Tooth extraction

Tooth extraction

Tooth extraction is a surgical procedure that involves pulling the tooth out of its socket using special instruments.

Each extraction should be performed in atraumatic manner (i.e. so that tooth extraction led to as little trauma of both hard tissue, i.e. the bone, and soft tissue – gums, as possible). If the procedure is performed like this, it takes longer and requires more precision from the operator, as well as other specialist tools. As a result of that, the advantages of using this procedure significantly influence healing and the further state of surrounding tissues.

The more the tooth is destroyed by caries and inflammation, the harder the extraction.

When starting tooth extraction, indications and possible contraindications to the procedure.

Surgical extraction

The term „surgical extraction” denotes a situation in which it is necessary to use elevators and to separate the roots. Surgical extraction is often associated with making an incision to gingiva, removing alveolar bone around the tooth, and wound suturing. In most cases, this problem affects wisdom teeth, impacted teeth, or residual roots.

Surgical extractions are usually characterised by higher risk and require more time than the so-called simple extraction.

Indications for tooth extraction

  Indications
 resulting from the disease of the tooth structure:

  • Teeth destroyed to such extent that it is impossible to restore them
  • Pulpitis in wisdom teeth,
  • Pulp necrosis in multirooted teeth in which endodontic treatment is impossible (calcified or curved root canals)
  • Deciduous teeth with necrotic pulp.

 

  Indications
 prosthodontic:

  • Misaligned teeth (if orthodontic treatment is impossible).
  • A single tooth in maxilla.

 

  Indications
  orthodontic:

  • Healthy tooth extraction (e.g. first premolars) in order to gain place for misaligned teeth, particularly anterior teeth,
  • Removal of wisdom teeth follicles in crowding and mandibular prognathism.

 

 

  Indications
periodontal:

  • 3rd grade tooth mobility according to Entin (the tooth is mobile in anterio-posterior- direction, mesio-distal, and longitudinal, along its axis),
  • recurrent periodontal abscesses that do not respond to conservative treatment.

 

  Indications
systemic:

They are related to necrotic teeth, teeth with apical periodontitis, and teeth treated endodontically. Extraction is performed during the remission phase of the disease.

  • Rheumatic disease.
  • Endocarditis and myocarditis.
  • Glomerulonephritis.
  • Optic neuritis and inflammation within the tissue of the eyeball.
  • Allergies.
  • Skin diseases.

  Indications
 surgical:

  • multirooted teeth with apical periodontitis lesions and single-rooted teeth, if conservative treatment is impossible, or if apicoectomy is contraindicated,
  • impacted teeth that cause pain or dislodge adjacent teeth,
  • problems in wisdom teeth eruption, if the teeth are not likely to be aligned correctly in occlusion,
  • fracture of the crown below bone level, which makes prosthodontic restoration impossible
  • oblique or vertical root fracture,
  • multi-rooted tooth fracture,
  • teeth with necrotic pulp, located in the fissure of bone fracture,
  • healthy teeth that make it impossible to reposition the bones after fracture.

  Indications
Iatrogenic causes:

  • teeth with perforations, either within the root canal or pulp chamber floor,
  • separated endodontic instrument located over the apical foramen and cause inflammation within surrounding tissues (if apicoectomy is impossible).

 

  Indications
Emergency indications:

  • dental and periodontal diseases in chronically ill and mentally ill patients,
  • teeth with lesions within the hard tissues and periodontium within the irradiation field before radiation therapy.

 

 

Contraindications

  Contraindications
absolute:

  • tooth located within a tumour or its environment,
  • tooth located within a haemangioma.

 

  Contraindications
 local relative:

  • trismus,
  • ulcerative mucositis,
  • teeth within the field of irradiation.

  Contraindications
  systemic:

  • acute and chronic leukaemia,
  • bleeding diathesis related to plasma factors (haemophilia A, B, C, von Willebrand disease),
  • bleeding diathesis related to platelet disorders (thrombocytopenia, thromocytopathy),
  • anaemia,
  • cardiovascular diseases (myocardial infarction in history, angina pectoris, status after cardiac surgery, cardiac rhythm disorders),
  • hypertension,
  • hepatic disorders,
  • nephrological disorders,
  • hyperthyroidism,
  • menstruation,
  • pregnancy,
  • post-irradiation reaction,
  • epilepsy,
  • mental disorders,
  • diabetes,
  • infectious diseases.

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