Dental extraction

( " Pull " the Latin ex - trahere ) The extraction is used in dentistry, the surgical removal of a tooth without a larger section is necessary. Also known under the name exodontia tooth extraction may be carried out in the normal case of any dentist. If a larger section and the formation of a Schleimhautperiostlappens required, which falls under the concept of Operational tooth removal ( osteotomy in dental jargon, " flap procedure ").

When anesthesia is normally used an infiltration or nerve block anesthesia.

• 2.1 instruments
• 2.2 technique of tooth extraction

Indication

A distinction between absolute and relative indications.

Absolute indications

• The tooth is extremely loose (loosening grade III) and a regeneration of the periodontal apparatus ( reattachment ) is not expected.
• Longitudinal fracture of the tooth crown or the tooth root
• Transverse fracture of the tooth root in the middle third of the root
• Massive Apical periodontitis when a surgical revision ( root resection or hemisection ) is not possible
• Displacement of a tooth, as frequently occurs with wisdom teeth, or lack of space, if it can not be corrected by orthodontic treatment.
• Removal of supernumerary tooth formation ( for example, a Mesiodens ), especially if they interfere with the breakthrough of real teeth

Relative indications

• Strong destruction of dental hard tissues ( enamel, dentin ) when a tooth preservation by means of dental fillings or crown on time is only possible.
• The patient rejects dental -sustaining measures, but must be freed from his pain.
• The patient, the cost of necessary dental sustaining measures ( for example, a crown) can not financially afford ( social indication ).
• There is a mismatch between tooth and jaw size, so do not find all of the teeth is sufficient space: systematic extraction therapy after Hotz in the context of orthodontic treatment.
• To compensate extraction, if in the opposite half of the jaw is missing a tooth and a ( center lines ) shift should be avoided ( for example: it is the tooth 35 is missing: the tooth 45 is in a countervailing extraction removed.)

Instruments and technique of tooth extraction

Instruments

As with any surgical procedure, the instruments used must be sterile.

Differently shaped pincers are used for the extraction for the different tasks and groups of teeth.

In the upper jaw:

• Anterior forceps
• Prämolarenzangen
• Molarenzangen (different for the right and left side)
• Wisdom tooth forceps
• Root Pliers

In the lower jaw:

• Front and Prämolarenzangen ( identical because both groups of teeth have only one root )
• Molarenzangen
• Wisdom tooth forceps
• Root Pliers

Within these groups there are very different special designs.

Also for the extraction of deciduous teeth, there are special pliers.

To cut through the fibers of the gums and loosening of teeth extraction levers are used (for example, leg shear lever or root lifter).

A historic extraction tool, for example, the stork 's beak.

All these instruments are made of high quality steel.

Forceps for upper incisors (teeth 13 to 23 )

Forceps for upper bicuspids

Forceps for upper molars right

Forceps for upper molars right, American model

Technique of tooth extraction

Like any surgical procedure in the human body for diagnostic and / or therapeutic purposes it is a surgical procedure. An injection of the local anesthetic is an invasive procedure, with which the mucous membrane is broken.

Usually a local anesthetic is performed before tooth extraction. With severely loosened teeth may possibly be waived. In exceptional cases, a general anesthetic is necessary.

The term " pull a tooth " is indeed in general use, but only very inadequately describes the actual technique of extraction. Rather, it is important to widen the tooth socket ( alveolus ) with soulful, suitable lever and tilt ( Luxationsbewegungen ) and to " sense" the where the tooth gives the most. This fragmentation of the alveolar walls must be avoided by supporting the bone with his free hand. By simply pulling it would in most cases impossible to remove a tooth, especially not in the (upper) molars, often diverge greatly their roots. After extraction, the alveolar walls are pressed together manually.

A normal part of each extraction is bleeding from the injured vessels of the gingiva, the gums and bone. Normally postoperative enough the insert a sterile swab as a pressure bandage for about 30 min from. The resulting blood clot ( clot ) is the ideal wound dressing. To reduce the open wound area, surgical sutures can be made. This should be done routinely in the extraction of several teeth in one sitting (row extraction). In the extraction of several teeth or foreseeable large-scale extraction wound and the inclusion of an association board can be useful. Where necessary, a pain medication will be prescribed. The painkiller should not acetylsalicylic acid (eg aspirin), as this affects the blood clotting negative.

