intra alveolar extraction, Exams of Chemistry

Download intra alveolar extraction and more Exams Chemistry in PDF only on Docsity! Simple tooth extraction (intra-alveolar) The dental surgeon should attempt to have 1.Quick, efficient, unhurried & methodical approach to his work. 2.Sympathetic encouragement, to gain confidence & cooperation of the patient. 3.You have to avoid to increase the misgivings of the patient by displaying instruments. 4.The dressing of operator should be suitable. 5.Try to do your work in a septic environment reduce the chance of contamination by using gloves, mask, trimming of the nails, tied the hair, etc. Instruments used in simple uncomplicated teeth extraction includes the followings: Diagnostic instruments: (Dental mirror, probe, Tweezer in kidney dish) Dental forceps. Dental elevators. The instrument required for extraction are selected, sterilized & placed ina sterile dish at the side of the patient. Dental forceps The most widely used instrument employed in extraction of the teeth are dental forceps. Dental forceps configuration which adapt are designed in a large number of patterns & to different teeth & techniques used to extract teeth. It is composed of three parts: 1. Handle 2. Hinge joint 3. Blades (beaks) Principles of tooth removal: Clear access to & vision of the surgical field. Use of controlled force Unimpeded path of removal What we do in extraction of a tooth? Separation of tooth from soft tissue and alveolar bone. Alveolar expansion Bleeding is arrested by pressure pack. Techniques of extraction: Two types of extractions can be performed. Simple tooth extractions remove visible teeth. They are usually performed by a general dentist. A surgical extraction is more complicated; it involves a tooth that is impacted inside the jaw and cannot be removed without making an incision. A. Intra-alveolar extraction (closed technique), (simple tooth extraction) B. Trans-alveolar extraction (open method) A. Intra-alveolar extraction (closed technique) 1. forceps Technique 2. elevator Technique forceps Technique Commonly used Not used in - hypercementosis - root deformities - grossly decayed crown - grossly decayed root - brittle root Advantages - least trauma - gingival fibers reduces the size of extraction orifice so promotes healing Basic principles of forceps technique: 1. Beaks should seated as far apically as possible 2. Beaks should be parallel to the long axis of tooth 3. Excess force should be avoided. HOW TO HOLD THE FORCEPS? Extraction of Maxillary Lateral Incisors The extraction movements for removal of the lateral incisor are labial and palatal. Because the lateral incisor has a thin root and there is usually curvature of the root tip distally, rotational force is not allowed. Slight rotational motions may be employed only in the final stage, with simultaneous traction of the tooth from the socket. Extraction of Maxillary Canines Maxillary canines present some degree of difficulty due to: (1) their firm anchorage in alveolar bone, and (2) their long roots and frequent curvature of the root tip. Also, the labial surface of the tooth’s root is covered by thin alveolar bone, and if due consideration is not given during movements, there is a risk of fracturing the alveolar process. The extraction movements are labial and palatal, with gradually increasing intensity. Because the canine has a flattened root and the root tip is usually curved distally, rotational motions are not permitted, or if they are used, they must be done so very gently and with alternating buccopalatal pressure. The final extraction movement is labial. Extraction of Maxillary Premolars As for the first premolar, because it usually has two roots, buccal and palatal pressure should be gentle and slight. If movements are vigorous and abrupt, there is a risk of fracturing the root tips. If one of the root tips does break, it may be removed easily since they are not very curved and the tooth has already been mobilized during the extraction attempt. Rotational motions are not allowed due to the tooth’s anatomy Extraction of the second premolar is easier, because the tooth has one root. Movements are the same as those for the first premolar. The final movement for both teeth is buccal. Extraction of Maxillary First and Second Molars The maxillary first molar has three diverging roots: the palatal, which is the largest and most widely divergent toward the palate, and the two buccal roots, which are often curved distally. The tooth is firmly anchored in the alveolar bone and its buccal surface is reinforced by the extension of the zygomatic process. This tooth therefore requires the application of strong force during its extraction, which may cause fracture of the crown or root tips. To avoid this from happening, initial movements must be gentle, with