华西口腔幻灯片-外科牙齿拔除术

Extraction of Teeth,Shi Zongdao (shizd0664163.com),Extraction is a surgery,The extraction of teeth, however accomplished, is a surgical operation involving bony and soft tissues of the oral cavity, access to which is restricted by the lips and cheeks, and further complicated by the movement of the tongue and mandible.,It is essential that this phase of oral surgery be given the same careful study and application of sound surgical principles as is given to surgery in any other part of the human body.,Indications for the extraction of teeth,The following are indications for the extraction of teeth. (a) teeth that are foci of infections; (b) teeth with nonvital pulps, or acute or chronic pulpitis when root canal therapy is not indicated;,(c) in cases of severe periodontoclasia in which excessive bony support of the teeth is destroyed;,Indications for the extraction of teeth,(d) teeth not treatable by apicoectomy; (e) teeth mechanically interfering with the placement of restorative appliances; (f) teeth not restorable by operative dentistry;,(g) impacted teeth; (h) supernumerary teeth; (i) retained deciduous teeth when a succedaneous tooth is present, and in normal position to erupt;,Indications for the extraction of teeth,(j) teeth with fractured crown; (k) malposed teeth not amenable to orthodontic treatment; (l) roots; (m) teeth that are traumatizing soft tissues, if other treatment will not prevent this trauma.,Contraindications:systemic diseases 1,1. Uncontrolled diabetes mellitus 2. Cardiac disease, such as coronary artery disease. hypertension, and cardiac decompensation, e.g. postinfarction within 6 months 3. Blood dyscrasias such as anemias, hemorrhagic diseases e.g. hemophilia, and the leukemias. 4. Debilitating diseases of any kind making patients poor risks for further traumatic insults. 5. Addison's disease or any steroid deficiency, such as the patient who has been treated for any disease with steroid therapy may not have sufficient adrenal cortex secretion to withstand the stress of an extraction without taking additional steroids.,Contraindications:systemic diseases 2,6. Fever of unexplained origin is rarely cured and often is worsened by extraction, e.g. subacute bacterial endocarditis would be complicated considerably by an extraction. 7. Nephritis 8. Pregnancy: extraction is better to be done in the second trimester. Menstruation: elective exodontia is not done during the period because of less nervous stability and greater tendency toward hemorrhage of all tissues. 9. Senility: greater care in overcoming a poor physiologic response to surgery and a prolonged negative nitrogen balance. 10. Psychoses and neuroses,Local contraindications,1. Acute infection with an uncontrolled cellulitis, toxemia until adequate blood level of a specific antibiotic had brought systemic factors under control and the infection had become localized, the pus was drained, and the infection had subsided to a chronic state. 2. Acute pericoronitis 3. Acute infectious stomatitis 4. Malignant disease 5. Irradiated jaws may develop an acute radio- osteomyelitis after extraction,special instruments for the extraction,The special instruments for the extraction of teeth and roots are forceps, elevators. In special cases, where bone has to be removed, other instruments required such as chisels and mallet, burs, etc,A very large variety of forceps and elevators have been devised. A few well-selected instruments will suffice all hut very extraordinary cases.,Straight elevator,Physical characteristics 1. Large, bulbous handle. 2. Working end resembles a sharp, narrow, elongated spoon. 3. Straight shank, parallel to the working end. Use 1. To separate and loosen the tooth in its alveolus. 2. To remove large tooth fragments. Application Positioned between the tooth and its alveolus.,Maxillary posterior forceps Universal maxillary forceps,Physical characteristics 1. Plierslike appearance. Beaks have smooth edges that allow them to fit around the bifurcated areas of all maxillary molar teeth. a point on the buccal beak that allows them to fit into the buccal bifurcation area. Use To extract maxillary posterior teeth from their alveoli.,Maxillary premolar forceps/universal forceps,Physical characteristics 1. Plierslike appearance. 2. Instruments with bayonet-shaped beaks are Universal. Use To remove premolar teeth from their alveoli in the maxillary arch.,Mandibular posterior forceps,Physical characteristics 1. Plierslike appearance. 2. Universal design and therefore functional in either quadrant of the arch. 3. Often referred to as a cowhorn forceps. Use To remove mandibular posterior teeth from their alveoli sockets.,Mandibular incisor and premolar extraction forceps,Physical characteristics l. Plierslike appearance. 2. Beaks designed to remove all mandibular teeth, but most often used on incisors and premolars. Use To extract mandibular incisor and premolar teeth. Pedodontic extraction