62 Pediatric Exodontia (Chapter outline) Inccation for Extraction of Teoth CGontvaindications for Extraction Preparation for Extraction Principle of Extraction Exodontia Techniques Procedure for Extraction ‘Nikhil Marwah Extraction of Permanent Maxi ry Teoth Extraction of Mandibular Tocth Extraction of Roots Exraction of Deciduous Teeth Operative Complications Postoperative Care Lhe horslyingespesionce associated with the tooth extraction in the past is sill to overcome by the layman, Lven woday the removal of soath is si dreaded by the patient almost ‘move shan any other surpial procedure. Many patients have raeiion phobia, despite modem methods of anesthesia ‘Today dentists often consider tooth extraction @ minor and ‘unimportant procedure and without pruper uaining, aempt ‘dfcul: cases and land up ina mess. efoee anleriaking the ‘extraction of tooth, one sek! thoroughly evaluate the care involved. Eurthes, consideration should be given to ype ot anesthesia used atl a good radiograph shoul he secure! rule wut wy abnunmalites chat may make extaction ditfeul Se in cis wuy we can avoid the hascy use of foetus ame the «ype of procedure can be selected tats most Hkely yield the best rests, ‘he ideal tooth extraction is he procedure of painless removal af whole tooth, or sao: with mnie seas to salt tissue and hard ussue so that Ue woud heals unevenly nd with no postoperative proalem INDICATION FOR EXTRACTION OF TEETH The value of coo should sot tendesestimted as Chey ‘ue important not only from an esthetic point of view but also help in proper digestion of food, there are many seasons why booth deciduous and permanent ceeth have to be extacte Sometimes, narmal teeth orcasionally must ne sacrificed to imprave masticatian and prevent malncciusion. In most 0 the insanees, disease ore wh re excracced because they areaffeest! by ye ill health due wo spread of the infection, Following are tie main indications: + Teeth affec ‘Teeth afleccec by periodontal disease Extraction af healthy teeth ro correct malocclusion (Overretained teeth Trauma tthe seeth oF jaws may cause dislacation of @ tots rons ts socket (alsin) + Extraction of teeth for esthetic seasons + stiaclon of eth for prosthodontic reasons + Ienpacted aed superman + Fstraction of decayed impaction of Srd molars woth involved in tactare line od by advanced caries and is sequelae ary teeth st oF 2nd molars 10 prevent tweet involved in tunots a evs Tooth as foc af infection Tweet aflecied by crow, abrasion, altsison or + Teern affceted by palpal lesions e pulpit pulp polyp + Teeth the area of direct therapeutic radiation poplasia pink spot or CONTRAINDICATIONS FOR EXTRACTION 1 is necessary for the well being of the patient wo delay tetraction Until certain local ur systemic conditions ean be convcted oF modified, Analgesics and antibiotics ean be use keep the patient comortable ts sometimes bestlevat she section fist and exact the tooth when the acute sympioms subside, There are few absolute conteaindications to the removal of teeth when itisnecessary for the wel boing ofthe patient + Presence of acute oral infersions such as, necrossing ingivits or erpetic gingival stomatitis + Peticornitis(dlfcul: surgical procedure involving bone rermovalisantiipaed + Batraction of teeth io previously inadiated areas (at least | year shoud be allowed for maximal recovery af sitelaon to the hone) + ‘There are sumber of relative systemie contraindications tothe tooth extraction, eg. = Uncontralled diabeses = Acute bland dyserasias = Uniteated coagulopathies = Adrenal insufficiency = General desilitation for any ceason © Myocardia! infaresion (wait for 6 months period), PREPARATION FOR EXTRACTION 1 Preoperative Assessment +A history of general eisease, nervousness, ar previous eifiulty with extractions, will govern both the choice of tinesthesia and procedure of south extraction, ‘© "The goneral cleanliness of the patient's mouth and o:al bowie moobserved sation sealing should be petformed, especially neglected! mouths at least one week prioc to surgery ‘+ Sickorfasigued should rest before operative procedures. 4+ Highly apprehensive patient should receive some form of sealation before the operation, 4+ Pasentimdergoigpeneralanestbestashouldbetnsteucted tw omit che previous meal and wo take nothing by mouth for at least 6 hours befose extraction + Paticnt wich inflamed or infected gingival should use an antiseptic mouth rinse hefore the extraction. ‘+ Removable prostheses must be taken out ofthe patien’s + "Tie adiminisiation of anubiosies is secommended 2s prophylac measure nal medical compzoraised patients i Pre-extraction Radiograph The purpose of pre-extracion eadiogzaphhisto show thew root structure and the alveolar bane savesting the toot with OPA, feral oblique view, OPG. The following are the main indication for preoperative radiographs: + History ofeifficult wr attempied extractions + Asoath which is esisant 0 orvepsextaction Chapter 2 Pedatic odor (IM + ifs twoth isto he nemoved by dissection + Close relationship uf touth or routwidh = Manillary sinus = Inferior alveolar coal = Montal nerves + All mandibular and maxilary 3:¢ molars, in standing premolars or misplaced cansnes lp less teth with resorbed roots Teeth affected by peeidlantal dis Irauimatie teeth An isoliced tanth + Any partially erupted o- unerupted tooth or retained 