Freshly extracted lower molar, exceptionally four roots

Possible complications

• Cancel the tooth
• Cancel the root
• Pain, edema ( swelling), hematoma ( bruising)
• Difficulty in opening the mouth up to the trismus, difficulty swallowing
• Dry socket: Dry Socket ( Latin: alveolitis sicca): clinical picture of wound infection of the jaw bone after a tooth extraction as a result of the disintegration of the blood clot (post extraction syndrome)
• Rebleeding

Rare:

• Opening of the maxillary sinus ( usually in the range of the maxillary posterior teeth )
• A tooth root (or a portion ) passes into the maxillary sinus
• Side effects of the anesthetic.
• Irritation (irritation ) of the inferior alveolar nerve or the lingual nerve by anesthesia
• Damage or loosening of other teeth
• Injury of soft tissue

Very rare:

• Demolition of the maxillary tuberosity ( Its location see figure)
• Fracture ( break) of the mandible or the jaw joint
• Luxation ( dislocation ) of the temporomandibular joint
• Fracture of the injection needle
• Ingestion of teeth or tooth parts
• Aspiration of teeth or tooth parts

The opening of the maxillary sinus at an extraction is not a treatment failure. It is only important that the opening of the maxillary sinus is recognized by the dentist. For this, the routine implementation of the nose blowing test ( Valsalva pressing pressure ( test) ) after extraction of upper teeth is recommended. Reliable, however, is to blank the alveoli with a blunt probe.

A dislocated into the maxillary sinus root must be removed - if necessary, further treatment by an ENT doctor.

A perforation of the maxillary sinus ( antral connection = oral maxillary sinuses connection) can be covered by a surgically experienced dentist, an oral surgeon or oral surgeon with a vestibular flap pedicled elongation (plastic cover). For this purpose, the periosteum is cut at the base of the flap from the inside of the flap side so that the mucosal flap stretch enough ( mobilize ) leaves. The subsequent suturing must be done very carefully.

If possible, the patient should avoid vigorous nose blowing and sneezing in the first few days after surgery, because you can tear open again by the pressure of the closure of the maxillary sinus.

In inflamed maxillary sinuses ( for example, by the infected root tip ) the primary cover with a flap technique often fails because the escaping secretion ( from the nasal cavity of the alveolus into the oral cavity ) are in good wound closure paves a connection. In this case, the healing of the inflammation in the antrum should be sought prior to the plastic cover. If necessary, the maxillary sinus is opened to flushed through the alveolus. From case to case, the support of an ear, nose and throat doctor should be taken advantage of. Only after the subsidence of the inflammation can be a plastic cover.

For complicated tooth extractions are basically all tooth parts to collect to ensure that no tooth parts are swallowed or aspirated.

Ingestion of teeth or tooth fragments is associated with low risks.

A dangerous complication, however, is an aspiration of teeth or tooth parts. It must take place quickly and further treatment by a specialist ( otolaryngologist ).

Follow-up treatment

In general, the doctor checks the following day the wound.

As far as the wound was sutured, the sutures must be removed after a few days - at a plastic cover at the earliest after 10 days.

In a alveolitis sicca a wound revision is by curettage and anschließendener multiple tamponade the drug of choice. ( Secondary wound healing)

The same wound after two days

The bone compartments (alveoli ) of the first lower molar tooth are not yet completely ossified again even after months.

Behavior after surgery

The wound usually closes during the first weeks of treatment (primary wound healing).

In the early period after the operation, the correct behavior for good wound healing and the reduction of the unavoidable consequences is important.

For the duration of anesthesia to drive vehicles and to operate machinery is not allowed.

In the first 24 hours, the wound should be cooled. This results in less swelling. For this purpose, ice packs can be used for example. And the sucking of ice reduces the temperature in the oral cavity and the wound is further cooled from the inside.

Some dentists and pharmacists recommend for faster decongestion of the wound region in addition the use of arnica preparations.

If no allergy exists against chamomile, the wound can be rinsed after eating with chamomile to support wound healing and disinfection.

Dairy products should be avoided, as the lactic acid bacteria contained therein would attack the forming blood clot. The consumption of caffeine ( coffee, black tea, energy drinks ), nicotine or alcohol is limiting because they promote bleeding. Also, whole grains and foods that have crumbly ingredients can be problematic, as the crumbs fall into the wound and can lead to inflammation.

Also, make sure that after each feeding the teeth and also the wound area gently with a small, soft toothbrush ( kids toothbrush ) to be cleaned. Alternatively, oral hygiene mouthwash are prescribed, what can be more pleasant, especially in the first few days. By " pollution" of the wound as this may result in an inflammation that interferes with wound healing.

Sprunghaft increasing blood pressure can also be problematic. Therefore, caution should be exercised when sporting efforts.