Tools. Testimony and Tools. Testimony and contra-indications contra-indications

Extraction of teeth:. Extraction of teeth:. Background of patient, Background of patient,

complication under time complication under time and after an operation, and after an operation,

their treatment and their treatment and prevention prevention

Tools. Testimony and Tools. Testimony and contra-indications contra-indications

Extraction of teeth:. Extraction of teeth:. Background of patient, Background of patient,

complication under time complication under time and after an operation, and after an operation,

their treatment and their treatment and prevention prevention

Teeth removal• Tooth removal is one of the most

widespread operations in polyclinic stomatologic practice. For carrying out its necessary to know the sequence of techniques of performance and skills of possession special instruments.

Indications and contra-indications to removal of permanent teeth.

Indications to planned tooth removal:• 1.)Unsuccessfulness of endodonthyc

treatment with presence of the chronic inflammation of periodontium and adjoining tissues of a bone. This intervention is especially indicated in case of chronic intoxications of the patient with odontogenic intoxication centres (chroniosepsis)

• 2.) Impossibility of conservative treatment through considerable crown destruction or the technical obstacles connected with anatomic features, treatment errors, caused by root perforation.

• 3.) Total destruction of crown part of the tooth, impossibility of using the root for tooth prosthetics.

• 4.) Mobility of ІІІ degree and tooth promotions as a result of resorption of bone round a cell with presence of heavy forms of a periodontosis and parodontitis.

• 5.) Atypically placed teeth which injure a mouth mucous membrane, tongue, and which can't be treated by ortodonthic treatment.

• 6.) Unteethed in time or partially teethed teeth which predetermine inflammatory processes in adjoining tissues, which cannot be liquidated some other way.

• 7.) Placed in crisis cracks, teeth do impossible reposition of fragments and can't be treated by conservative treatment.

• 8.) Outstanding as a result of loss of the antagonist teeth, teeth which convergence and divergence, disturb embarrass the process of manufacturing tooth prosthetics. treatment. For elimination of anomalies of a bite (occlusion) during the orthodontic treatment, intact teeth removal is also indicated.

Contra-indications. A number of inflammatory and local diseases, and also some physiologic conditions are contra-indications to this intervention. Removal of tooth at such patients can be done after preparation and treatment.

Relative contra-indications to operations of tooth removal are:

• 1.) Cardiovascular diseases (preinfarction conditions and 3-6 month after the infarction of a myocardium, hypertonic illness in crisis. IHD(ischemic heart disease), paroxysm, blinking arhythmia, paroxysmal tachycardia, acute septic endocarditis);

• 2.) Acute diseases of parenchymatosic organs - liver, kidneys, pancreas (an infectious hepatitis, (glomerunonephritis);

• 3.) Haemorragical diseases (a hemophilia, illness of Verlgof, agranulocytosis, acute leukemia);

• 4.) acute infectious diseases (a flu, ARVD(acute respiratoric virus disease), a pneumonia);

• 5.) disease of CNS (central neuronic system), (acute disorder of encephal blood circulation, a meningitis);

• 6.) Mental (psychological) diseases in an aggravation period (a schizophrenia, a psychosis, an epilepsy);

• 7.) acute radiation sickness І - ІІІ degrees;

• 8.) disease of a mucous membrane of a mouth (a stomatitis, gingivitis, cheilitis).

Preparation of tooth removal:

• -Inspection.• -Preparation of the patient.• -Preparation of doctor’s hands.• -Preparation of the operation field.

Technique of tooth removal:

• Tooth removal consists in violent rupture of tissues which connect root with walls of a cell and gums, and its deducing from a cell. During removal of the distorted roots from a cell, its walls are being replaced and the entrance to it extends. Tooth removal is being made by special tools, forceps and elevators. In certain cases tooth extraction by using this tool is impossible. Then a drill for bone removal is used. (operation of root cutting)

Forceps and elevetaors for teeth removal:• Forceps. Under the process teeth removal a

lever principle is used. Forceps consists of: cheeks, handles and the lock. In some kind’s of forceps between cheeks and the lock there is a transitive part. Cheeks are used to cover the root or a crown. The handle – a part which is used to hold the forceps. The lock is placed between the handle and a cheek.

