Extraction of non-restorable Retained Root - extraction

Extraction of non-restorable Retained Root

 

Indication For extraction : Non restorable tooth

Steps to put on personal barriers:
Mask and goggles  gown  wash hands 

GLOVES!!!

 

 

How to do simple tooth Extraction ?

 

 

1. Test the effectiveness of local anesthesia with the pointed end of a periosteal elevator.

2. Sever the gingivodental fibers with the same end of the periosteal elevator.

3. Elevate the tooth (never use an elevator on the lingual side of a tooth)

a. Small straight elevator: Insert the elevator into the mesial or distal PDL space with firm apical pressure, with the concave side toward the tooth to be extracted. Rotate the elevator in such a way as to move the tooth toward the facial.

b. Large straight elevator: Use the same technique to obtain a greater amount of movement. This instrument may be too large for small teeth, such as lower incisors.

c. Offset elevator: Maxillary third molars

d. Cryers: Left or Right, to get to a section of a tooth

e. Davis: double ended to get tiny roots out.

4. Luxate and extract

a. Forceps selection

i. Upper universal  – any upper tooth, small one for pediatric patients

ii. Lower universal  – any lower tooth, small for pediatric patients

iii. Cowhorn – lower molars with fairly straight non-fused roots

iv. Ash (various sized) – lower anteriors and bicuspids

v. Anatomic upper molar forceps  – for upper molars with non-fused roots.

b. Forceps placement: Keep the beaks in the long axis of the tooth and between the free gingiva and the tooth. Seat the forceps as apical as possible (keeps center of rotation apical, minimizes root fracture). Squeeze hard enough that the beaks do not slip when you luxate the tooth.

c. CONSTANT FIRM APICAL PRESSURE during luxation – converts the center of rotation of the tooth from the apical third to the apex. Prevents broken root tips.

d. Directions of luxation: Take your time; let the bone of the socket expand.

i. Upper anteriors – rotate in the long axis of the tooth

ii. Upper bicuspids – luxate to the buccal until you feel a loss of resistance, then PULL. Protect the lower teeth from injury if the tooth comes out suddenly. Only tooth you pull!

 

 

iii. Upper 1st and 2nd molars – buccal luxation

iv. Upper 3rd molars – buccal and distal luxation

 

 

v. Lower anteriors and bicuspids – rotate in the long axis of the tooth. A little bit of buccal luxation is okay for canines and bicuspids.

vi. Lower molars – Can opener or pump handle; buccal luxation motions in that order for extraction of lower molars using cowhorn forceps

5. Examine the root for complete extraction.

6. Carefully palpate the apical region with a curette.

a. To check for oro-antral communication (upper posteriors)

b. To check for and then remove periapical granulation tissue or cyst.

7. Remove periodontal granulation tissue with a Lucas curette and/or rongeur.

8. Palpate the alveolar process for sharp edges and undercuts , Perform alveoloplasty as necessary.

9. Suture the gingival tissues if necessary.

10. Place gauze dressing. Check for hemostasis before dismissing the patient.

11. Give postop instructions, analgesic prescription, and follow-up appointment if necessary