200 + Retained devidaos tooth + Submerged soot, + Conditions whieh predisposes ir denal ar alveolar abnormaliy, ei = Cleidoerania Mysostolia — for pseudo-anodontis, = Oswitisde‘ormans— for hypercementosed root © Patiens with therapeutic radiation = Usteoperrosia, Choice of Anesthesia ‘Teeth may he extracted under ether Jneal anesthesia or ‘general anestvesia and one should assess the indication And contraindications of both be‘ore deciding which to tose im a parsicular case, Most extraction of toh ean be done with local anesthesia alone + To doeswase 10 nervousness, teliove tension and conte psychic behavior sedation can be used ia eonjunciion With the local anesthesia, In young children, general Anesthesia rather than local anesthesia may'be indicated to facitte patient managemens All patients with general anesthesia of local anesthesia should be observed! in recovery area uni hey’ are able to go home unaided or should be accompanied by adult and not permitted co deve, PRINCIPLE OF EXTRACTION I ostine practice, the following three principles of extraction should be followed for the w ofthe patienss by doing atraum: sme mechanical boing | Expansion of the Socket The extraction ofa tools requires the separation ofits attach= meat @ the alveolar bone via the etestal ae rcp bers ‘of the PDL whiel involves a prucess of expansion of alveolar socket, ‘Ihis is achieved by using the woth as che dist insitament with the help faneeps, co peteit the removal a! the woth(EE) section 12 Oral surgical Procedures in Children SE Use of a Lever and Fulcrum nis basi principle is use with elevators that force a tooth oF ro0t out oF tae sacket along the pats af least resiscance lThe Insertion of a Wedge This fy dome beoween dhe wut ruut surface and dhe buny sachet wail ta help the ooth forse in its sockes EXODONTIA TECHNIQUES Ih following iechnigues may be used for tooth removal + The forceps wechnigue — closed meshad Ihe elevate techoique— open + Transalveoiartechnique— open method + Odomorory ll Forceps Technique 1s the most ea teeth, ut, ie should nat be we in dificelt cases, ex. cooth with hypercementoid soot or tooth with defosmlsy of the roots Ibis forcep technique gves feast amount oF ANA 1 smunly used red forthe extraction 0 soft ussues and hare issue oF juicious'y used. Ta multiple rion the marginal gingival may have toe eelected to permis rounding anu smoothing of the sharp prominences Dt the alveular process. Care shold the height and }roadth af the ridge for stabiiy of a Fuse denture, Proper use of ths eclnique mvolves the application several base principles. + The beaks of the selected foreep should be sealed as apically as possible wichout compression of the soft tissues alter reflecting dhe cervical gingival + “the placomen of the beaks af the forceps shoul be as pacallel as possible tothe long ais of tie tooth, + ihe applleailon of escessive force should be avoided so chat he ature uf the alveolar process ut och itself dues Elevator Techniques This technique is used in twa ways Elevator asaleversIn ths eas, Ue alveolar crest serves.as tho filerum, The aroa ofthe eampresseal bone should be removed with afile or rangeur to reduce the pastaperative pain and infection, With elevators, ene should awvid traumatiing the gingival and loosening nf adjacent tet, This method is wed far the removal of whole or neal wale eoots, 2. Hlevator as.awedee"Ihis prineipe is used forthe removal to small root sips by way of displacement, W the wat tip cannot he dsioiged from the sockot easily, an open view ‘ethos! should be used. lETransalveolar Method (Open View Technique) This method is used where ronis are inaccessible to coutine removal by forceps ar by an elevatas, when they cannot be nated with simple forees, or when the roots are covered by ome, his method is fa less usumatie than when thece is prolonged use of forceps oF elevaior attempted wot @Odontotomy In this method, ye extraction procedure may he simplified by culling a tooth apart, eg in multirooted deciduous or ppermanen coeuh with civexgent cs, wherecrowsn is decayed PROCEDURE FOR EXTRACTION Instrumentation and Positioning + Instruments are select an! arranged acurding to the ‘need and according ta the surgean’s preference + Posidon ofthe operatos = Whenextractingany nathesceptiherightmnancthular ‘quadrant the operavor sianesan the righthand side ot the patient. = For she removal of the th im sight manclibular ‘quadrant, the operator stands bind the patient = For sniniliary two, the char should be adjusted so that the sie of aperatinn is about & em below the shoules love: af she opesatar = During the extraction of mandibular tooth the chair highs should be abous 16 cm below the level of the ‘operator's elbow. = When the operator is stating belie the patient the hair Siould be adjusted o enable him to have a clear view of the field of exactien, hese aspects wumbined with good iluaninatiun uf the operative Feld is an essential voniivon for the sucess! tion af the teat, Technique See low chart 2.1 EXTRACTION OF PERMANENT MAXILLARY TEETH (FIGS 62.1 TO 62.3) + Coniral tacisars: These often have a exnieal rot and rately deformed or curved. They are grasped with straight wide heaked forceps and can be sally rotated Dist ie fone divection» and ten iy the ather ciection until PPI atcachment is rake and itcan fo taken ous with slight