• For the best fixing of tooth or a root, cheeks have fillets with longitudinal cutting from the inside. The external surface of handles on significant length is relief, internal - smooth. The form of forceps is not the same. Construction depends on anatomical structure of the tooth and it’s place in row of teeth.

Kinds of forceps:

• 1.) Forceps for removal of teeth and roots of the top and bottom jaws. Forceps for the top jaw have prolongated axis of the cheeks and handles, are coincide or parallel, or form a corner. With forceps for removal of teeth on the bottom jaw, cheeks and handles are placed at right angle or at an angle which is approached to it;

• 2.) Forceps for removal of teeth with the kept crown (crown forceps) and for root removal (root forceps). Cheeks for removal of a crowned teeth do not converge, for removal of roots - converge;

• 3.) Forceps for removal of separate groups of teeth of the top and bottom jaw. They differ by width and features of a structure of cheeks, their placing in relation to handles, the form of handles;

• 4.) Forceps for removal of the first and the second molars of the top jaw on the right and at the left. The left and right cheeks of these nippers are constructed unequally;

• 5.) Forceps for removal of teeth of the bottom jaw in case of the limited opening of a mouth. They have a bend of cheeks in a horizontal direction.

• Forceps for maxilla

• Forceps for the root’s of maxillar teeth

• Forceps for mandibula

• Structure of the forceps, about the surface

• Types of correct forceps handling

• Luxation and rotation during teeth removal

• Correct and incorrect forceps positions

• To execute operation successfully, it is necessary to apply the forceps, which design to anatomic features of removable tooth.

• Removal of the central incisor, lateral incisor and canine of top jaw, is being done by forceps which have the direct form, - direct forceps. Longitudinal axes of cheeks and handles are in one plane and coincide. Both cheeks are identical by the form, from the inside fillets, round off the ends. Forceps can have big and small width cheeks.

• Removal of small root teeth of the top jaw is being made by nippers which have S-like bend. Cheeks are placed with them at an obtuse angle to handles. Such form of forceps allows to impose them correctly on tooth and during its removal to prevent obstacles from the bottom jaw.

• Removal of the big molars of the top jaw is being made by forceps which have S-like bend and are similar by the form to forceps for removal of small molars. However their cheeks are arranged differently. They are shorter and are wider, the distance between them in the closed condition is greater. Both cheeks from inside have Deepening. End of one cheek is round, other one ends by a thorn, from which, in the middle, from indside surface lasts small crest.

• During removal of tooth the thorn enters between cheeks roots, the cheek with the plane end, captures a neck of tooth from the palatal surface. One forceps the cheek with a thorn is on the right side, in the second - at the left. Such structure of a cheek provides dense coverage of the tooth and makes its removal easier. Removal of the third big molar of the upper jaw is being done by special forceps. The oblong axis of cheeks and an axis of handles at them are parallel. Two cheeks are equally wide, with thin, and rounding in edges ends. On inside they have a dimple; during interlocking, forceps do not converge. The construction of forceps gives the ability to enter them deeply into the oral cavity, thus the lower jaw does not Hinders the operation carrying out.

• Roots of incisors, canines and premolars of the upper jaw, are being deleted by the same forceps, as other teeth, only with more thin and narrow cheeks. For removal of roots of the big molars use bayonetlike forceps. They have the transitive part from which long cheeks are going out which coincide with the thin rounding off end and a fillet throughout an axis of all internal surface. The oblong axis of handles at them is parallel. Depending on width of cheeks distinguish bayonetlike; with narrow, average and wide cheeks. They are used for removal of roots of incosors, canines, small molars and teeth with the destroyed surface.

• Removal of teeth and roots of the lower jaw is being made by forceps, which are bent on an edge and have beaklike form. The axis of brushes and an axis of handles form a corner, which is direct or close to direct. All components of forceps are allocated in a vertical plane, handles - one over the second.

• Cheeks of forceps for removal of incsors of the lower jaw, are narrow with fillets on inside, they are rounded on the end, during interlocking they do not converge. Canines and small molars are deleted buy such forceps, but with wider cheeks.

