Extraction Techniques

• Principles of extraction:

  • Expansion of bony socket
  • Disruption of periodontal ligament
  • Removal of tooth
• Extraction techniques:

  • Forceps extractions
  • Elevators
  • Surgical extractions (MOS)
• Forceps:

  • Give operator grip on tooth root
  • 2 blades/beaks
  • Blades are wedge-shaped and sharp
  • Blades are hollow to fit root
  • Different designs for different teeth
• Basic movements:

  1. Push up the long axis of the root

  • 1st movement is universal

  1. Dilate the socket
  2. Disrupt the periodontal ligament
• Basic movements:

  1. Push up the long axis of the root

  • 1st movement is universal
  • 2. Dilate the socket
  • 2nd movement depends on the tooth morphology
  • Roots with a circular cross-section are rotated
  • Multi-rooted or oval cross-section move buccally
  • 3. Disrupt the periodontal ligament - will happen!
• Upper molars:

  • Forces are applied on buccal and palatal aspects of tooth
  • Buccal force alone is likely to cause tooth/root fracture
  • Force through long axis of tooth
  • Upward force has very little effect on tooth as it is designed to resist these "occlusal" forces
  • Combining upward and buccal force gives resultant force which moves point of rotation further up the root. Equal forces still not ideal as root fracture may still occur
  • Increasing upward force changes resultant force, moving point of rotation closer to buccal apices
• Lower molars:

  • It is not possible to get point of rotation through apex as any buccal force moves the resultant away from the apex
  • Apex should rotate within the socket
• Conical roots:

  • Upper anterior teeth and other teeth with round cross-section
  • Pure rotational force will result in a spiralling force through the tooth which can result in fracture
  • Maintaining upward pressure while rotating directs force to apex, which starts the whole root rotating at the same time
• For upper molars and premolars, you apply an apical and buccal force.
• For lower molars, you apply an apical and buccal force, and sometimes a figure of 8 rotation is used.
• For lower premolars and upper incisors, use an apical and rotational force.
• For lower incisors and canines, use an apical and buccal force.
• Elevators:

  • Used to assist forceps extraction
  • Used to remove root fragments
  • Used by rotation (screw driver)
  • Leverage gained by ratio of width of handle to width of blade
  • Neighbouring tooth should never be used as a fulcrum, unless it's being extracted in the same visit; the force will loosen the tooth in the socket
• Luxators:

  • Used to move bone away from tooth
  • Help to create an application point
  • Not an elevator
• Surgical extraction:

  • Sterile technique
  • Special instruments
  • Involves:
  • Making a gingival incision and then raising the mucoperiosteal flap to expose the underlying bone
  • Bone removal
  • Division of tooth and removal
  • Area then debrided and irrigated with saline to remove any debris
  • Suturing of mucoperiosteal flap back into position
• Surgical extraction:

  • They're the final answer to any problems
  • Clear view of tooth/root
  • Gives opportunity to debride and clean out the socket - lessens chance of post-operative infection
  • Less traumatic than you think
  • Easier than forceps and elevators