Unit 6 - Extraction of ectopic teeth, multiple extractions, alveoloplasty, extraction of temp teeth

What are common ectopic teeth (and definition)

3rd molars, 2nd premolars, canines, lateral incisors

Teeth that erupt partially or totally out of normal position in arch

What are the 2 treatment options to treat ectopic teeth?

1. Combined orthodontic-surgical treatment

2. Extraction

What are reasons to treat ectopic teeth? (Learn )

Aesthetics

Prosthesis

Functional or orthodontic

Pulpar or periodontal pathology

Avoidance of caries

Ulcerations in mucosa or tongue

What is important to consider before extraction of ectopic teeth?

Different relation with anatomical structures

Bone arcitecture and relation with bone corticals

Possibility of different approaces

Extraction technique for teeth in buccal positon?

Maxilla

Elevator in palatine area to luxate buccally

Mandible

Fine valve forceps to get lingual grip

Extraction techique for teeth in lingual position?

Luxate towards palatine/lingual with forceps or elevator

Extraction technique for mesialized and distalized teeth, and what does it depend on?

Depends on degree of deviation

Place active part of instrument following tooth long axis

Extraction technique for rotated teeth?

Luxate towards area of least resistance

Forcep placement can be difficult

What area the steps in a surgical extraction?

Incision-flap release, Osteotomy, odontosection, luxation, extraction, debridement, suture

Avoid lingual access

What is it reccomended to do after multiple extractions of adjacent teeth?

Fit an immediate prosthesis

What are the advantages of immediate prosthesis after multiple extractions?

• Hemostasis

• Tissue healing speed

• Less bone resorption

• Adequate muscular toe

• Restores mastication

• Improves phonetics, swallowing, breathing

• Keeps VD

What are the 4 types of immediat prosthesis?

Fixed prosthesis - conservative surgery (keep papilla)

Fixed implant prosthesis - conservative surgery

Dentomucosupported removable prosthesis (partial denture)

Mucosupported removable prosthesis (complete denture)

What is an alveoloplasty, and why should the alveolar reduction be minimal?

Remodeling of the alveolar crest after a dental extraction (prosthetic purpose)

Should be minimal to allow placementof a stable, retentive prosthesis

What are the three methods of alveoloplasty?

Alveolectomy

Interseptal alveolotomy

Radical alveoloplasty

What is involved in an alveolectomy?

• Remove part of alveolar cortical bone. Can also remove interdental/interradicular septum.

• Minimal gingival flap, regularizaton of external cortical bone

- Sulcular incision

- Flap with no relieves, only in attached gingiva

- Osteotomy before/after extraction

- Dental extractions

- Eliminate sharp bone edges, smooth with bone files

- Suture, first in midline

What is involved in an inteseptal alveotomy?

Reduction of alveolar socket by compressing Bc cortical bone towards Lg/Pt alveolar wall after excision of interdental bone septa.

What is involved in radical Alveoloplasty?

Radical contouring of alveolar ridge to correct large horizontal discrepancy between jaws (that has caused protrusion, overjet etc)

Why are temp teeth extractions less surgically complicated?

Root resorption and bone elasticity.

Procedures similar to permanent teeth

What are indications for extractions of temporary teeth?

• Non restorable caries

• Ankylosis

• Obstruction to perm. teeth normal eruption

• Periapical/interradicular infection

• Dentoalveolar abcess with celulitis

• Close relation to cystic or tumor process

• Congenital heart disease, kidney disorders etc.

What are contraindications of temp teeth extractions?

• Never before exfoliation time

• Infectious or herpetic estomatitis

• Blood discrasias

• Periodontitis, abscesses, celulitis without ab prophylaxis

• Malignant tumors

• Radiotherapy

What is important to consider before temp teeth extraction?

Occlusion

Tooth size

Resorption of temp tooth root

Development of permanent tooth

Absence or presence of infection

What are anaesthesia considerations for temp teeth extractions?

Age

Maturity

Physical condition

Prev. experiences

Difficulty of treatment

What is the technique for temp teeth extraction (upper and lower)?

Anterior - Bc luxation, mesial rotation, Bc traction

Posterior - Bc + Pt/Lg luxation, extractoin towards Pt/Lg or Bc

Normal, or smaller instruments used

Do not use currettes - injury risk to permanent tooth follicle