• Forceps for removal of the big molars have wide cheeks which do not converge. Each of them ends by triangular bend(thorn). From the inside both cheeks have a dimple. During superimposing on tooth bends enter the furrow between front and back roots that provides good fixing of forceps on tooth.

• In case of restricted opening of a mouth,big molars are deleted by the horizontal forceps, bent on a plane. They are constructed differently, than beaklike. Handles and the lock are allocated at an angle which comes nearer to direct and is in a vertical plane. A working part of brushes is the same, as the beaklike forceps for removal of the big molars, bent on an edge. Roots of all teeth of the lower jaw are deleted by forceps of the same form, as incisors, canines and small molars, only by cheecks that converge.

• The position of the doctor during

• Elevators.• Extracting teeth by elevetaors, as well as by

forceps, use the lever principe. Elevator consists of three parts:

• The working part, the connective rod and the handle. There are many different constructions of elevetaors, however the most widespread are three types: straight, angular and beaklike elevator.

• Straight elevator. Its working part is a continuation of the connective rod and together with the handle are allocated on one direct line. The cheek on the one hand convex, semicircular, from the other – bent, also looks like a fillet, the end is refined and rounded.

• Straight elevators are intended for removal of roots of teeth,of the upper jaw which have one root. They are intented for removal of teeth of the upper jaw allocated out of a tooth arc, rarely - the lower third molar.

• • Angular elevator. The working part

(cheek) is bent on an edge and allocated to longitudinall axis by the elevator at an angle, approximately 120 ⁰.

• Cheek small.One of its surface is convex, the second - slightly bent with longitudinal edges. The concave surface of a cheek at one elevator is turned to left (to itself), in others - to the right - from itself.

• In an elevator operation time, the concave surface of a cheek is directed to a root, which is being deleted, convex - to a cell wall.

• Angular elevator is used for removal of the lower teeth.

• Bayonetlike elevator (Lekljuz Elevator).Connective rod of elevator is bayonetlike, curve . The working part has spearlike form. It is narrowed and thiner in finite department. The handle is round, thicker in the middle part, allocated perpendicular to connective rod and to working part. Elevator is intended for removal of the third lower molar.

Types of elevators:

Lekljuz elevator

• Types of elevators:

• Stages of operation of removal of tooth:

• Operations of removal of tooth,are being led by forceps, also consists of several serial stages:

• 1.) Superimposing of forceps• 2.) Advancement of forceps• 3.) Interlocking of forceps (fixing)• 4.) A tooth Dislocation (luxation or

tooth rotation)• 5.) Deduction of tooth from a cell

(traction)

• Extraction of teeth, and it’s roots using drill, hammer and chisel.

• In such cases, when tooth or the root can’t be removed by using forceps or elevator, it is necessary to use drill, hammer or chisel. as an indication to such operation could be presence of a root or tooth which was not erupt, or a root with the curved top, and also expressed hypercementosis. This method is used more often, when extracting of the bottom wisdom tooth is needed.

• Processing of a wound after tooth removal. After the termination of operation of removal of tooth it is necessary to examine it carefully. Presence of keen edges in the root channel testify a root crisis. It’s unallowed to leave the broken root in a cell, especially if removal was spent concerning a sharp purulent periodontitis. Root removal needs to be finished by using hammer, drill, or chisel.

• When ensured, that tooth is fully removed, a sharp spoon is necessary to clear a cell of small splinters of a bone, granulations or a bone cover. External and internal edge of a cell shoud be squeezed by fingers through gauze tampons. On a wound impose one or several gauze tampons and ask the patient to compress jaws strongly. In 10-15 minutes a tampon delete’s to make sure of clot preservation. When there’s no bleeding, the patient can leave a medical institution. It is recommended to eat within 1-2 hours then it is possible to consume cool meal. In the first day after operation, it is not recommended to rinse oral cavity by solutions of antiseptic tanks, except those cases when purulent - inflammatory process is present. Rinsings by weak solutions furacilimun, chlorheksidinum, hydrocarbonate sodium, or permanganate potassium is allowed only on 2-3rd day. Usually the wound after tooth removal heals by a secondary tension, thanks to formation of blood clot. Putting a gauze in a sonorous impregnated with a solution of iodoform, is possible only with the purpose of preventing the infication of a clot if inflammatory process has developed

• Complication, that can occur during, and after tooth exraction.

