essay 23 - anatomical and mechanical considerations for tooth extraction - steps and methods. dentists and patients care for the extraction wound. extraction wound healing - characteristics of the process

anatomical and mechanical considerations for tooth extraction

• tooth anatomy = number of root, root curvature, proximity to sinuses or nerves, periodontal support

• bone Quality = the mandible is a denser bone and it may require more force than the maxilla

• root morphology

• adjacent anatomical structures

• wound healing

• direction of force when performing traction = for maxillary teeth all are extracted vestibular or buccaly depending on the bone, whereas for mandibility this differs. Mandibular molars are to be extracted with force directed lingually while the anterior teeth with a force directed vestibular.

steps and method of tooth extraction

1. sindesmotomy (periodontal ligament severing)

• performed with a Desmotome or straight elevator

• objective = sever the periodontal ligament without damaging alveolar bone

2. dislocation of the tooth (luxation)

• forceps adaption:

— beaks must grip the tooth at the cervical line, apically as far as possible

— readjust grip periodically as luxation progresses

• application of force:

— movement should be slow, deliberate and controlled

— hold each force for several seconds to allow bone expansion

— direction of applied force depends on the tooth group (e.g Buccal lingual for molars)

3. traction (removal of the tooth)

• gentle traction is applied only after sufficient bone expansion

• objective = lift the tooth vertically from the socket, not to pull forcefully

• important = extraction is not pulling, but a process of progressive loosening and removal wants alveolar socket has expanded adequately

list the dentist's responsibilities for care of the extraction wound

1. atraumatic technique

2. hemostasis

3. wound assessment

4. wound closure if needed

5. post operative instructions to patient

atraumatic technique

• minimise soft tissue and bone trauma during extraction

• preserve the integrity of surrounding structures (bone, gingiva, adjacent teeth)

hemostasis

• achieve proper clot formation by = Applying pressure with sterile gauze. Using local haemostatic agents if necessary

• avoid over packing the socket, which can dislodge the clot

wound assessment

• Inspect this socket for = fractured root tip, bone fragments, signs of infection or cyst

• smooth sharp bone edges with a bone file

wound closure if needed

• use sutures to approximate wound edges, especially after surgical extractions

• selection of observable or non observable switches depends on case specifics

post operative instruction to patients

• provide clear written and verbal instructions including:

— bite on gauze for at least 30 minutes

— avoid rinsing, splitting or sucking actions for 24 hours

— maintain hydration and a soft diet

— no smoking or alcohol for at least 72 hours

— use prescribed medication (e.g analgesics, antibiotics if needed)

List Patients responsibilities for care of extraction wound

• immediate post operative care

• oral hygiene

• diet and habit

• monitoring for complications

immediate post operative care

• maintain pressure with gauze pad for initial haemostasis

• apply cold compress to the cheek - 50 minutes on/off for the first few hours

• avoid physical exertion or bending over

oral hygiene

• do not rinse or brush near the socket for the first 24 hours

• after 24 hours, begin gentle rinsing with warm saline or prescribed mouthwash

• continue brushing other teeth gently

diet and habit

• eat soft, lukewarm foods for 24 - 48 hours

• avoid hard, hot, spicy foods and carbonated beverages

• absolutely no smoking or using straws (negative pressure can dislodge clot)

monitoring for complications

• watch for:

— prolonged bleeding

— severe pain after 2-3 days (possible dry socket)

— swelling or pus (infection)

— fever or difficulty opening mouth

• contact the dentist if any of the above signs occur

extraction wound healing period

• immediate response(0-48 hrs) = blood clot formation, leukocyte infiltration

• 1st week = fibrin reorganisation, epithelial proliferation, crestal bone resorption

• 2nd week = fibrioplegia, osteoid formation, more evident socket remodelling

• 3rd week = craniotic tissue dominates, woven bone begins formation

• 6-8 weeks = radio graphic bone healing becomes apparent

• 6-8 months = full remodelling, socket becomes indistinct

consequences of tooth extraction - Bone loss

• loss of stimulation leads to resorption of alveolar bone

• up to 60% of bone may be lost in the first six months post extraction

• long term effects include:

— localised bone atrophy

— nerve exposure

— facial structure changes and premature ageing

• these consequences reinforce the importance of atraumatic extraction and Ridge preservation techniques