Extraction of Teeth: Indications, Techniques, Complications, and Management of Unerupted/Impacted Teeth

This flashcard set covers essential concepts from Dr. Okechi Uchenna C.’s lecture on tooth extraction indications, techniques, principles, complications, and the management of unerupted/impacted teeth. Use them to test understanding of anatomy, instrumentation, surgical steps, special situations, and modern advancements.

Why do many patients still dread dental extractions today?

They associate the procedure with pain and past ‘horrifying’ historical experiences, leading to extraction-phobia.

What joint attaches a tooth to its alveolar socket via Sharpey’s fibers?

Gomphosis.

Give two anatomical reasons why maxillary extractions are usually easier than mandibular extractions.

Maxilla has thin, spongy cortical plates that expand easily and it possesses richer vascularity for faster healing.

Which maxillary teeth pose a risk of creating an oro-antral communication during extraction?

Maxillary molars because their root apices lie close to the floor of the maxillary sinus.

List two factors that complicate mandibular extractions.

Thick cortical plates require greater force, and reduced vascularity slows healing; open-mouth position also risks TMJ injury.

State Geoffrey L. Howe’s definition of tooth extraction (exodontia).

The painless removal of the whole tooth or root with minimal trauma so the wound heals uneventfully and causes no prosthetic problem.

What are the three essential components for pain control in exodontia?

Adequate local analgesia, appropriate choice between local and general anesthesia, and individualized patient assessment.

Name four common indications for tooth extraction.

Advanced caries, periodontal disease, non-responsive necrotic pulp with periapical lesion, retained deciduous tooth (after radiograph).

Which systemic condition is an absolute contraindication to immediate extraction due to bleeding risk?

Central haemangioma or large AV malformation.

Within how many months after a myocardial infarction is tooth extraction generally contraindicated?

Within 6 months.

What pre-operative radiographic information is critical before extracting a tooth?

Relationship to vital structures, root configuration, and condition of surrounding bone.

State the three mechanical ‘simple machines’ that underlie tooth extraction.

Lever, wedge, and wheel & axle.

Which elevator type primarily uses the wheel-and-axle principle?

Triangular or pennant-shaped (e.g., Cryer) elevator.

What is the first (initial) forceps movement for most teeth except mandibular 2nd and 3rd molars?

Buccal or labial (outward) movement.

Why should rotational forces be used cautiously on multirooted teeth?

Excess rotation can cause spiral root fractures; rotation is best for single-conical-root teeth.

What chair height is ideal for maxillary extractions relative to the operator?

About 8 cm (3 in) below the operator’s shoulder level.

Give two roles of the operator’s non-working (opposite) hand during extraction.

Reflect soft tissue, support/stabilize the mandible or patient’s head, protect adjacent teeth, compress socket, and provide tactile feedback.

What is the recommended sequence when multiple teeth are extracted in one visit?

Maxillary teeth first, posterior before anterior, and within each quadrant: 3rd M → 2nd M → 2nd PM → 1st M → 1st PM → lateral incisor → canine → central incisor.

Describe one basic principle of the forceps technique.

Forceps beaks are forced apically into the periodontal ligament space to wedge and expand bone before controlled luxation.

Why must elevators never use an adjacent healthy tooth as a fulcrum?

It risks luxation or damage to that tooth.

During menstruation, why is elective extraction preferably avoided?

High estrogen increases tissue bleeding and stress levels may raise risk of alveolar osteitis.

Which trimester of pregnancy is considered safest for minor oral surgery such as extraction?

Second trimester.

List three immediate post-extraction socket care steps.

Inspect socket, irrigate with saline, remove debris/root fragments, compress socket, suture if needed, place moist gauze pack.

State two key postoperative instructions given to a patient after extraction.

Bite on gauze for 10–15 min; avoid mouth-rinsing and hot foods for 24 h; stick to cold fluids/soft diet initially.

Define ‘trans-alveolar extraction’.

Open surgical method where bone is removed around the tooth/roots when intra-alveolar (closed) extraction fails or is impossible.

Name three modern technological aids that facilitate atraumatic extraction.

Powered periotome, piezosurgery unit, physics forceps (plus lasers, coronectomy, orthodontic extrusion).

What ultrasonic frequency does piezosurgery typically use and what main advantage does it provide?

24–29 kHz; selective bone cutting sparing soft tissues even with accidental contact.

How does a physics forceps work mechanically?

Acts as a first-class lever with a bumper fulcrum; gentle wrist rotation luxates the tooth without squeezing.

When retrieving a root tip, what two essentials dramatically improve success of the closed technique?

Excellent lighting and high-suction with narrow tip.

What initial simple measure may dislodge small apical root fragments before using elevators?

Vigorous irrigation of the socket with normal saline.

Give three common operative complications of exodontia.

Fracture of tooth, injury to adjacent teeth, alveolar bone/tuberosity fracture, oro-antral perforation, soft-tissue laceration.

Name two typical postoperative complications after tooth extraction.

Post-extraction hemorrhage and alveolar osteitis (dry socket), plus pain, swelling, infection, ecchymosis.

Outline two measures to control bleeding from an extraction socket.

Pressure pack with gauze; inject LA with vasoconstrictor; curettage; suture; place hemostatic agents like Surgicel/Gelfoam.

Which teeth are most commonly impacted or unerupted?

Third molars, maxillary canines, premolars, supernumeraries, mandibular canines, mandibular premolars.

What radiographic method can localize an unerupted tooth when two films at 90° are unavailable?

Parallax technique or CBCT.

From which side is a palatally impacted maxillary canine typically approached surgically?

Via a palatal full-thickness mucoperiosteal envelope flap extending 6–6.

Why must palate incisions always follow an envelope design rather than perpendicular cuts?

To avoid severing the greater palatine artery; perpendicular cuts would section it.

If a palatally impacted canine cannot be removed intact, what is the recommended alternative?

Section at the cervical margin, remove crown and root separately.

In mandibular premolar impactions, why might a buccal flap be extended?

To visualize and protect the mental nerve and allow bone removal and sectioning.

What special extraction technique is preferred for patients with bleeding disorders?

Rubber band (elastomeric ligature) extraction.

Which simple machine principle does the straight elevator use when wedged into the PDL space?

Wedge principle (and lever when using bone as fulcrum).

What is the usual final withdrawal direction for most upper and lower teeth?

Outward (buccal) and occlusal.

During closed extraction, why should trunk movement from the hips, not elbow flexion, deliver force?

To apply controlled, smooth, powerful pressure while minimizing operator fatigue and accidental jerks.

How does powered periotome help preserve bone during extraction?

It precisely severs PDL fibers with minimal wedging, reducing need to expand or remove alveolar bone.

Explain the ‘open window’ modification for retrieval of root tips.

Instead of removing buccal bone, a cortical window is made to access the root while preserving overall buccal plate integrity.

What two main goals should forceps accomplish according to exodontia principles?

Expand the bony socket and remove the tooth with minimal trauma.

What complication can excessive initial rotational force cause in a multirooted tooth?

Spiral fracture of the root.

Why do straight elevators require a finger guard during use?

To protect soft tissues if the instrument slips forward.

What feature of Er:YAG lasers is advantageous in bone removal for impacted teeth?

Bloodless surgical field, precise layer-by-layer ablation, reduced postoperative pain.

Before extracting a submerged deciduous molar, which surgical approach and tactic are recommended?

Buccal approach; vertical sectioning of the crown followed by elevation along each root’s path.