buccopalatal pressure and an increasing range of motion, especially buccally, where resistance is less. The final extraction movement is a buccal upwards curved motion, following the direction of the palatal root. Because the root tips are close to the maxillary sinus, their removal requires careful consideration, due to the risk of oroantral communication. Extraction of the maxillary second molar may be accomplished in the same way as for the maxillary first molar, because the teeth have similar anatomy. Extracting the second molar, however, is considered to be easier than extracting the first molar, because there is less resistance from the buccal alveolar process and relatively little divergence of the roots. Quite often the roots of this tooth are fused together in a conical shape. In this case, extraction of the tooth is even easier. Extraction of Maxillary Third Molar its extraction does not usually present any difficulty and it may be removed with only buccal pressure. The risk of fracturing the palatal alveolar process is avoided this way, which would otherwise occur if force were applied palatally (the palatal bone is thinner and lower than the buccal bone). When the tooth has three or more roots, though, its extraction is accomplished by applying buccal pressure and very gentle palatal pressure. The final extraction movement must always be buccal. Root anatomy of the third molar permitting, extraction is easily accomplished using the straight elevator. The elevator is positioned between the second and third molars and the tooth is luxated according to the direction of its roots. Extraction of mandibular teeth: Extraction of Mandibular Anterior Teeth Mandibular incisors have narrow flattened roots, which are not very firmly anchored in the alveolar bone. These teeth have one root and are curved at the root tip, especially the lateral incisor. Their extraction is easy, due to their morphology and the thin labial alveolar bone surrounding the root. Extraction pressure is applied labially and lingually, gradually increasing in intensity. Due to the flattened roots of the teeth, only slight rotational force is permitted. Mandibular canines usually have only one root. Seventy per cent of these teeth have a straight root, while 20% present distal curvature. Compared to incisors, canines are more difficult to extract, due to the long root and frequent curvature of the root tip. Extraction movements are the same as those employed for central and lateral incisors. The final extraction movement for all anterior teeth is labial, curved outwards and downwards. Damage of maxillary teeth by the forceps is thus avoided._ teeth, especially if their roots are resorbed. Deciduous teeth are difficult to extract when root resorption is incomplete. The subjacent tooth then erupts partially, causing thinning of the roots instead of total resorption. These thin root remnants are interposed between the crown of the permanent tooth and the bone, and fracture easily during the attempt to extract the deciduous tooth. This extraction is deemed necessary because the deciduous tooth is not shed spontaneously due to incomplete resorption of the root or roots. Extraction Technique Using Root Tip Forceps The root tip forceps are used in exactly the same way as the tooth forceps. In order to use this instrument, the root must protrude out of the gingivae, so that it can be firmly grasped. If the root is at the same level as, or a little beneath, the alveolar margin, a small portion of the root must be exposed before the dentist is able to grasp the root with the root tip forceps. This is accomplished after carefully reflecting a small portion of the gingivae and removing part of the buccal and palatal alveolar bone. As for the dentist’s position, placement of fingers of the nondominant hand and extraction movements, they are no different than those described for intact teeth. 2. Elevator Technique Extraction of Roots and Root Tips A variety of elevators may be used to extract roots and root tips. The most commonly used elevator is the straight elevator. This elevator, besides root extractions, may also be used to remove intact teeth - especially the maxillary and mandibular third molars, root anatomy permitting. There is no doubt that the straight elevator is the ideal instrument in everyday dentistry, as long as it is used correctly. Otherwise, it may cause a number of undesirable complications. In order to avoid such situations, certain basic rules must be followed: O The straight elevator must be held in the dominant hand and the index finger placed along the blade, leaving its anterior end exposed, which is used to luxate the tooth or root. O This instrument must always be used buccally, and never on the lingual or palatal side. O The concave surface of the blade must be in contact