Teeth extraction technique and complications. Complex and atypical removal of wisdom teeth: stages of rehabilitation

METHODOLOGICAL DEVELOPMENT FOR TEACHERS No. 2

TO CONDUCT A CLASS ON

4th COURSE OF DENTAL FACULTY IN CHILDREN'S CARE

ORAL MAXILLOFACIAL SURGERY

TOPIC: TOOTH EXTRACTION OPERATION IN CHILDREN.

Time 3 hours 30 minutes

LEARNING AND EDUCATIONAL GOALS

1. Study the features child's body and indications for tooth extraction in children.

2. Study the features of tooth extraction in children.

3. Study the basic principles of deontology when working with children.

2. MATERIAL EQUIPMENT: tables, slides, phantom, tools for tooth extraction. The lesson is held in the maxillofacial surgery hospital, children's surgical room dental clinic

3. QUESTIONS WHICH KNOWLEDGE IS NECESSARY TO STUDY THIS TOPIC:

1. Anatomy dental system.

2. Indications for tooth extraction.

3. Stages of tooth extraction.

4. Tools for removing teeth.

5. Errors and complications of tooth extraction.

QUESTIONS TO BE STUDYED IN CLASS

1. Anatomical features teeth and jaws in children.

2. Periods of tooth change.

3. Indications for tooth extraction in children.

4. Stages of tooth extraction in children.

5. Features of the technique of tooth extraction in children.

6. Errors and complications of tooth extraction in children.

CALCULATION OF STUDY TIME

1. Introduction – 10 min.

2. Test control initial level of knowledge – 20 minutes.

3. Oral interview on class issues - 40 minutes.

4. Carrying out the tooth extraction operation on a phantom – 20 minutes.

5. Work with patients – 120 minutes.

6. Analysis of situational problems on the topic of the lesson - 20 minutes.

7. Review of case histories - 30 minutes.

8. Final control, homework- 10 minutes.

GENERAL GUIDELINES

After checking those present, the teacher introduces students to the tasks and topic practical lesson. The significance of the topic is determined by the peculiarities of the operation of tooth extraction in a nursery. surgical dentistry. Control of the initial level of knowledge is carried out in the form of test and situational tasks. In a training class, students perform tooth extractions on phantoms. In the dressing room and surgical room, students, 3-4 people in each subgroup, become familiar with the operation of tooth extraction in pediatric dentistry. Students, under the supervision of a teacher, perform dental extractions on patients childhood. The teacher corrects practical skills. The final level of knowledge on a given topic is determined through a survey, during which the teacher evaluates students’ knowledge and corrects it. In conclusion, the teacher gives a description of the group’s work. The degree of preparedness of students is noted. An assignment is given for the next lesson.

PROGRESS OF CLASSES

INDICATIONS FOR TEETH EXTRACTION IN CHILDREN:

I. Temporary bite (up to 6 years).

1. Temporary teeth that erupt at birth.

2. Acute odontogenic diseases (purulent periostitis, osteomyelitis, lymphadenitis, abscesses and phlegmon).

3. Ineffective treatment of chronic granulating periodontitis when the process spreads to the follicle of a permanent tooth.

4. Resorption of more than half the length of the root and tooth mobility of II – III degrees.

5. Removal due to injury or traumatic dystopia of incisors during root resorption.

II. Changeable bite (from 6 to 11 years).

1. Acute odontogenic diseases (purulent periostitis, lymphadenitis, abscesses and phlegmon):

· with resorption of more than half the length of the root of a temporary tooth;

· if the tooth is not subject to conservative treatment.

2. Odontogenic osteomyelitis of the jaws.

3. Acute pulpitis and periodontitis of temporary molars in children 9–10 years old.

4. Ineffectiveness of treatment chronic periodontitis temporary and permanent teeth.

5. Spread of inflammation to the interroot septa of multi-rooted temporary and permanent teeth.

6. The presence of a temporary tooth or its roots when the permanent one has erupted.

7. Delayed resorption of the roots of a temporary tooth, which prevents the timely eruption of a permanent one.

8. All types of traumatic fractures of the root of a temporary tooth and fracture of the root of a permanent tooth when it is impossible to use it under a pin tooth.

9. Fracture of the crown of a tooth due to resorption of its root.

10. Removal of temporary teeth due to trauma.

11.Temporary and permanent teeth located in the jaw fracture line.

