Tools. Testimony and
contra-indications
Extraction of teeth:.
Background of patient,
complication under time
and after an operation,
their treatment and
prevention
Teeth removal
• Tooth removal is one of the most
widespread operations in polyclinic
stomatologic practice. For carrying out
its necessary to know the sequence of
techniques of performance and skills of
possession special instruments.
Indications and contra-indications to
removal of permanent teeth.
Indications to planned tooth removal:
• 1.)Unsuccessfulness of endodonthyc
treatment with presence of the chronic
inflammation of periodontium and adjoining
tissues of a bone. This intervention is
especially indicated in case of chronic
intoxications of the patient with odontogenic
intoxication centres (chroniosepsis)
• 2.) Impossibility of conservative treatment
through considerable crown destruction or
the technical obstacles connected with
anatomic features, treatment errors, caused
by root perforation.
• 3.) Total destruction of crown part of the
tooth, impossibility of using the root for
tooth prosthetics.
• 4.) Mobility of ІІІ degree and tooth
promotions as a result of resorption of bone
round a cell with presence of heavy forms of
a periodontosis and parodontitis.
• 5.) Atypically placed teeth which injure a
mouth mucous membrane, tongue, and which
can't be treated by ortodonthic treatment.
• 6.) Unteethed in time or partially teethed
teeth which predetermine inflammatory
processes in adjoining tissues, which cannot
be liquidated some other way.
• 7.) Placed in crisis cracks, teeth do impossible
reposition of fragments and can't be treated
by conservative treatment.
• 8.) Outstanding as a result of loss of the
antagonist teeth, teeth which convergence
and divergence, disturb embarrass the
process of manufacturing tooth prosthetics.
treatment. For elimination of anomalies of a
bite (occlusion) during the orthodontic
treatment, intact teeth removal is also
indicated.
Contra-indications. A number of
inflammatory and local diseases, and
also some physiologic conditions are
contra-indications to this intervention.
Removal of tooth at such patients can
be done after preparation and
treatment.
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Relative contra-indications to operations of
tooth removal are:
1.) Cardiovascular diseases (preinfarction
conditions and 3-6 month after the infarction of a
myocardium, hypertonic illness in crisis.
IHD(ischemic heart disease), paroxysm, blinking
arhythmia, paroxysmal tachycardia, acute septic
endocarditis);
2.) Acute diseases of parenchymatosic organs liver, kidneys, pancreas (an infectious hepatitis,
(glomerunonephritis);
3.) Haemorragical diseases (a hemophilia, illness
of Verlgof, agranulocytosis, acute leukemia);
4.) acute infectious diseases (a flu, ARVD(acute
respiratoric virus disease), a pneumonia);
• 5.) disease of CNS (central neuronic
system), (acute disorder of encephal blood
circulation, a meningitis);
• 6.) Mental (psychological) diseases in an
aggravation period (a schizophrenia, a
psychosis, an epilepsy);
• 7.) acute radiation sickness І - ІІІ
degrees;
• 8.) disease of a mucous membrane of a
mouth (a stomatitis, gingivitis, cheilitis).
Preparation of tooth removal:
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-Inspection.
-Preparation of the patient.
-Preparation of doctor’s hands.
-Preparation of the operation field.
Technique of tooth removal:
• Tooth removal consists in violent rupture
of tissues which connect root with walls of
a cell and gums, and its deducing from a
cell. During removal of the distorted roots
from a cell, its walls are being replaced
and the entrance to it extends. Tooth
removal is being made by special tools,
forceps and elevators. In certain cases
tooth extraction by using this tool is
impossible. Then a drill for bone removal is
used. (operation of root cutting)
Forceps and elevetaors for teeth removal:
• Forceps. Under the process teeth removal a lever
principle is used. Forceps consists of: cheeks,
handles and the lock. In some kind’s of forceps
between cheeks and the lock there is a transitive
part. Cheeks are used to cover the root or a
crown. The handle – a part which is used to hold
the forceps. The lock is placed between the
handle and a cheek.
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For the best fixing of tooth or a root, cheeks
have fillets with longitudinal cutting from the
inside. The external surface of handles on
significant length is relief, internal - smooth. The
form of forceps is not the same. Construction
depends on anatomical structure of the tooth and
it’s place in row of teeth.
