Dental extractions: diagnosis and simplified therapy (Proceedings)
Indications for extraction
Teeth are extracted for a number of reasons. These include periodontal disease, caries, advanced feline dental resorptive lesions apical abscesses, traumatic malocclusion, tooth root fracture, tooth crown fracture, retained deciduous, teeth, root tips, supernumerary teeth and client preference.
There are many alternatives to extraction for the treatment of many of these conditions as described in other modules. Financial and other pressures may lead the client to request extraction.Teeth with periodontal lesions are easier to extract than those which having normal bony support. The alveolar bone and periodontal ligament are weakened and progressively destroyed by the periodontal disease process. Rendering affected teeth more easily extracted.
There are three extraction techniques for most carnivores and omnivores. Herbivores require a surgical extra oral approach for the extraction of' most of their teeth. Number of tooth roots, the amount of tooth retention, and the instrumentation requirements determine the exact technique.
Small single rooted teeth indicated for extraction are deciduous teeth or periodontal involved permanent incisors.
Deciduous teeth often seem to be the easiest to extract, but their small size, long delicate roots, and roots that are partially resorbed by the erupting permanent tooth make them more difficult too extract without root fracture. Patience and the delicate use of fine sharp instruments are preferable to the use of force, which usually results in root fracture. Fractured root tips are far more difficult to extract than intact teeth.
Four possibilities exist with fractured retained root tips. 1, if the root tip was fractured at the time of acute dental infection, such as advanced periodontal disease or Periapical involvement, the root tip will most likely serve as a source of continued infection. All efforts should be taken to remove root tips that at left when extracting these diseased teeth. 2, the root tip can simply resorb. 3, the root tip can become encapsulated in bone, and 4, the root tip can migrate out of the extraction site. As you can see, the last three possibilities suggest leaving these non diseased root tip fragments in place rather than induce unneeded trauma to the patient trying to remove these retained root tips.
Extraction techniques dental elevation
Extraction with the use of an only dental elevator is usually reserve for deciduous teeth. Permanent teeth that are loose as a result of periodontal disease can fall into this category.
When extracting deciduous teeth it is important to do as little damage as possible to the soft tissues and to avoid damaging the erupting permanent teeth.
The epithelial attachment is cut with a #15 scalpel blade directed at 45 degrees to the long axis of the tooth. The attachment is cut around the entire tooth.
A sharp fine dental elevator is inserted between the tooth root and the crestal alveolar bone. It should be narrower than the root and as fine and sharp as possible to minimize bone trauma and the risk of root fracture. This is of particular importance when extracting retained temporary teeth or feline teeth both of which fracture readily.
The elevator is gently moved caudally and rostrally around the circumference of the root and pushed apically.
The periodontal ligament fibers are gradually cut, torn. The elevator should compress the tooth in all directions and held in place for approximately thirty seconds or more in all directions. This will fatigue the periodontal ligament fibers facilitating extraction. Hemorrhage of the periodontal ligament during elevation creates a hydraulic effect that can aid the extraction process. When the tooth is sufficiently loose, the final movement is to work the elevator down the anterior face of the root to its apex. The tooth will follow behind the elevator out of the socket and be removable with the fingertips. It is very important not to use a dental forceps for the final removal or extraction of these primary teeth even if they appear extremely loose. The end result almost always results in root fracture.
The roots of deciduous teeth are longer and narrower than those of their permanent counterparts. Normally, the roots are gradually resorbed as their permanent replacements begin to erupt. When the deciduous tooth is still in place and the permanent tooth erupts through the gingiva, this condition is classified as a retained deciduous tooth. These retained teeth often induce a dental malocclusion and should be removed as soon as possible. The roots of deciduous teeth are more likely to fracture than those of permanent teeth. Their length and small diameter along with partial resorption make careful elevation a must. With patience and a sharp fine elevator, these teeth are easily removed as described above.