III. Permanent bite (11 – 15 years).

1. Teeth that are the source of odontogenic osteomyelitis (mainly molars).

2. Teeth with chronic granulating or granulomatous periodontitis that is not amenable to treatment (conservative or surgical).

3. Significant destruction of the coronal part of the tooth when it is impossible to use its root for prosthetics.

4. Complications associated with dental treatment (perforation of the bottom of the pulp chamber or tooth root during exacerbation inflammatory process).

5. Supernumerary, impacted teeth that do not have the conditions for eruption.

6. Temporary teeth that have survived up to 15 years in the presence of correctly positioned permanent teeth (according to x-ray data).

7. Teeth located in the jaw fracture line:

· intact, making it difficult to reposition fragments;

· teeth with a chronic inflammatory process in the area of ​​the root apexes, which do not prevent the reposition of fragments.

8. Comminuted or longitudinal fracture of the root.

9. Orthodontic indications.

10. Supernumerary, as well as complete, severely dystopic teeth, which cannot be moved to their normal position using modern orthodontic and surgical methods.

STEPS OF TOOTH EXTRACTION OPERATION

1. Separation– separation of the circular ligament from the neck of the tooth and gums from alveolar process.

The basic rule: thoroughness.

2. Applying forceps to a tooth.

Basic rule: the axis of the cheeks of the forceps must coincide with the axis of the tooth.

3. Advancing the cheeks of the forceps.

When removing teeth with a retained crown, the cheeks of the forceps are advanced to the neck of the tooth. When resolving the bone around the tooth, it is permissible to move the forceps deeper, top part root When removing tooth roots, forceps are applied to the edge of the alveoli.

Basic rule: the axis of the cheeks must coincide with the axis of the tooth.

4.Fixing or closing the forceps.

The forceps and the tooth being removed must form a “single whole”. The tooth and forceps form common lever arm.

5. Dislocation tooth

There is a rupture of the periodontal fibers connecting the tooth with the walls of the socket.

There are two possible methods of dislocation:

· luxation – rocking (pendulum-like) movements in the vestibular-oral direction;

· rotation – rotational movements around the tooth axis by 20-28 0 in one direction and then in the other direction. Rotation is possible with dislocation of: 11, 12, 13, 21, 22, 23 and separated roots 14, 24, 17, 18, 26, 27, 28;

Basic Rules:

a) the first dislocation movement should begin in the direction of least resistance (where the wall of the socket is thinner);

The vestibular wall of the alveolar process is usually thinner than the palatal wall. Therefore, the first dislocation movement when removing teeth and tooth roots upper jaw should be done in the vestibular direction (outward). The exception is teeth 16 and 26, because at the level of these teeth there passes the zygomaticalveolar ridge, thickening the outer wall. Therefore, when removing these teeth, the first dislocation movement is carried out in the palatal direction. When deleting lower teeth The presence of an external oblique line in the molar area leads to the fact that when removing these teeth, the first movement must be made in the oral direction.

b) make the first dislocation movement weak; the amplitude of oscillations should be gradually increased.

6. Extracting a tooth from its socket. It occurs when the connection between the tooth and the tissues that hold it in the socket is completely lost. It is carried out smoothly, without jerking.

7.Socket curettage.

The basic rule: the curettage spoon must be the same size as the hole. On the upper jaw, one should remember the presence maxillary sinus.

8.Ensuring the formation of a complete clot and bringing the edges of the socket closer together using gauze swabs.

Basic rule: the clot must be complete, i.e. do not go beyond the hole (do not be loose, overlapping the edges of the hole).

The operation of removing teeth with forceps consists of the following sequential steps:

1. Peeling of the gums.
2. Forceps delivery.
3. Advancement of forceps.
4. Fixation of forceps.
5. Tooth dislocation.
6. Extracting a tooth from its socket.
7. Bringing the edges of the hole closer together.
8. Hemostasis.

The application of forceps is carried out by opening them and placing them on the crown of the tooth to be removed so that the axis of the cheeks of the forceps coincides with the axis of the tooth. The layout of the cheeks of the forceps when removing a tooth is shown in the figure.

The forceps are moved under the gum along the axis of the tooth. This is helped on the lower teeth thumb left hand, which presses on the lock area. The cheeks should be advanced until you feel a tight grip on the tooth or root. With purulent inflammation in the area of ​​the marginal edge of the gum, part of the bone alveolus around the neck of the tooth can dissolve, so the cheeks of the forceps can be advanced significantly deeper than the cervix tooth

When removing teeth with a completely destroyed crown, the cheeks of the forceps are moved under the gum along the alveolar process to a depth of 0.4-0.5 cm, capturing the bony edge of the alveolus.