Kinds of forceps:
• 1.) Forceps for removal of teeth and roots
of the top and bottom jaws. Forceps for
the top jaw have prolongated axis of the
cheeks and handles, are coincide or
parallel, or form a corner. With forceps
for removal of teeth on the bottom jaw,
cheeks and handles are placed at right
angle or at an angle which is approached
to it;
• 2.) Forceps for removal of teeth with the
kept crown (crown forceps) and for root
removal (root forceps). Cheeks for removal
of a crowned teeth do not converge, for
removal of roots - converge;
• 3.) Forceps for removal of separate groups
of teeth of the top and bottom jaw. They
differ by width and features of a
structure of cheeks, their placing in
relation to handles, the form of handles;
• 4.) Forceps for removal of the first
and the second molars of the top jaw
on the right and at the left. The left
and right cheeks of these nippers are
constructed unequally;
• 5.) Forceps for removal of teeth of
the bottom jaw in case of the limited
opening of a mouth. They have a bend
of cheeks in a horizontal direction.
• Forceps for maxilla
• Forceps for the root’s of maxillar
teeth
• Forceps for mandibula
• Structure of the forceps, about the
surface
• Types of correct forceps handling
• Luxation and rotation during teeth
removal
• Correct and incorrect forceps
positions
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To execute operation successfully, it is necessary
to apply the forceps, which design to anatomic
features of removable tooth.
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Removal of the central incisor, lateral incisor
and canine of top jaw, is being done by forceps
which have the direct form, - direct forceps.
Longitudinal axes of cheeks and handles are in one
plane and coincide. Both cheeks are identical by
the form, from the inside fillets, round off the
ends. Forceps can have big and small width
cheeks.
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Removal of small root teeth of the top jaw is
being made by nippers which have S-like bend.
Cheeks are placed with them at an obtuse angle to
handles. Such form of forceps allows to impose
them correctly on tooth and during its removal to
prevent obstacles from the bottom jaw.
• Removal of the big molars of the top jaw
is being made by forceps which have S-like
bend and are similar by the form to
forceps for removal of small molars.
However their cheeks are arranged
differently. They are shorter and are
wider, the distance between them in the
closed condition is greater. Both cheeks
from inside have Deepening. End of one
cheek is round, other one ends by a thorn,
from which, in the middle, from indside
surface lasts small crest.
• During removal of tooth the thorn enters between
cheeks roots, the cheek with the plane end, captures
a neck of tooth from the palatal surface. One
forceps the cheek with a thorn is on the right side,
in the second - at the left. Such structure of a
cheek provides dense coverage of the tooth and
makes its removal easier. Removal of the third big
molar of the upper jaw is being done by special
forceps. The oblong axis of cheeks and an axis of
handles at them are parallel. Two cheeks are equally
wide, with thin, and rounding in edges ends. On inside
they have a dimple; during interlocking, forceps do
not converge. The construction of forceps gives the
ability to enter them deeply into the oral cavity,
thus the lower jaw does not Hinders the operation
carrying out.
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Roots of incisors, canines and premolars of the
upper jaw, are being deleted by the same
forceps, as other teeth, only with more thin and
narrow cheeks. For removal of roots of the big
molars use bayonetlike forceps. They have the
transitive part from which long cheeks are going
out which coincide with the thin rounding off end
and a fillet throughout an axis of all internal
surface. The oblong axis of handles at them is
parallel. Depending on width of cheeks distinguish
bayonetlike; with narrow, average and wide
cheeks. They are used for removal of roots of
incosors, canines, small molars and teeth with the
destroyed surface.
• Removal of teeth and roots of the lower
jaw is being made by forceps, which are
bent on an edge and have beaklike form.
The axis of brushes and an axis of handles
form a corner, which is direct or close to
direct. All components of forceps are
allocated in a vertical plane, handles - one
over the second.
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Cheeks of forceps for removal of
incsors of the lower jaw, are narrow with
fillets on inside, they are rounded on the
end, during interlocking they do not
converge. Canines and small molars are
deleted buy such forceps, but with wider
cheeks.
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Forceps for removal of the big molars have wide
cheeks which do not converge. Each of them ends
by triangular bend(thorn). From the inside both
cheeks have a dimple. During superimposing on
tooth bends enter the furrow between front and
back roots that provides good fixing of forceps
on tooth.
