Simple extractions of maxillary

teethArmamentarium & techniques

Simple tooth extraction or

closed technique

or

exodontiauncomplicated

Presented by:

Dr.Ahmed Ghazi

Supervisor

Dr Hashem Hassouna

Lecturer Oral Maxillofacial

Learning objectives

You should:

• understand the indications for removal of a tooth

• know how to complete the preoperative

assessment

• know the techniques available for extraction

• be aware of the potential complications

following extraction and their treatment.following extraction and their treatment.

Presurgical Medical Assessment

Clinical Evaluation Of Teeth For Removal

Access To Tooth

Mobility Of Tooth

Condition Of Crown

Radiographic Examination Of Tooth For Removal

Relationship Of Associated Vital Structures

Configuration Of Roots

Condition Of Surrounding Bone

Patient And Surgeon Preparation

Chair Position For Forceps Extraction

Mechanical Principles Involved In Tooth Extraction

Principles Of Forceps Use

Procedure For Closed ExtractionRole of Opposite Hand Role of Assistant During Extraction

SPECIFIC TECHNIQUES FOR REMOVAL OF

EACH TOOTH

Maxillary Incisor Teeth

Maxillary Canine

Maxillary First Premolar

Maxillary Second Premolar

Maxillary First and Second Molars

Maxillary Third Molars Maxillary Third Molars

Post Extraction Care Of Tooth Socket

Set Of Instruments Necessary

For Simple Tooth Extraction

1. Local Anesthesia Syringe, Needle, And Ampule.

2. Desmotome Or Freer Elevator

3. Retractor Or Mouth Mirror

4. Extraction Forceps 4. Extraction Forceps

(Depending On The Tooth To Be Removed).

5. Surgical Or Anatomic Forceps.

6. Elevators.

7. Sterile Gauze.

8. Periapical Curette.

9. Suction Tip.

10. Towel Clamp.

11. Needle Holder.

Extraction Forceps�The simple intra-alveolar extraction is accomplished with the

help of extraction forceps and elevators.

� Each extraction forceps is composed of two parts, which are

the handle, which is above the hinge, and the beaks, which are

below the hinge.

The forceps is held in the hand by the handle, upon whichThe forceps is held in the hand by the handle, upon which

pressure is exerted during the extraction.

The beaks are the functional component of the forceps and

grasp the tooth at the cervical region and remove it from the

alveolar socket.

�Because tooth anatomy varies, extraction forceps with

specially designed beaks have been manufactured, so that they

may be used for specific teeth. So, according to the size and

shape of the handles and beaks, the following types exist.

Maxillary Universal Forceps

Or No. 150 Forceps (Mainly Used For Upper

Premolars)

Maxillary Right Molar Forceps,

For The First And Second Upper Molars Of

The Right Side

Maxillary Left Molar Forceps,

For The First And Second Upper Molars Of

The Left Side

Maxillary Third Molar Forceps

Maxillary Root Tip Forceps

�� Patient Position�� Patient Position

�� Dentist Position

�� Extraction

�� Post extraction Care of Tooth Socket

�� Postoperative Instructions

The basic requirements for a successful outcome in

simple tooth extraction are as follows:

@ Informing and reassuring the patient, so that stress

and fear levels are minimized, and so to ensure

desirable cooperation during the procedure.

@ Knowing tooth anatomy well, which can be

variable.

@ Detailed clinical and radiographic examinations,@ Detailed clinical and radiographic examinations,

since these provide important information pertaining to

procedure planning and selecting the appropriate

technique.

@ Preparation of the patient, which includes: (1)

rinsing the oral cavity with various antiseptic solutions,

and (2) correct positioning of the dental chair.

Position Of The Patient

Maxilla: Angle Between Dental

Chair And The

Horizontal(floor) Is °,-.

For the extraction of a maxillary tooth, the patient’s mouth must

be at the same height as the dentist’s elbow and the angle

between the dental chair and the horizontal (floor) must be

approximately ,-.°Also, the occlusal surface of the maxillary

teeth must be at a 23° angle compared to horizontal when the

mouth is open.

Position of dentist during extraction.

In this and all other figures, positions for right-handed dentists are illustrated.

For all maxillary teeth the dentist is to the front and right (and to the left, for left-handed dentists) of the patient.

Extraction of maxillary teeth

Extraction Technique Using Tooth Forceps

The correct way to hold maxillary extraction forceps

Guidelines for extraction

1.Correct way to hold the forceps and the tooth

2. Forces applied to the tooth

3. Direction of movement during the extraction3. Direction of movement during the extraction

4. Role of the nondominant hand in the extraction

procedure

After reflecting of the gingiva, the beaks of the forceps are positioned at

the cervical line of the tooth, parallel to its long axis, without grasping

bone or gingiva at the same time.

The initial extraction movements applied are very gentle. More

specifically, the dentist applies slow steady pressure to move the tooth

buccally at first, and then palatally or lingually.

Movements must become greater gradually and the buccal pressure is

greater than the corresponding palatal or lingual pressure, because the

labial or buccal bone is thinner and more elastic compared to that of thelabial or buccal bone is thinner and more elastic compared to that of the

palate.

If anatomy of the root permits (single, conical roots), rotational force may

be applied in addition to buccopalatal or buccolingual pressure. These

movements expand the alveolar bone and also sever all the periodontal

fibers.

Slight traction is also employed at the same time, facilitating the tooth

extraction.

Extraction of Maxillary Incisors &

canine

Extraction Forceps Should Be Seated With Strong Apical

Pressure To Expand Crestal Bone And To Displace Center Of

Rotation As Far Apically As Possible.

Video_3.flvVideo_3.flvVideo_3.flv

Extraction movements:

i) initial labial (L) pressure ; ii) the tooth is brought back to its original position, with

direction of motion continuing to the palatal (P) side ; iii) the final extraction movement is

curved, with the concave part facing upwards

Extraction of maxillary premolars

Extraction Of Maxillary First

And Second Molars

Extraction Of Maxillary Third

Molars

ON THE DAYOF TREATMENT

1.Do not rinse your mouth for at least 24 hours.

2.Avoid hot fluids, alcohol, hard or chewy foods. Choose cool drinks and

soft foods.

3.Avoid vigorous exercise.

4.Smokers should avoid smoking.

5.Should the wound start to bleed, apply a small compress.

This can be made from some cotton wool in a clean handkerchief. Place this

on the bleeding point and bite firmly on it for 5-10 minutes or longer if

necessary.

If you cannot stop the bleeding yourself, please seek professional advice.If you cannot stop the bleeding yourself, please seek professional advice.

6. Any pain or soreness can be relieved by taking the prescribed medication.

If none was prescribed, take tablets such as paracetamol (Panadol) 2 tablets

every 4 hours as required. Do not take more than the recommended number

per day.

STARTING 24 HOURS LATER

• Gently rinse the wound with hot saltwater mouth rinses (or other rinse as

recommended) for a few days. This should be carried out three times a day

after each meal.

Assumed Knowledge

•,. Anatomy (including radiographic features) of structures surrounding the teeth.

•-. Root morphology including common

variations. 7. Relation of the roots to the maxillary sinus. 7. Relation of the roots to the maxillary sinus.

•2. Impact of medical status of the patient on surgery

•3. Anxiety and stress reduction protocol.

Thanks a lot for not sleeping !