Rice.

After moving the forceps to the desired depth and making sure that the forceps are applied correctly, fix the forceps (closing). You should not put too much pressure on the crown of the tooth, especially a damaged one. carious process, as this may result in crushing of the crown. If the forceps are closed weakly, they slide off the tooth, and the further stage (dislocation) becomes impossible.

The purpose of dislocation is to destroy the periodontal fibers that hold the tooth, to push the walls of the alveoli apart, i.e. to prepare the conditions for tooth extraction.

Dislocation is carried out using rotational and pendulum-like movements (rotation and luxation). The forceps-tooth system acts like a lever, providing a manifold increase in the doctor’s efforts. Rotational movements consist of small (25-30°) turns in one direction or the other around the axis of the tooth and are used to remove roots and single-rooted teeth. During pendulum-like movements when removing multi-rooted teeth on the upper jaw, the handles of the forceps are moved in the buccal-palatal direction, to lower jaw The handles of the tongs are aligned alternately downwards and upwards. Lateral and rotational movements should be made carefully, gradually increasing the range, without rough jerks, until tissue resistance is no longer felt. During dislocation, the patient's head must be well supported so that it does not move to the sides when the forceps move. To do this, hold the alveolar process of the jaw in the area of ​​the tooth being removed with your left hand, and if necessary, ask an assistant to hold your head with your hands. The first dislocation movement is made in the direction of least resistance, i.e. where the wall bone socket thinner and therefore more pliable (see removal section separate groups teeth with forceps).

Removing a tooth from the socket (traction) involves removing the tooth from the socket after freeing it from the ligamentous apparatus.

After the tooth is extracted, it is necessary to examine it, make sure that the root has not broken off, inspect the socket, and, if necessary, carry out curettage and rinse the socket with antiseptics. Then use the first and second fingers of the left hand to bring the edges of the hole closer to each other. This ensures much faster and less traumatic healing of the hole and good fixation of the blood clot.

All stages of tooth extraction are shown in the figure.

"A practical guide to surgical dentistry"
A.V. Vyazmitina

(tooth extraction) - this is the most frequent operation in humans. It can be typical (simple), complex, atypical. The main goal of a typical (simple) tooth extraction operation is the need to create conditions for the tooth to emerge from the jaw, that is, it is necessary to destroy the connection of the tooth with the surrounding tissues and slightly expand the alveolus. During surgery, the doctor usually stands (or sits) with right side from the patient. However, the position of the doctor, the patient in the chair and the tilt of the patient’s head should be such that it is comfortable for the doctor to work and for the assistant to help. The dentist and assistant must have a clear view of the surgical field and be able to control the condition of the oral cavity and fix the jaw and alveolar process near the tooth that is being removed with their left hand.

The following mandatory stages of a simple tooth extraction operation are distinguished, which are carried out after anesthesia:

1. syndesmotomy - detachment of the mucous membrane from the tooth and destruction upper sections dental-gingival junction;
2. applying forceps to a tooth
3. advancement of forceps
4. fixation of forceps
5. loosening of the tooth (luxation or rotation, depending on the shape of the tooth root)
6. traction - removing a tooth from the alveolus
7. hole revision
8. treatment of the tooth alveolus (reposition or suturing of its edges)

Apply forceps so that their axis coincides with the axis of the tooth, advance the forceps until they come into contact with the neck of the tooth and the edge of the alveolus.

Applying the cheeks of the forceps to the tooth (a – correct; b – incorrect) and to the upper edges (c) of the walls of the tooth socket (this is undesirable, since bone is lost)

You need to squeeze the forceps so as not to split the tooth, especially if it is fragile or has a carious cavity. After applying the forceps, the first luxation movement is usually made in the direction the thinnest wall alveoli of the tooth (usually outward in the buccal direction) so that it breaks and enlarges the hole for the tooth. In the lower jaw, when removing molars, the first movement is made in the lingual direction, because on the outside there is an external oblique line (buttress of the lower jaw), which counteracts the force that is applied.

