7- extraction of ectopic teeth

What may be reasons for ectopic teeth extraction?

Aesthetic

Prosthetic

Functional/ortjodontic

Periodontal pathology

Avoid caries

Ulcerations

How should you extract when teeth in buccal position?

Maxilla- apply elevator in palatine area to luxate buccally

Mandible- use forceps with fine valves for lingual grip

How should you extract when teeth in lingual position?

Luxate towards palatine- forceps or elevator 

How should you extract mesialized and distalized teeth?

Depends on degree of deviation 

Place active part so it follows long axis of tooth 

How should you extract rotated teeth?

Difficult to place forceps 

Luxate towards area of least resistance 

Why are ectopic 2nd premolar common?

Due to premature loss of 2nd temp molar 

1st perm molar drifts mesially, 2nd pm more commonly erupts lingually

What should the clinical assessment include before extracting an ectopic tooth?

Assess grade of eruption

Root anatomy

Extraction trajectory

Presence of retentions

1st Pm and m space- evaluate crowding, plan for space?

What are the grades of eruption?

How much of tooth erupted- 

Grade 1: Crown visible in mouth → simple extraction

Grade 2: Covered by soft tissue → needs minor flap

Grade 3: Embedded in bone → surgical extraction

What are the advantages of an immediate prosthesis?

Better hemostasia

Faster healing of tissues

Less bone resorption

Keeps adequate muscular tone

Restores mastication

Improves phonetics, swallowing and breathing

Keeps vertical dimension

What are the types of immediate prosthesis?

Fixed prosthesis- conservative surgery- keep papilla

Fixed implant prosthesis

Dentomucosupported removable- partial

Mucosupported removable- complete

What is an alveoloplasty and its 3 methods?

Remodelling of alveolar crest after extraction

Minimal alveolar reduction to allow placement of stable retentive prosthesis

Alveolectomy, interspetal alveolotomy, radical alveoloplasty

What is an alveolectomy and it’s procedure?

Removal of part of the alveolar cortical bone, sometimes with elimination of interdental/interradicular septa

• Sulcular incision and minimal flap (no relieving incisions, only in attached gingiva)

• Ostectomy performed before or after extractions.

• Extract teeth, remove sharp bone edges, and smooth bone with files

• Suture, starting from the midline

What is interspetal alveolotomy?

Reduction of alveolar socket by compressing buccal cortical bone towards lingual wall after excision of interdental bone septa

What is a radical alveoloplasty?

Radical contouring of alveolar ridge due to horizontal discrepancy between jaws with protrusion or overjet  

Why is extraction of temporary teeth less complex than permanent?

Root resorption and bone elasticity 

Indications for temp teeth extraction

Non restorable carious teeth 

Ankylosis delays eruption 

Obstructed eruption 

Infection in periapical area 

Dentoalveolar abscess with cellulitis 

Related to tumour or cyst 

Have congenital heart disease, kidney disorders 

Contraindications for temp teeth extraction

Not before eruption time- make sure permanent tooth present 

If have infectious or Herpetic stomatitis

Blood dysprasia

Periodontitis, abscess, celulitis without antibiotics

Malignant tumour

radiotherapy  

What should you consider before extracting temp teeth?

Occlusion

Size of tooth

Root resist ion

Development of permanent tooth

Absence/presence of injection

Technique for extracting temp teeth?

Anaesthesia- consider age, maturity, body health, previous experience

Instruments- smaller size or normal forceps

Anterior- Buccal luxation, mesial rotation, buccal traction

Posterior- b and p luxation, extract towards p

Doesn’t use currettes- may damage permanent tooth follicle