An ideal extraction of tooth is defined as painless removal of tooth or root of tooth from its bony attachments with minimal injuries to surrounding investing structures such that there will be minimum post operative complications.
1. INDICATION FOR EXTRACTION OF PERMANENT TEETH :
» Grossly decayed teeth which cannot be saved by conservative procedures.
» Teeth that are foci of infection.
» Teeth with non-vital pulp, where root canal is not possible.
» In case of severe periodontoclasia in which excessive bony support of the teeth is destroyed.
» Teeth in line of radiation therapy.
» Teeth mechanically interfering with placement of restorative appliances.
» Impacted or unerupted teeth.
» Supernumerary teeth.
» Retained deciduous teeth.
» Tooth with fractured roots.
» Malposed teeth not amenable to Orthodontic treatment.
» Roots and fragments.
» Teeth traumatizing soft tissues.
» Teeth associated with cysts and other pathologies.
2. INDICATION FOR EXTRACTION OF DECIDUOUS TEETH :
» Extensive decay resulting in death of the dental pulp.
» Extensive decay which makes pulpotomy and pulpectomy impossible.
» When the deciduous teeth interfere with the normal eruption and alignment of their permanent successor.
» When there is sinus opening through mucoperiosteal membrane.
» When roentgenogram reveals evidence of periapical infection.
» When the root is fractured as a result of subsequent infection.
» Supernumerary teeth.
A. Absolute :
Central Haemangioma. May cause uncontrolled bleeding.
B. Relative :
When some precautions have to be taken.
» Acute cellulitis.
» Uncontrolled Diabetes Mellitus, Hypertension.
» Bleeding disorders.
» Cardiovascular diseases.
» Liver disorders.
» Patients on long-term steroid therapy.
» Teeth that have undergone radiation [6 months – 1 yr ].
SELECTION OF ANESTTHETIC AGENT :
Choice is determined by :
1. Patient’s desire.
2. Operating dentist’s personal preferences.
3. Patient’s physical condition.
4. Age of the patient.
5. Type of the operation.
6. Condition of the operating site is there any infection.
7. Place of operation.
Local Anesthesia is the choice in majority of cases.
EXAMINATION OF TEETH
1. TOOTH TO BE EXTRACTED :
- Is the tooth carious?
- Is it abraded?
- Does it contain large filling?
- Does the tooth have artificial crown?
- Size of the tooth.
- Formation size and number of roots.
- Hypercementosis present on the root or roots.
- Is there on area of condensing or infective osteitis?
- Condition of roots.
- Position of roots.
- Relationship with adjacent teeth, tuberosity and maxillary sinus, mandibular canal.
2. DENTAL RADIOGRAPHS AND EXTRACTION OF TEETH
- Radiographs are an invaluable aid to the surgeon in preventing untoward incident such as fracture of mandible, tearing of floor of the maxillary sinus.
- Intelligent planning of the proposed surgery.
- Small intra-oral filling are necessary to take extra oral views to completely visualize impacted molars. Also necessary to localize position of the teeth.
3. EXAMINATION OF THE SUPPORTING HARD AND SOFT TISSUES.
4. AGE OF THE PATIENT: IN ELDER PATIENT TEETH IS BRITTLE AND IS MORE DENSE AND OPPOSITE IS THE CASE IN YOUNGER INDIVIDUALS.
5. PREVIOUS EXTRACTION