After the operation, the edges of the alveoli are brought together with fingers, and if necessary, the mucous membrane above the alveoli can be sutured with catgut, silk or applied to it pressure bandage(a tampon that the patient presses with his teeth to stop bleeding from the alveoli). It should be noted that extracted tooth They do not immediately throw it away, but examine it and show it to the patient to avoid questions about the need to remove the tooth and the presence of all its roots.

Classical tooth extraction surgery technique has some features when removing various teeth, which is determined by the number and structure of their roots, the alveolar process and the jaw itself, the nature of the pathological process in the area of ​​the alveolar process, the degree of destruction of the tooth, its position in the jaw, characteristics of soft tissues and other factors. Teeth with rounded roots (canines, central incisors) are removed with a predominant use of rotational movements, and teeth with flat roots or multi-rooted teeth are removed with a predominance of luxation movements. The force of tooth dislocation must correspond to the resistance of the bone of the walls of the tooth socket.

The use of a particular elevator, as well as the direction of the first luxation movement (inward or outward) also depends on the above factors. Thus, a direct elevator is usually placed on the medial surface of the tooth and rotational movements are carried out with the elevator based on the alveolar bone or medially located teeth, which will make it possible to remove teeth or their roots. An angular elevator is inserted into the alveolus of an already removed tooth root and also carries out a rotational movement in the direction of the root and interradicular septum, which are subject to simultaneous removal.

Scheme of removing the root of the upper tooth with a straight elevator (a – d – stages of the operation) and removing the roots of the lower molars with an angular elevator (according to A. E. Verlotsky) (e)

Features of root anatomy and tooth extraction in the upper jaw

• Anterior incisors- their roots are round in shape. Use straight forceps; rotational movements, dislocation - in the direction of the vestibule of the oral cavity.
• Lateral incisors- slightly flattened, the top is bent towards the sky. Rotational and luxation movements are used.
• Fangs- the roots are massive, long, flattened, like a aligned triangle. The forceps are straight, the movements are luxation, then rotation.
• Premolars- the roots are flattened, the first premolar has 50% buccal and palatal roots. The forceps are S-shaped, the movements are luxation, the first movement is made in the buccal direction.
• Molars- the first two (6 and 7) have three roots: two buccal and one palatal. In the area of ​​the 6th tooth, the outer wall of the alveolus is thickened due to the zygomatic-alveolar ridge, and in the area of ​​the 7th tooth, the outer wall is thinner than the inner. An S-shaped forceps with a spike on the outer cheek is used to bifurcate between the buccal roots. The first luxation movements are towards the palate (6th tooth) or outwards (7th tooth).
• Upper 8 teeth removed with special bayonet forceps with long cheeks, the first movement is outward. Often they can only be removed using a direct elevator.
• Roots upper teeth - removed with bayonet forceps or straight and S-shaped forceps with cheeks that converge. The roots of the upper molars are removed either all together (while maintaining the connection between them), or one by one (when the connection is already destroyed, the roots are single).

Features of the anatomy of roots and tooth extraction in the lower jaw

The patient's position is as low as possible, the head is almost vertical, the chin is tilted towards the chest. When removing left teeth, the doctor stands to the right and in front near the patient, the first finger covers the chin, 2 and 3 fingers cover the alveolar process, and when removing right teeth, the doctor stands immediately behind the patient, 1-2 fingers of the left hand cover the alveolar process, and 3-4 5 fingers - chin, holding the lower jaw. The line of strength (thick cortical plate) comes from the lingual surface in the area of ​​1-2-3 teeth, gradually passes at the level of 4-5 to the outer surface and at the level of 6-7-8 teeth passes into the external oblique line (buttress of the lower jaw). Taking this into account, the first luxation movement is carried out, gradually increasing the amplitude of movements, and rotational movements are also used. Traction of the tooth is carried out upwards and outwards so as not to injure the upper teeth.

• Incisors- roots are flattened laterally, narrow beak-shaped forceps are used, movements are mainly luxation.
• Fangs- long roots, strong, use wide beak-shaped forceps, movements - luxation and rotation.
• Premolars have one round root, slightly flattened. Movements - luxation and rotation.
• Molars(6, 7) have two flattened roots (anterior and posterior). Beak-shaped forceps with spikes, the first luxation movement of the 6th tooth is towards the buccal side and the 7th tooth is towards the lingual side. 8th tooth - the structure of the roots (there are 1-4 of them) can be multivariate, so removing a tooth is very difficult, even after an X-ray examination. They use special forceps with spikes, elevators, and often perform complex or atypical removal.