with the mesial or distal surface of the tooth to be extracted, and be seated between the tooth and alveolar bone. O When the instrument is placed between the maxillary posterior teeth, it must be perpendicular to their long axis. As for the rest of the teeth of both the maxilla and mandible, it may be perpendicular, parallel, or at an angle. O During luxation, a cotton roll or gauze should be placed between the finger and palatal or lingual side, to avoid injury of the finger or tongue in case the elevator slips. O During luxation, the adjacent tooth should not be used as a fulcrum, but only the alveolar bone. Otherwise, there is a risk of damaging the periodontal ligament fibers. O The straight elevator should not be used to extract multi-rooted teeth, because there is a risk of fracturing their roots if they have not been sectioned previously. During the luxation attempt using the straight elevator, the fingers of the nondominant hand must be in a certain position. O More specifically for right-handed dentists: Maxilla: From the right premolar up to the right third molar, the index finger is placed palatallyandthethumbisplacedbuccally. From the right canine up to the left third molar, the index finger is placed labially or buccally and the thumb is placed palatally . Mandible: From the right first premolar up to the right third molar , the nondominant hand embraces the patient’s head and the index finger is placed buccally, while the thumb is placed lingually . From the right canine up to the left third molar , the index finger is placed lingually and the thumb is placed labially or buccally. Extraction of Single-Rooted Teeth with Destroyed Crown The removal of single-rooted teeth whose crown has been destroyed is accomplished with the help of the straight elevator. More specifically, the blade of the elevator is seated between the root and alveolar bone (perpendicular or at an angle), with the concave surface of the blade in contact with the mesial or distal surface of the root. Using the alveolar bone as a fulcrum, rotational forces are applied around the axis of the elevator, in the mesial and distal area, resulting in displacement of the root and elevation from the socket. Extraction of Root Tips In order to extract root tips from the maxilla and mandible, double- angled elevators are considered the most appropriate instruments, due to their sharp tip, which fits easily between the root tip and the alveolar bone, first mobilizing and then luxating the root tip from the socket . In these cases, especially useful instruments are those that have very narrow blades of various shapes (straight, hooked, etc.). Their use is indicated for the removal of small root tips remaining at the bottom of the socket, since they may be placed in that area more easily than standard elevators. When the root tip is very small and deep in the socket, a narrow angled elevator is placed between the alveolar bone and the root tip, and the instrument is pushed forward gently as apically as possible. Luxation is then attempted until the root tip is mobilized. If the root tip belongs to the palatal root, even though the extraction may be accomplished using the same procedure, the dentist must be especially careful, because there is an increased risk of displacing the root tip into the maxillary sinus. The root tip may also be removed with the aid of an endodontic file, which is first positioned inside the socket and then screwed into the root canal, upon which the root tip is delivered either by hand or with a needle holder. f ann Fig. 5.43. Curettage of the socket after tooth extraction for removal of the periapical lesion Postextraction Care of Tooth Socket After extraction of the tooth, the bottom of the socket is curetted (as long as the tooth is nonvital) with a periapical curette, to remove any periapical lesion from the area. Curetting must be done carefully, because if any remnants of granulation tissue remain in the socket, there is a chance they will develop into a cyst, because a large percentage contain epithelial cells. Sometimes the lesion is firmly attached to the root tip of the tooth and is extracted together with the tooth. Even in this case, the socket must be inspected, but only in the apical region. When the lesion is large and the entire lesion cannot be removed through the socket alone, then surgery is required. Afterwards, and only if considered necessary (e.g., there are sharp bone edges), the alveolar margin is smoothed using rongeur forceps or a bone file, and then the lingual and buccal plates are compressed using finger pressure. This is done to restore the expansion of the socket caused by the extraction, and also for initial control of hemorrhage. Hemostasis is also aided by the patient applying pressure on gauze placed over the socket for 30-45 min.