Introduction

• Diagnosis

  • Med history, x-rays

  • Assess ability to cooperate

• General principles ~ to adult

  • Profound anesthesia, aseptic technique, visibility and surgical site stability, protect airway

Equipment Used

McKesson Bite Block

• Degree of opening controlled by size selected and placement

• Attach floss and knot

  • 

Molt Mouth Prop

• Utilizes a ratchet-type mechanism

• Prevents iatrogenic (treatment-induced) injury to the patient

  • 

Indications for Simple Exodontia

• Nonrestorable teeth

• Fracture of crown/root

• Prolonged retention due to improper root resorption or ankylosis

• Impacted teeth

• Supernumerary teeth

Caveats

• Concepts that may dictate modifications

  • Proximity of primary tooth to succedaneous tooth

  • Roots on primary teeth with nonresorbed roots will be long and slender

Steps for Tooth Extraction

1. Preparation

   • Place gauze screen

   • Separate attachment

   • Elevation - concave blade placed against tooth being extracted

2. Elevation Technique

   • Elevator turned so that the blade resting on alveolus acts as a fulcrum & coronal part of blade rotates toward tooth being extracted.

     • 

3. Forceps Extraction

   • Beaks should adapt of root surface

   • Beaks should be parallel to long axis

   • Size of beaks should not impinge on adjacent teeth

Pediatric Forceps

• These stainless steel forceps are designed especially for use with primary teeth.

• Beak & handle are accurately proportioned

• Forceps can be hidden in the palm, reducing patient stress

• Allows greater field of view in child’s mouth

• 5 different forceps are available

• Cowhorn’s are contraindicated in primary exodontia

Universal Pediatric Forceps

• 150s and 151s

  • 

• Denovo Dental

  • 

Exodontia Technique

• First force is apical

• Apical center of rotation decreases the translational movement of the root

  • Decreased root fracture

  • Disrupts PDL

• Tooth is SLOWLY luxated to buccal/lingual

• Movement is in one direction & then stopped allowing the alveolus to expand

• With each movement force is increased causing expansion of alveolus

• May position opposite hand so that thumb or index finger can feel expansion

• Finally slight coronal traction forces are applied

Extraction Techniques

Maxillary and Mandibular Anterior Teeth

• Accomplished with a rotational movement due to conical single roots

• Care must be taken not to loosen adjacent teeth

Erupted Maxillary and Mandibular Molars

• Complications

  • Root fracture not uncommon

  • Inadvertent extraction or dislocation of succedaneous tooth

• Technique

  • slow palatal/lingual and buccal force to expand the alveolar bone

  • Support mandible to protect TMJ

  • Consider sectioning when primary molar roots encirle the successor's crown

Fractured Primary Tooth Roots

• Inform perform you perform

• Dilemma: removing root tip may damage permanent tooth, while leaving may cause infection, delay or deflect permanent tooth eruption

• Rule of thumb:

  • if tooth root is easily removed do it

  • if tooth root is very small, deep in the socket, close to permanent successor, or unable to remove after several attempts let it be

Ankylosis

• Periodic monitoring for timing of extraction if space loss, supereruption

  • Wait too long results in tipping of adjacent teeth and creating a difficult extraction

• Show no signs of mobility despite amount of root present and exhibit a distinctive sound when percussed

Standard of Care

• Timing to optimize health and minimize risks

• Optimal bone healing with improvement of intrabony defects on 2nd molars occurs when surgery is done on individuals less than 25 years of age

• Associated risks of surgery have been shown to be greater in individuals 25 years and older

Other Impactions

• Most common is 3rd molar

• Maxillary canine > second premolar > mandibular second molar > maxillary incisors

• Impactions of primary teeth associated with patholory

  • Supernumerary teeth

  • Odontomas

    • seen frequently

• 

Soft Tissue Lesions

• Mucoceles

• Ranulas

• Fibromas

• Pyogenic Granulomas

Over-retained Teeth