If a typical operation does not allow tooth extraction, then proceed to surgery complex removal tooth Complex tooth extraction involves the use of additional surgical techniques and instruments to remove a root or tooth from the alveolus without opening and detaching the mucoperiosteal flap and without partially or completely removing one or two bone walls of the alveolus. For this they use additional tools and means - bone burs and a drill, narrow chisels, a dental mirror and additional illumination of the fossa, various probes, narrow elevators, and other tools. First of all, you need to accurately determine the presence, position and size of a broken tooth root, the proximity of important neighboring anatomical structures. To do this, after drying and illuminating the hole with a mirror, it is carefully examined, radiographs are taken, or the position of the root is determined already during surgical intervention. All methods of complex tooth extraction are conventionally divided depending on the degree of destruction of the walls of the fossa in order to expose the root of the tooth, or according to the impact on the tooth - removing the remains of the tooth completely or fragmenting the remains of the tooth and removing its fragments one by one. The following surgical techniques are used that are indicated in the presence of a single-rooted tooth or an isolated root of a two- or three-rooted tooth (mainly in the upper jaw), an unfilled root canal, and the absence of hypercementosis of the tooth root:

• submucosal subperiosteal application of the cheeks with forceps on top edge alveoli of the tooth, compressing and simultaneously removing the root of the tooth and the upper edge of the alveolus, but this is not optimal, since part of the bone of the fossa is lost
• removing the bone from the top of the hole around the root with a bur so that you can dislocate the root outward with a long elevator-stroker or use narrow long forceps (bayonet) to fix and remove it
• use a bur to expose the entire length of the tooth root on one side, then remove it using a scaling hook or an excavator
• push the apex of the tooth root out of the hole with any straight instrument, for example a straight elevator, which is inserted through an incision in the mucous membrane and the outer wall of the tooth alveolus perforated with a bur in the area of ​​the root apex
• After visualizing the root canal, a cone-shaped screw with a strong thread and a handle is tightly inserted into it, the screw is securely fixed in the canal, the screw is gradually turned by hand several times in the direction of tightening the thread and the screw is pulled out. After such combined movements, the root is freed from the hole and removed (if the intraradicular screw does not enter the root canal, it is carefully expanded)
• after inserting a screw into the root canal, a special device is used to create mechanical traction to remove the tooth root
• expansion of the tooth fossa without exposing it - use a hand-held cylindrical cutter of the required diameter with a ratchet, round with the diameter of the root, to remove bone around the root along its length, followed by removal of the tooth root
• separation of the tooth with a bur (or chisel) in the zone of root connection into separate parts of the tooth and root, followed by alternate removal of roots and tooth fragments alone

Scheme of the operation of complex tooth extraction - separation of the roots of the teeth with a bur and their alternate removal with an elevator: a - d - stages of the operation

They also use other surgical techniques and their combinations, instruments for complex removal of teeth and their roots, taking into account specific clinical conditions. After the operation, the tooth socket is treated in a typical manner. Only after the failure of a complex tooth extraction operation do they proceed to an atypical tooth extraction operation.

The operation of atypical tooth extraction consists of opening the bone of the alveolar process of the jaw in the area of ​​the tooth, removing 1-2 sides of the root of the tooth or the bone of the tooth socket, exposing the tooth and removing it. This operation is quite complex and traumatic.

Indications

Fracture of the tooth root and the inability to remove it typically with forceps due to the small size of the root that remains, fragility of the root after endodontic treatment or hypercementosis, significant curvature and atypical structure of the roots of the tooth, dystonia and inclusion of teeth when their typical removal is impossible, insufficient mouth opening due to various reasons. Sometimes the need to perform an atypical removal is due to a lack of tools, equipment, or an insufficient level of qualifications of a doctor who does not know sufficiently method of typical and complex tooth extraction.

Contraindications to atypical tooth extraction surgery

There are generally accepted contraindications, to which can be added the doctor’s uncertainty regarding his ability to carry out such an operation, the insurmountable reluctance of the patient to continue the removal, who is already tired of the operation, insufficient organizational capabilities surgical room(shortage of instruments, equipment, etc.), difficult clinical situation and inability to perform the operation on an outpatient basis. It should be emphasized that in the case of a difficult clinical situation, the doctor should not continuously continue the operation fruitlessly, trying to typically remove a tooth and only further injuring nearby tissues. It is necessary to move on to others in a timely manner surgical instruments and operating techniques that are more effective and appropriate in new specific clinical settings.

