Surgical instruments and principles of exodontia Dr. Soukaina Tawfiq Ryalat

Principles of Exodontia Pain and Anxiety Control Local Anesthesia: type of local anesthesia Inferior alveolar nerve Lingual nerve Long buccal nerve Maxillary Nerve (Ant. Middle and post. Superior alveolar Nerve) Nasopalatine Nerve Greater palatine Nerve.

Contraindications of teeth removal Systemic conditions Local conditions

Systemic factors Sever uncontrolled metabolic diseases Un controlled diabetes End stage renal disease Un controlled leukemias and lymphoma Un controlled cardiac diseases (Ischemic heart disease) Bleeding problems Medications ( warfarin, steroids, immunosuppressive agents.

Local factors History of radiation to cancer (osteoradionecrosis) Teeth in the area of tumor (dissemination of cells) Pericoronitis around an impacted mandibular molar

Clinical evaluation of teeth for removal Access to tooth (mouth opening) Mobility of tooth (periodontal disease) Condition of the crown ( Large caries, large amalgum restoration) Scaling before extraction Radiograghic evaluation of teeth Configuration of roots Condition of surrounding bone: periapical pathology

Vital structures Maxillary sinus Inferior alveolar canal Closed versus surgical exrraction

Chair position for Forceps extraction Maxillary extraction: Maxillary occlusal plane is about 60 degrees to the floor. Mandibular extraction: More up right position , occlusal plane is parallel to the floor

Mechanical principles of Extraction Lever : Elevators Wedge:1- beaks of the forceps (bone expansion). 2- elevator during luxation Wheel and axle: Triangular elevator (Cryer)

Forceps Use Apical pressure (center of tooth rotation is displaced apically) Buccal force Lingual force or pressure Rotational pressure ( conic roots) Tractional force: tooth delivery

Alveolar Bone Anatomy Buccal versus lingual movements Give the bone time to expand Avoid jerky movements.