• Root crisis can be prevented by using the method of section and separation of gums, with the following chisel debridement of cell wall, to one third of length, and also by using forceps for root extraction.

• Damage of soft tissues, occurs during careless, rough manipulations of physician, disorder of tooth extraction technique.

• When insufficient gums dislayering, before tooth extraction, rupture of mucous membrane often occurs during operation;

• In case of wrong tooth extraction technique, when a doctor imposes forceps directly on a mucous membrane, dislayered it not enough from the cell process, or a part.

• In case of careless dislocating of roots, by direct elevator, tissue damage of the bottom of oral cavity, tongue(when removing the roots of lower molars) and palate(when removing the roots of upper molars) occurs.

• On a background of the damage of soft tissues, bleeding occurs, which complicates the work of a doctor, while tooth extracting; In postoperative period, inflammatory complications can occur.

• A technique of granting of the urgent help: a stop of a bleeding and suturing the wound.

• a fragment break of cell parts (more often on the bottom jaw) - damage of tisses arises:

• - Under condition of an union of a tooth root with cell walls;

• - In case of deep imposing cheeks of nippers on cell walls - thus tooth removes together with a bone tissues.

• Technique of granting the urgent medical aid: to smooth down (if necessary - to remove) sharp, unequal edges of a cell of tooth, to suture a mucous membrane.

• Break of a tuber of the top jaw arises during removal of the third top molar, as a result of deep imposing forceps cheeks on walls of a cell, or a rough dislocation of tooth by straight elevator:

• In such case, there is a broken off fragment of a tuber of the top jaw on extracted tooth (roots)

• -a considerable bleeding occurs;• -If the maxillar sinus is damaged, vials of air from the extracted

tooth cell occure during attempt to blow air through closed with fingers nose.

• The technique of granting urgent help: smoot keen edges of tooth cell by bone spoon, mobilize and suture tightly a mucous membranem so that a bone wound would be completely closed. If the stomatologist cannot independently stop a bleeding, and suture a wound, he put iodoform tampon and transport’s the patient immediately in a surgical stomatologic department.

• Perforation of the bottom of maxillar sinus arises during removal of the first top molar, sometimes - the second and premolar.

• It is explained, that tops of the given teeth are closely located to the bottom of sinus.

• Perforation of the bottom of maxillar sinus can occur, when:• - Traumatic removal of the named teeth (if rough

manipulation in a tooth cell is done), and during careless manipulations;

• - Owing to anatomic features, when the root is located under a sinus mucous membrane;

• - When inflammatory process on a top of a root has destroyed a sinus bottom.

• Diagnostics:• During careful tubage of a cell, the instrument gets for the

length more than the deepnes of the cell.• On the basis of passage of the air from the oral cavity, into a

nasal cavity, ot contrary. The patient, having clamped fingers on his nose, should try to blow the air throughout it. Thus air through an aperture (perforation) of the bottom of maxillar sinus leaves it with a whistle and goes into oral cavity, or blood vials of air from a cell of extracted tooth occur;

• Radiological research is conducted (an aim picture).

• Technique of granting urgent medical aid in case of perforation of maxillar sinus:

• - In the presence of a purulent antritis (pus is goin out from a tooth cell, through a perforated aperture) in entrance of cell iodoform tampon and hospitalization of the patient in maxillofacial deparment;

• - In case of pushing a root through in a sinus, its removal in the conditions of a hospital is indicated;

• - In case of a healthy sinus (when radiological research does not reveal a root in a sinus) it is necessary to close a perforated aperture (a cell of extracted tooth) by a mucosial rag, taken from a vestibular surface of cell process. If the doctor has not mastered this technique, he should tightly suture a cell (to Impose 2-3 seams of polyamides).

• The bleeding arises after operation of removal of tooth. Distinguish early bleedings and late. Early bleedings, arise right after removals of tooth (trauma).

• Late bleedings can arise:• 1) In some hours after tooth removal,

for example in case of adrenaline overdose.

• 2) For some days after operation which becomes complicated by an inflammatory process.

Thank you for attention!