Incisional options for atypical tooth root removal

For atypical tooth extraction they use following tools: scalpel, raspatory, hemostatic clamps, needle holders, dental mirrors, bone burs and cutters various types and sizes, straight and angled dental handpieces, needles, suture material (), Farabeuf hooks, chisel and hammer, bone nippers, hemostatic sponges(), syringes for washing the wound and other instruments. However, the hammer and chisel can only be used in as a last resort, since it negatively affects the state of the brain, general somatic and psychological condition the patient, leaves him with unpleasant memories of the operation if it is performed while the patient remains conscious. An atypical tooth extraction operation usually involves the following steps:

1. dissection of the mucous membrane and periosteum
2. detachment of the mucoperiosteal flap
3. removal of the necessary (usually the outer) walls of the alveoli and exposure of the tooth root
4. dislocation (root) of a tooth from its socket
5. tooth root removal
6. revision and treatment of the alveoli
7. mobilization of the mucoperiosteal flap
8. closing surgical wound placing a mucoperiosteal flap in place and suturing the surgical wound. If necessary, additional fragmentation of the tooth or its roots is carried out during the operation.

Stages of atypical tooth extraction surgery. 1, 2 – dissection and detachment of the flap; 3, 4 – removal of the outer wall of the fossa; 5, 6, 7, 8 – separation and removal of tooth roots; 9 – sewn wound (according to V. A. Evdokimov)

This operation is complex and must be performed by highly qualified doctors with the help of an assistant in appropriate clinical conditions. The patient's position is lying or half-sitting in a chair, in good lighting. The operation requires high-quality pain relief, the availability of all necessary instruments, and often premedication, medication and postmedication.

If a tooth (root) penetrates into the maxillary sinus (upper molars and premolars) or into the soft jaw tissue (the lower wisdom tooth and lower molars are most often displaced into the pterygomandibular space), they must be removed as quickly as possible (to prevent the development of neck phlegmon , pterygomandibular space, acute or aggravated sinusitis) in a hospital setting. These operations are complex, can take a long time and lead to severe complications. Preparing the patient for elective surgery atypical tooth extraction should be sequential and, first of all, include complete therapeutic sanitation of the oral cavity: removal of dental plaque, filling carious cavities, treatment acute diseases periodontal and mucous membranes. Immediately before the operation, rinse the mouth with antiseptic solutions.

From the point of view of general and local preparation, it is usually typical, with the exception of cases of removal of impacted and semi-impacted teeth, when it is necessary to provide for everything in advance possible features operations, warn and psychologically prepare the patient, give him premedication, and also prepare all necessary tools and equipment, prepare the necessary ones in advance orthopedic aids(mouthguards, bite bars, etc.). IN postoperative period to the patient to prevent inflammatory complications(especially if a tooth is removed in a functionally active place - a wisdom tooth), anti-inflammatory, painkillers and restorative medications are prescribed, and monitoring of the patient continues until the wound is completely healed.

The wound can heal primary intention, and then the alveolus of the tooth and the bone defect around it represent closed space. Sometimes suppuration of the wound and separation of its edges are noted, and then healing occurs by secondary intention. Complications of the operation: inflammatory (myositis, suppuration of the surgical wound, lymphadenitis, etc.), neurological (neuritis mandibular nerve, dental plexus, nerve sensitivity disorders), anatomical disorders (formation of defects in the alveolar process of the jaws, penetration of the maxillary sinus or nasal cavity, long-term pain, etc).

The reasons for tooth extraction may be different, depending on the circumstances in the form of the patient’s condition and the characteristics of the ongoing pathological processes in the crown or roots. The procedure is a last resort measure used in the absence of the possibility of prosthetics with an artificial crown or inlay.

Tooth extraction can be carried out for two reasons: urgently due to the inflammatory process in acute phase, flowing inside the cavity or in neighboring tissues, or planned, according to. These factors include significant destruction of the crown, excluding the possibility of prosthetics on the remaining roots, as well as long therapeutic treatment chronic inflammation, which did not bring results.

An additional reason is the complication of the inflammatory process in the form of infection of the maxillary sinuses and other anatomically adjacent areas.

Important! A separate category includes the removal of supernumerary or unerupted teeth, such as a wisdom tooth or an incorrectly growing canine, which injures the periodontium or tongue.

