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Principles and steps of surgical tooth extraction
This document outlines the principles and steps of surgical tooth extraction. It describes the indications for surgical extraction, including teeth with unusual root morphology, hypercementosis, dilacerated roots, ankylosed roots, fused teeth, retained root tips, and deciduous molars that embrace permanent teeth. Contraindications include asymptomatic root tips and situations with risk of local complications. The steps described include flap creation, bone removal, tooth extraction using forceps or elevators, and wound closure. Specific techniques are described for single-rooted, multi-rooted, ankylosed, and retained root extraction cases. Postoperative antibiotic recommendations are also provided.
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Introduction to surgical extraction methods, overview of procedure and applicability by practitioners.
Indications include unusual root morphology, hypercementosis, dilaceration, ankylosis, fused roots, broken tips, roots below gumline, and risk in deciduous molars.
Reasons to avoid surgical extraction include asymptomatic fractured roots, serious complication risks, need for extensive bone removal, and significant health issues.
General steps in surgical extraction: flap creation, bone removal, tooth extraction, and postoperative care.
Detailed approach for single-rooted teeth including flap creation, bone removal, and extraction methods.
Multi-rooted extraction steps: flap creation, sectioning, and suturing for proper healing.
Techniques for specific cases like deciduous molars and ankylosed teeth including flap creation and root sectioning.
Steps for extracting retained roots of single and two-rooted teeth, including flap creation and luxation.
Techniques for two-rooted teeth and using semilunar incisions with flap stabilization methods.
Recommended antibiotics for post-operative care and their dosage for effective management.
Final remarks and thanks presented at the conclusion of the presentation.
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Principles and steps of surgical tooth extraction
- 1. Principles and steps of SurgicalTooth Extraction Done by : Dr. Muthanna Ibraheem
- 2. Surgical extraction isthe method by which a tooth is removed from its socket, after creating a flap and removing part of the bone that surrounds the tooth. This technique is relatively simple and can be done by general Practitioner if the basic principles of the surgical technique are followed.
- 3. INDICATIONS 1. Teeth ofthe maxilla or mandible that present unusual root morphology. In such cases, a surgical extraction is performed preventively, because their removal is impossible with the simple technique without complications arising (e.g., root breaking, fracture of alveolar bone, etc.).
- 4. 2. Teeth withhypercementosis of root and root tip, presenting large bulbous roots.
- 5. 3.Teeth with dilacerationof root tips.
- 6. 4. Teeth withankylosed roots or with abnormalities, e.g., dens in dente.
- 7. 5. Teeth fusedwith an adjacent tooth.
- 8. 6. Broken roottips that have remained in the alveolar bone and are involved in osteolytic lesions.
- 9. 7. Roots ofteeth found below the gumline,
- 10. 8. Deciduous molarswhose roots embrace the crown of the subjacent premolar. If the simple extraction technique were to be attempted, there is a great risk of concurrent luxation of the premolar.
- 11. CONTRAINDICATIONS Asymptomatic fracturedroot tips, whose pulp was vital, located deep in the socket. when there is a risk of serious local complications, such as the dislodging of a root tip into the maxillary sinus or injury of the inferior alveolar nerve, mental nerve, or lingual nerve. A large part of the alveolar process needs to be removed. There are serious health problems present.
- 12.
- 13. IN GENERAL 1. Creationof a flap. 2. Removal of bone and exposure of an adequate part of the root. 3. Extraction of the tooth or root with elevators or forceps. 4. Postoperative care of wound and suturing.
- 14. A.single-rooted tooth AnL-shaped incision is made and the flap is reflected. The buccal plate covering the surface of the root is removed, the tooth is extracted using forceps 1. Extraction 0f Tooth With Hypercimintosis at the root tip
- 15. B.Multi-rooted teeth • Theenvelope flap is reflected, part of the buccal plate is removed, • Extraction of the mesial portion of the tooth, which includes the crown and root • and the tooth is sectioned buccolingually at the crown as far as the intraradicular bone
- 16. • Extraction ofthe distal portion of the tooth using forceps after creating a pathway for removal • Suturing of the flap using interrupted sutures • Widening of the alveolus with a round bur.
- 17. 2. Extraction ofDeciduous Molar that Embraces Crown of Permanent Tooth. • Envelope flap created and bone removed as far as the root bifurcation. • Roots of the molar sectioned with a perpendicular groove on the crown, which extends as far as the intraradicular bone.
- 18. • Removal ofthe mesial portion of the tooth, which includes the crown and root. • Suturing of the flap with interrupted sutures. • Removal of the distal portion of the tooth, which includes the crown and root, using forceps.
- 19. 3. Extraction ofAnkylosed Tooth Radiograph and clinical photograph of a maxillary canine with dens in dente
- 20. A trapezoidal flapis created, which extends from the lateral incisor as far as the distal aspect of the maxillary first premolar. Use of a chisel to remove the tooth, together with the ankylosed portion of the labial plate. Operation site after placement of sutures.
- 21. 4.Surgical Extraction ofRetained Roots A. Single rooted tooth Radiograph and clinical photograph of a maxillary 1st premolar.
- 22. Creation of anL-shaped incision, which extends from the mesial aspect of the canine as far as the distal aspect of the second premolar
- 23. Reflection of theflap.
- 24. Removal of thebuccal plate along the length of the root using a round bur
- 25. luxation of theroot in the outward direction using a straight elevator
- 26. Surgical field atthe end of the operation Smoothing of bone margins of the wound using a bone file
- 27. Operation site aftersuturing
- 28. B. Two rootedtooth
- 29. Creation of anenvelope flap to expose the roots
- 30. • the removalof the buccal plate as far as the root bifurcation. • Roots are separated using a fissure bur in the buccolingual direction
- 31. Luxation of rootsafter sectioning
- 32.
- 33. • Creation offlap • removal of the buccal plate and exposure of the root
- 34. Removal of theroot from the osseous window using double-angled elevator.
- 35. • Stabilization ofthe flap in its initial position with placement of the first suture at the center of the semilunar incision.
- 36. Antibiotic coverage The recommendedAntibiotic for p.o. administration is : Ampicillin : 500–1000 mg every 6–8 h, Amoxicillin : 500 mg every 8 h, erythromycin : (Macrolides) every 12 or 24 h, Clindamycin : 300 mg every 8 h, Tetracyclines : 100 mg every 12 h.
- 37.