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In case of restricted opening of a mouth,big
molars are deleted by the horizontal forceps,
bent on a plane. They are constructed differently,
than beaklike. Handles and the lock are allocated
at an angle which comes nearer to direct and is in
a vertical plane. A working part of brushes is the
same, as the beaklike forceps for removal of the
big molars, bent on an edge. Roots of all teeth of
the lower jaw are deleted by forceps of the same
form, as incisors, canines and small molars, only by
cheecks that converge.
• The position of the doctor during
• Elevators.
• Extracting teeth by elevetaors, as well as by
forceps, use the lever principe. Elevator consists
of three parts:
• The working part, the connective rod and the
handle. There are many different constructions
of elevetaors, however the most widespread are
three types: straight, angular and beaklike
elevator.
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Straight elevator. Its working part is a
continuation of the connective rod and together
with the handle are allocated on one direct line.
The cheek on the one hand convex, semicircular,
from the other – bent, also looks like a fillet, the
end is refined and rounded.
• Straight elevators are intended for
removal of roots of teeth,of the upper jaw
which have one root. They are intented for
removal of teeth of the upper jaw
allocated out of a tooth arc, rarely - the
lower third molar.
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Angular elevator. The working part
(cheek) is bent on an edge and allocated to
longitudinall axis by the elevator at an
angle, approximately 120 ⁰.
• Cheek small.One of its surface is convex, the
second - slightly bent with longitudinal edges. The
concave surface of a cheek at one elevator is
turned to left (to itself), in others - to the right from itself.
• In an elevator operation time, the concave
surface of a cheek is directed to a root, which is
being deleted, convex - to a cell wall.
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Angular elevator is used for removal of the
lower teeth.
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Bayonetlike elevator (Lekljuz
Elevator).Connective rod of elevator is
bayonetlike, curve . The working part has
spearlike form. It is narrowed and thiner in finite
department. The handle is round, thicker in the
middle part, allocated perpendicular to connective
rod and to working part. Elevator is intended for
removal of the third lower molar.
Types of elevators:
Lekljuz elevator
• Types of elevators:
• Stages of operation of removal of
tooth:
• Operations of removal of tooth,are
being led by forceps, also consists of
several serial stages:
• 1.) Superimposing of forceps
• 2.) Advancement of forceps
• 3.) Interlocking of forceps (fixing)
• 4.) A tooth Dislocation (luxation or
tooth rotation)
• 5.) Deduction of tooth from a cell
(traction)
• Extraction of teeth, and it’s roots using drill, hammer
and chisel.
• In such cases, when tooth or the root can’t be removed by
using forceps or elevator, it is necessary to use drill,
hammer or chisel. as an indication to such operation could
be presence of a root or tooth which was not erupt, or a
root with the curved top, and also expressed
hypercementosis. This method is used more often, when
extracting of the bottom wisdom tooth is needed.
• Processing of a wound after tooth removal. After the
termination of operation of removal of tooth it is necessary
to examine it carefully. Presence of keen edges in the root
channel testify a root crisis. It’s unallowed to leave the
broken root in a cell, especially if removal was spent
concerning a sharp purulent periodontitis. Root removal
needs to be finished by using hammer, drill, or chisel.
• When ensured, that tooth is fully removed, a sharp spoon is
necessary to clear a cell of small splinters of a bone,
granulations or a bone cover. External and internal edge of a
cell shoud be squeezed by fingers through gauze tampons.
On a wound impose one or several gauze tampons and ask
the patient to compress jaws strongly. In 10-15 minutes a
tampon delete’s to make sure of clot preservation. When
there’s no bleeding, the patient can leave a medical
institution. It is recommended to eat within 1-2 hours then
it is possible to consume cool meal. In the first day after
operation, it is not recommended to rinse oral cavity by
solutions of antiseptic tanks, except those cases when
purulent - inflammatory process is present. Rinsings by weak
solutions furacilimun, chlorheksidinum, hydrocarbonate
sodium, or permanganate potassium is allowed only on 2-3rd
day. Usually the wound after tooth removal heals by a
secondary tension, thanks to formation of blood clot.