The complexity, duration and cost of tooth extraction depends on its type:

• lactic;
• permanent (simple or complex multi-root);
• retinated;
• dystopic;
• fragmented;
• cranky.

Before instrumentally removing a tooth from the socket, it is necessary to collect an anamnesis and a series of studies.

Before instrumentally removing a tooth from the socket, it is necessary to collect an anamnesis and a series of studies aimed at analyzing general condition the entire dental system, blood clotting and reaction to standard anesthetics. In order for gum healing after tooth extraction to be successful, you must also resort to radiography and orthopantomography, which will provide information about the condition and structure of the tooth being removed, including the location and shape of its roots.

The entire procedure should be as painless and comfortable as possible for the patient with, which will be facilitated by the use of infiltration or conduction type anesthesia. In the first case, the anesthetic is injected into the gingival tissue near the tooth socket or into the periosteum area, and in the second, the entire branch is anesthetized trigeminal nerve, responsible for the sensitivity of this half of the jaw.

Indications for the procedure

The general indication for removing a crown with roots from the alveolus is the lack of possibility or practical sense in performing conservative treatment for its preservation. The operation may be an emergency if purulent inflammation affected adjacent sections of the jaws, causing either periostitis, or if significant destruction of the crown occurred as a result of mechanical trauma.

The indication for elective removal is extensive loss of coronal tissue resulting from deep caries, and root canals that cannot be passed (if it is impossible to use necrotizing pastes). The situation can be complicated by the following pathologies:

• perihilar periodontitis;
• sinusitis;
• neuralgia;
• jaw oncology.

The indication for elective removal is extensive loss of coronal tissue as a result of deep caries.

Note! In heavy surgical cases a general fracture of the alveolar process or the entire jaw may trigger the need for removal if crowns in this area complicate bone grafting or may cause a secondary infection.

How the gum heals after tooth extraction depends on its location: an extracted wisdom tooth (third molar), growing atypically from the alveolus, requires a longer recovery period. Also difficult for the dentist are supernumerary or any other teeth that cannot erupt due to adjacent crowns or gum tissue. In this case, the decision is dictated by the fact that such molars prevent the patient from eating and articulating normally, disrupting the bite and causing discomfort.

Other pathologies and indications for which an extracted tooth is effective solution, are looseness of the third or fourth degree, as well as interference that can be created by crowns in relation to installed prostheses or orthopedic structures. In this case modern tactics to preserve living teeth by any means available methods yields to the need to provide normal functioning the entire row or jaw.

To the list pathological conditions, which are contraindications that complicate wound healing after tooth extraction, include:

Additional Information. Relative contraindications include pregnancy and menstruation in female patients: planned dental treatment should be postponed to another time.

Process steps

The entire removal process is divided into three stages: anesthesia, extraction and coagulation hemostasis, to which pre-procedural antibiotic therapy may be added. The anesthetic is used of infiltration or conduction type - Articaine, Ultracaine, Ubistizin, Septanest, Mepivacaine or Scandonest, which are injected into soft fabrics using a syringe.

Additionally, before the injection, the dentist can numb the gums using the application method. In a number of clinics that have a full-time anesthesiologist, the patient will be offered, practiced in the case of hypersensitivity person to pain or allergies to local anesthetics. This method is more expensive and not very beneficial for the body.

Normal coagulation hemostasis of the body copes with the resulting bleeding within 40-50 minutes.

When a tooth is removed, it takes a long time to heal, usually due to individual characteristics the patient and the difficulties that arose during the operation. Amputation classical method involves careful expansion of the alveolar socket and destruction of the periodontal ligaments, for which the crown is instrumentally loosened along several axes. With proper anesthesia, there should be no pain, although the sensations of rocking and pressure cause discomfort to the patient. After a short period of time, the tooth can be extracted with forceps.

The wound after tooth extraction can be more serious if the root system is so complex and curved that it is too difficult to simply get it out, and the dentist decided to resort to sequential fragmentation of the crown. The remaining roots must be removed with special tools without damaging the soft tissue, after which the free hole must be cleaned and treated with an antiseptic.

Normal coagulation hemostasis of the body copes with the resulting bleeding within 40-50 minutes, so it is enough to apply a sterile tampon for this period. Otherwise, socket tamponade using triiodomethane should be used. Complex surgical removal The tooth may require stitches to be placed on the gums at the end of the operation.

