Indications for Dental Extractions

The main indication is:

If the tooth cannot be saved by Dental treatment due to one of the following
reasons:
Technical reasons ... and/or
Local reasons ... and/or
Systemic reasons ... and/or
Psychological reasons ... and/or
Financial reasons.
In general the following indications can be considered:
1. Fractured teeth with pulp exposure
2. Non-vital teeth which can not be treated endodontically
3. Complete bifurcation exposure (Grade III)
4. Periodontal disease with loss of >50% bone
5. Periodontal Disease with secondary endodontic disease
6. Untreatable tooth Mobility >1mm
7. Retained deciduous teeth
8. Orthodontics consideration
9. Supernumerary teeth, if causing problem such as Dentigerous Cyst
10. Malpositioned teeth causing trauma
11. Retained roots if associated with inflammation or drainage
12. Prosthodontic considerations
13. Impacted tooth especially those associated with pathology or may cause malocclusion
and/or when there is orthodontic recommendation
14. Cases that client is unwilling to treat (patient advices should be considered).

Contraindications for Dental Extractions

There is no absolute contraindication for dental extraction. All the contraindications are
relative and may present due to a certain systemic or local conditions. Almost in all cases
these relative contraindications can be solved which make the extraction possible sometime
with special precautions.
WHEN TO DO ENDODONTIC THERAPY?
This is sometimes difficult to decide simply when there is doubt about the case selection for
endodontic therapy. Sometimes patients come to clinic having no symptoms with large
restorations on teeth which require crowns. But the clinician suggests that endodontic
reatment is needed for that particular tooth. So one can say that sometimes decision to do
endodontic therapy becomes complicated because of involvement of multiple factors are
involved in deciding the need, treatment planning and prognosis of tooth. Following factors
are important in deciding the need and success of the overall endodontic therapy:

i. Actual Reason for Endodontic Therapy

If there is pulp involvement due to caries, trauma, etc. (Figs 8.1 to 8.3) the tooth must be
treated endodontically and restored with proper restoration.
ii. Elective Endodontics
Sometimes elective endodontic is done with crack or heavily restored tooth, to prevent
premature loss of cusp during their restoration (usually crown preparation) and eliminate fear
of pulp exposure (Figs 8.4A to C). Elective endodontics allows to do more predictable and
successful restorative dentistry
iii. Inadequate Restorations
Patients with cracked or carious teeth having crowns, when want patch up of the crown argins
or use pre-existing crown even after another restorative procedures show high degree of
restorative failure. In such cases endodontic treatment followed by optimal restoration of the
tooth provide high success rate.
iv. Devitalization of Tooth
In patients with attrited teeth, rampant caries or recurrent decay and smooth surface defects, it
is wise to do desensitization of the teeth so that patients do not feel discomfort to cold or
sweets (Fig. 8.5).
v. Endodontic Emergency
Sometimes patient comes with acute dental pain, in such cases endodontic therapy is often
indicated before a complete examination and treatment plan has performed. It is important to
place endodontic case in perspective with the needs of patient’s entire mouth.

CONTRAINDICATIONS OF ENDODONTIC THERAPY

There are only few true contraindications of the endodontic therapy. Otherwise any tooth can
be treated by root canal treatment. Mainly there are following four factors which influence
the decision of endodontic treatment:
a. Accessibility of apical foramen.
b. Restorability of the involved tooth.
c. Strategic importance of the involved tooth.
d. General resistance of the patient.

Therefore, before deciding the endodontic treatment, multiple factors should be considered.
In general, following cases are considered poor candidates for endodontic treatment:
1. Non-restorable teeth: Such as teeth with extensive root caries, furcation caries, poor
crown/root ratio and with fractured root are contraindicated for endodontic treatment.
Because in such cases even the best canal filling is futile if it is impossible to place the
restoration.
2. Teeth in which instrumentation is not possible: Such as teeth with sharp curves,
dilacerations, calcifications, dentinal sclerosis are treatment difficulties. Though use of recent
instruments and techniques may help sometimes like NiTi files, anticurvature filing may help
sometimes. Several teeth with previous treatment show canal blockage by broken
instruments, fillings, posts, ledges, and untreatable perforations and canal transportations. So,
careful evaluation is needed before starting treatment in such teeth.
3. Poor accessibility: Occasionally trismus or scarring from surgical procedures or trauma,
systemic problems, etc. May limit the accessibility due to limited mouth opening. These
result in poor prognosis of the endodontic therapy.
4. Untreatable tooth resorption: Resorptions which are extremely large in size make the
endodontic treatment almost impossible for such teeth (Fig. 8.6).
5. Vertical tooth fracture: Teeth with vertical root fractures pose the hopeless prognosis.
6. Non-strategic teeth: There are two major factors which relegate a strategic tooth to the
hopeless status; restorability and periodontal support. The tooth that cannot be restored or that
has inadequate, unmanageable periodontal support is hopeless. Evaluation of the oral cavity
can decide whether tooth is strategic or not, for example, if a person has multiple missing
teeth, root canal of third molar may be needed. But in case of well maintained oral hygiene
with full dentition, an exposed third molar can be considered for extraction.
7. Evaluation of the clinician: Clinician should be honest while dealing with the case. Self
evaluation should be done for his experience, capability to do the case, equipment he has or
not for the completion of the case.
8. Systemic conditions: Most of the medical conditions do not contraindicate the endodontic
treatment but patient should be thoroughly evaluated in order to manage the case optimally

Endodontik merupakan cabang dari kedokteran gigi klinis yang berhubungan dengan
pencegahan, diagnosis dan perawatan penyakit pulpa dan gejalanya. Tujuan perawatan
saluran akar yaitu untuk menghasilkan lingkungan pada sistem saluran akar yang
memungkinkan untuk terjadinya penyembuhan dan melanjutkan pemeliharaan kesehatan
jaringan periradikular. Jika gigi mengalami kerusakan yang parah dan jaringan
pendukungnya terganggu, maka satu-satunya alternatif perawatan yaitu ekstraksi gigi.