar nerve: Canines and Incissor Sensory supply of palate from greater and lesser palatine nerves as well 25
Mandibular nerve: Lingual nerve Inferior alveolar nerve : Enters the mandibular canal 26
Dental block Types of blocks Supraperiosteal injection Mental nerve block Anterior superior alveolar (Infraorbital) nerve block Posterior superior alveolar nerve block Inferior alveolar nerve block 27
Choice of anesthesia in dental procedure 2% lidocaine/Xylocaine with 1:100,000 epinephrine is a good choice. This provides about 1 hour of dental pulp analgesia 3 to 5 hours of soft-tissue analgesia For temporary relief of pain, the preferred agent is 0.5% Bupivacaine with 1:200,000 epinephrine 1 to 3 hours of dental pulp analgesia 4 to 9 hours of soft-tissue analgesia Duration of analgesia is less with supraperiosteal injections than with regional nerve blocks 28
Inferior alveolar nerve block Most widely used anesthetic procedure in dentistry All mandibular teeth to midline Anterior 2/3 of tongue Floor of oral cavity Complication: Infection Patient having tendency to bite tongue or lips 29
Aim is to deposit solution around the inferior alveolar nerve as it enters the mandibular foramen underneath the lingula The patient's mouth must be widely open, inferior border being parallel to ground Palpate the landmarks of external and internal oblique ridges and note the line of the ptyerygomandibular raphe 30
Index finger is used to stretch the tissues over the injection site, maximizing visibility and minimizing the pain of the injection. Orient the syringe so that the barrel is in the opposite corner of the mouth, resting on the premolars Aim toward your index finger and slowly penetrate the mucosa until bone is contacted, usually a distance of about 2.5 cm Needle should be parallel to occlusal surface 31
Withdraw slightly and aspirate If no blood is returned, inject 1.5 to 2 mL of anesthetic If aspiration is positive, pull back and redirect slightly, then repeat If a lingual nerve block is required 0.5 ml of LA is injected after withdrawal of 0.5cm of the needle 32
Supraperiosteal infiltration Also called local infiltration Teeth affected Any maxillary tooth Only can anesthetize 2 or 3 adjacent teeth Poor option for mandibular tooth because of relatively high density 33
The aim is to deposit LA supraperiosteally in as close proximity as possible to the apex of the tooth to be anaesthetized. The LA will diffuse through periosteum and bone to bathe the nerves entering the apex. Reflect the lip or cheek to place mucosa on tension and insert the needle along the long axis of the tooth aiming towards bone. At approximate apex of tooth, withdraw slightly and deposit LA slowly 34
Mental nerve block Apex of the second premolar Tissue and teeth affected Buccal soft tissues from 2nd mandibular premolar to midline skin of lower lip and chin 35
Infraorbital block Just inferior to the infraorbital notch Teeth affected Incisors Canines premolars 36
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Tooth Extraction Ngoma.pdf

  • 2. OVERVIEW A Dental extraction (also referred to as tooth extraction, exodontia, exodontics or informally, tooth pulling) is the removal of teeth from the dental alveolus in the alveolar bone 2
  • 3. Tooth extraction Indications: 1. Grossly carious tooth which cannot be restored 2. Acute/chronic pulpitis which cant be restored by Root Canal Treatment 3. Periodontal diseases More than half of alveolar bone loss 4. Fracture of tooth Root Longitudinal If tooth lies on jaw # line 3
  • 4. 4
  • 5. 5
  • 6. Indication cont.. 5. Bony lesion lies over the tooth Cyst, Tumor,Osteomyelitis 6. Impacted tooth 7. Aesthetic indication 8. Orthodontic appliances Teeth crowding 9. Supernumerary and malposed teeth 10. Retained deciduous tooth if permanent successor is present 11. If tooth hurting the soft tissue Upper 3rd molar damaging the lower 3rd molar gum tissue 6
  • 7. Contraindications: General 1. Cardiac diseases - Valvular heart diseases, RHD, Hypertension,Patients on anticoagulation therapy 2. Blood disorders (Severe anemia, Leukemia, Hemophilia) 3. Liver disease (Vitamin K deficiency, Clotting factor deficiency) 4. DM 5. Pregnancy- 1st and 3rd trimester 6. Epilepsy patient 7. Allergic to local anesthesia 8. Psychiatric patient 9. Very old patient 10. Uncooperative patient/ Lack of consent 7
  • 8. Contraindication : Local 1. Acute gingivitis 2. Acute periodontitis 3. Acute pericoronitis 4. Acute cellulitis 5. Acute osteomyelitis 6. Malignancy 8
  • 9. EQUIPMENT Dental chair Operating light Dental forceps Scalpel Needle holder Dean scissors Curved hemostat Minnesota retractor Right angle Austin retractor Weilder tongue ratractor 9
  • 10. Seldin retractor Molt periosteal elevator Suction tip Adson tissue forceps Allis tissue forceps Double ended curette Small half circle needle Suturing kit 10
  • 11. Blumenthal rongeur forceps Bone file Burs Handpiece Hall drill Rubber bite block 11
  • 12. Post extraction instructions: 1. Bite on cotton or gauge for half an hour 2. Dont spit or rinse as far as possible 3. Dont take hot water or food at least for 12 hour 4. No physical activity for 24 hours 5. Soft lukewarm comfortable foods 6. Intake of antibiotics and analgesics as prescribed by dentist 7. Cold compress with ice packs 8. No smoking / Alcohol / Tobacco 9. If any bleeding, pain or complications contact hospital or dentist immediately 10. Warm saline wash after 24 hrs for next 2 or 3 days 12
  • 13. 13