Postoperative complications

The stages of healing a hole after tooth extraction consist of observing a number of measures to ensure the safety of the prepared area:

If swelling occurs after removal, it is permissible to apply ice or cold objects to the skin with outside face - cooling the gums directly is prohibited due to the risk of infection. When the hole heals after tooth extraction, short-term antibiotic therapy may be required to prevent the development of inflammatory complications.

Every fourth case of surgical intervention ends in the development of postoperative alveolitis, due to which the wound after tooth extraction takes longer to heal than usual. This inflammation of the hole is a consequence of unprofessional treatment by the dentist, failure to comply with hygiene measures after surgery, or poor clotting blood. Clinical picture alveolitis consists of the formation of dry plaque on the walls of the socket, pain, swelling and an unpleasant odor.

The healing time of the gums depends on the reaction of neighboring teeth to the patient’s extraction: in rare cases, they may become dislocated or loosened after surgery. Congenital or acquired osteoporosis, as well as the presence of cysts in the alveolar process, affects how long it takes the jaw to heal, since the traumatic nature of the operation during which the tooth was pulled out can lead to its fracture.

During the entire period of time during which the gums heal, you should plan the installation of a prosthesis: a bridge or an implant, since the toothless area of ​​the alveolus provokes movement healthy teeth towards him. Many options for the development of events in this case include malocclusion, decreased attractiveness of the smile, atrophy of the alveolar process and impaired articulation.

When a gingival fistula has already appeared, it threatens with serious complications. If such a tooth is not removed in time, the infection will spread further and further. Severe damage to a tooth by caries, when it cannot be restored, is also an undoubted indication for removal. The doctor also has to resort to radical measures in case of complicated periodontal diseases, for example, when no methods of treating periodontitis can eliminate severe tooth mobility and keep them in the socket. It should be noted that tooth extraction for pregnant women, as a rule, is not carried out and it is better to take care of this problem before conceiving a child.

Teeth removal technique

Today, prosthetics on bridges have already been replaced by the installation of implants, but the methods of removing teeth actually remain the same. The following main methods of tooth extraction are distinguished: simple and surgical. The first is used in cases where the crown of the tooth is well preserved and there is something to grab onto with forceps. As a rule, this happens with periodontitis. Here, destruction occurs rather around the periodontal tissues, so the crowns are generally well preserved.

Surgical tooth extraction is required in cases where access to it is difficult. For example, if the crown of a tooth is broken off, or it has not erupted completely - these are typical problems that a wisdom tooth can cause. In these cases, the dentist needs to do research and plan the procedure well. Surgical intervention helps to open the necessary access to the tooth. This type of tooth extraction is also called complex or atypical. In such cases, it is important to reduce the risk of developing inflammation after tooth extraction. Therefore, before tooth extraction, dental deposits are removed with ultrasound, and when a tooth is removed, antibiotics are prescribed.

Tooth extraction without pain

There is no need to be afraid that it will hurt you when a tooth is removed. Unlike the Middle Ages, in the 21st century this procedure has ceased to be barbaric. Thanks to anesthesia, tooth extraction is completely painless and comfortable for the patient. Light prick- this is the only thing you will feel. Painful sensations you may experience after a difficult wisdom teeth removal, but they can also be eliminated with the help of painkillers.

As a rule, when a tooth is removed, a local anesthetic is used, but sometimes tooth extraction is also performed under general anesthesia, for example, to delete multiple units in one session. Only the doctor decides what type of anesthesia to use when removing a tooth. The main thing for the patient is to inform him before the procedure whether he is allergic to painkillers or serious chronic diseases. This will help avoid serious complications, such as, anaphylactic shock for anesthesia during tooth extraction.

To ensure successful healing at the removal site, you must adhere to a few simple rules:

• Avoid eating for 2-3 hours after the procedure.
• Do not touch the socket with your tongue or foreign objects.
• Do not eat hot foods; chew on the side opposite to where the tooth was removed.
• You can brush your teeth only the next day after surgery.
• You should not use rinses without a doctor’s prescription.
• And the next day you need to visit the dentist again for a follow-up examination.

Tooth extraction in modern dentistry ceased to be a scary and painful event. You shouldn’t draw terrible pictures from the last century, when teeth were torn with huge forceps and without anesthesia. Simultaneously with tooth extraction, today it is already possible to place an implant, resorting to one-stage dental implantation. But consider this radical measure It still shouldn't be used as a treatment.