Putting a gauze in a sonorous impregnated with a solution of
iodoform, is possible only with the purpose of preventing
the infication of a clot if inflammatory process has
developed
• Complication, that can occur during, and after tooth
exraction.
• Root crisis can be prevented by using the method of section
and separation of gums, with the following chisel
debridement of cell wall, to one third of length, and also by
using forceps for root extraction.
• Damage of soft tissues, occurs during careless, rough
manipulations of physician, disorder of tooth extraction
technique.
• When insufficient gums dislayering, before tooth
extraction, rupture of mucous membrane often occurs
during operation;
• In case of wrong tooth extraction technique, when a doctor
imposes forceps directly on a mucous membrane, dislayered
it not enough from the cell process, or a part.
• In case of careless dislocating of roots, by direct elevator,
tissue damage of the bottom of oral cavity, tongue(when
removing the roots of lower molars) and palate(when
removing the roots of upper molars) occurs.
• On a background of the damage of
soft tissues, bleeding occurs, which
complicates the work of a doctor,
while tooth extracting; In
postoperative period, inflammatory
complications can occur.
• A technique of granting of the urgent
help: a stop of a bleeding and
suturing the wound.
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a fragment break of cell parts (more often on the bottom jaw) damage of tisses arises:
Under condition of an union of a tooth root with cell walls;
In case of deep imposing cheeks of nippers on cell walls thus tooth removes together with a bone tissues.
Technique of granting the urgent medical aid: to smooth down (if
necessary - to remove) sharp, unequal edges of a cell of tooth, to
suture a mucous membrane.
Break of a tuber of the top jaw arises during removal of the third
top molar, as a result of deep imposing forceps cheeks on walls of
a cell, or a rough dislocation of tooth by straight elevator:
In such case, there is a broken off fragment of a tuber of the top
jaw on extracted tooth (roots)
-a considerable bleeding occurs;
-If the maxillar sinus is damaged, vials of air from the extracted
tooth cell occure during attempt to blow air through closed with
fingers nose.
The technique of granting urgent help: smoot keen edges of tooth
cell by bone spoon, mobilize and suture tightly a mucous
membranem so that a bone wound would be completely closed. If
the stomatologist cannot independently stop a bleeding, and suture
a wound, he put iodoform tampon and transport’s the patient
immediately in a surgical stomatologic department.
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Perforation of the bottom of maxillar sinus arises during removal
of the first top molar, sometimes - the second and premolar.
It is explained, that tops of the given teeth are closely located to
the bottom of sinus.
Perforation of the bottom of maxillar sinus can occur, when:
Traumatic removal of the named teeth (if rough manipulation
in a tooth cell is done), and during careless manipulations;
Owing to anatomic features, when the root is located under a
sinus mucous membrane;
When inflammatory process on a top of a root has destroyed
a sinus bottom.
Diagnostics:
During careful tubage of a cell, the instrument gets for the length
more than the deepnes of the cell.
On the basis of passage of the air from the oral cavity, into a nasal
cavity, ot contrary. The patient, having clamped fingers on his
nose, should try to blow the air throughout it. Thus air through an
aperture (perforation) of the bottom of maxillar sinus leaves it
with a whistle and goes into oral cavity, or blood vials of air from a
cell of extracted tooth occur;
Radiological research is conducted (an aim picture).
• Technique of granting urgent medical aid in case
of perforation of maxillar sinus:
• - In the presence of a purulent antritis (pus is
goin out from a tooth cell, through a perforated
aperture) in entrance of cell iodoform tampon
and hospitalization of the patient in maxillofacial
deparment;
• - In case of pushing a root through in a sinus,
its removal in the conditions of a hospital is
indicated;
• - In case of a healthy sinus (when radiological
research does not reveal a root in a sinus) it is
necessary to close a perforated aperture (a cell
of extracted tooth) by a mucosial rag, taken from
a vestibular surface of cell process. If the doctor
has not mastered this technique, he should tightly
suture a cell (to Impose 2-3 seams of polyamides).
• The bleeding arises after operation of
removal of tooth. Distinguish early
bleedings and late. Early bleedings, arise
right after removals of tooth (trauma).
• Late bleedings can arise:
• 1) In some hours after tooth removal, for
example in case of adrenaline overdose.
• 2) For some days after operation which
becomes complicated by an inflammatory
process.
Thank you for attention!