  • 14. Complications 1. Fracture of Crown, Root, Alveolar bone, Adjacent tooth 2. Dislocation of TMJ 3. Trauma to Gingiva, Lips, Tongue, Palate 4. Intraoperative and post operative hemorrhage 5. Trismus 6. Infection : local /systemic 7. Anesthesia related complication 14
  • 15. Antibiotic prophylaxis: Under L.A Amoxycillin 3gm 1 hour before surgery,If allergic to Amoxycillin then give Clindamycin 600mg Under G.A Amoxycillin IV + oral 1gm at induction and 0.5 gm 6 hours later,If allergic then Vancomycin IV infusion1gm over 1 hour+Gentamycin120mg IV 15
  • 17. The surgeon and patient should be positioned in such a way that patient is comfortable and the surgeon can stand or sit in front of the patient without undue strain. Instruments should be placed out of the patients sight but close to the surgeon 17
  • 18. Mandibular Extraction CHAIR AXIS- The chair is positioned so that the mandibular occlusal plane is parallel to the floor CHAIR HEIGHT- The chair is lowered to afford the surgeon the leverage and control needed for extraction PATIENT HEAD- the patient is asked to turn the head towards the operator OPERATOR- The operator is 9 oclock position relative to the patient SECOND HAND OPERATOR- The second operator is at 3 oclock position to help the operator in retracting the cheek, lip and tongue and stabilizing the jaw 18
  • 19. ASSISTANT- The assistant places the suction tip in one hand and the soft tissue retractor in the other hand 19
  • 20. Maxillary Extraction CHAIR AXIS- the chair is tipped backward so that the maxillary occlusal plane is at an angle of about 60 to the floor CHAIR HEIGHT- the chair is lowered to the height of the operators elbow PATIENT HEAD- the patient is asked to lift the head and turn toward the operator for access and visualization OPERATOR- is at the 9 oclock position relative to the patient SECOND OPERATOR- is at the 3 oclock position and helps with retraction suctioning irrigation and jaw stabilisation 20
  • 21. Extraction movement Primary movement: Along longitudinal axis of root Secondary movement: Main extracting movement Rotatory Buccolingual or labiolingual Mesodistal Lifting the tooth 21
  • 22. Upper central and lateral incissor Rotation only Upper canine Rotation initially, some labiolingual movement may be needed Upper premolar and molar Buccopalatal movement 22
  • 23. Lower central and lateral incissor Labiolingual movement Lower canine Rotatory and labiolingual Lower premolar Rotatory Lower molar Buccolingual movement 23
  • 24. 24
  • 25. Nerve supply: Maxilla Posterior superior alveolar nerve: Molars Middle superior alveolar nerve: Premolars Anterior superior alveolar nerve: Canines and Incissor Sensory supply of palate from greater and lesser palatine nerves as well 25
  • 26. Mandibular nerve: Lingual nerve Inferior alveolar nerve : Enters the mandibular canal 26
  • 27. Dental block Types of blocks Supraperiosteal injection Mental nerve block Anterior superior alveolar (Infraorbital) nerve block Posterior superior alveolar nerve block Inferior alveolar nerve block 27
  • 28. Choice of anesthesia in dental procedure 2% lidocaine/Xylocaine with 1:100,000 epinephrine is a good choice. This provides about 1 hour of dental pulp analgesia 3 to 5 hours of soft-tissue analgesia For temporary relief of pain, the preferred agent is 0.5% Bupivacaine with 1:200,000 epinephrine 1 to 3 hours of dental pulp analgesia 4 to 9 hours of soft-tissue analgesia Duration of analgesia is less with supraperiosteal injections than with regional nerve blocks 28
  • 29. Inferior alveolar nerve block Most widely used anesthetic procedure in dentistry All mandibular teeth to midline Anterior 2/3 of tongue Floor of oral cavity Complication: Infection Patient having tendency to bite tongue or lips 29
  • 30. Aim is to deposit solution around the inferior alveolar nerve as it enters the mandibular foramen underneath the lingula The patient's mouth must be widely open, inferior border being parallel to ground Palpate the landmarks of external and internal oblique ridges and note the line of the ptyerygomandibular raphe 30
  • 31. Index finger is used to stretch the tissues over the injection site, maximizing visibility and minimizing the pain of the injection. Orient the syringe so that the barrel is in the opposite corner of the mouth, resting on the premolars Aim toward your index finger and slowly penetrate the mucosa until bone is contacted, usually a distance of about 2.5 cm Needle should be parallel to occlusal surface 31
  • 32. Withdraw slightly and aspirate If no blood is returned, inject 1.5 to 2 mL of anesthetic If aspiration is positive, pull back and redirect slightly, then repeat If a lingual nerve block is required 0.5 ml of LA is injected after withdrawal of 0.5cm of the needle 32
  • 33. Supraperiosteal infiltration Also called local infiltration Teeth affected Any maxillary tooth Only can anesthetize 2 or 3 adjacent teeth Poor option for mandibular tooth because of relatively high density 33
  • 34. The aim is to deposit LA supraperiosteally in as close proximity as possible to the apex of the tooth to be anaesthetized. The LA will diffuse through periosteum and bone to bathe the nerves entering the apex. Reflect the lip or cheek to place mucosa on tension and insert the needle along the long axis of the tooth aiming towards bone. At approximate apex of tooth, withdraw slightly and deposit LA slowly 34
  • 35. Mental nerve block Apex of the second premolar Tissue and teeth affected Buccal soft tissues from 2nd mandibular premolar to midline skin of lower lip and chin 35
  • 36. Infraorbital block Just inferior to the infraorbital notch Teeth affected Incisors Canines premolars 36
  • 37. 37