Dental Extractions. Dr. Martin C. Langhofer
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1 Dental Extractions Dr. Martin C. Langhofer
2 Extraction Technique Periosteal elevators Tooth spreaders-allow clot to begin forming Apply extractors-rock, rock, rock side to side Wait, wait, wait Resume rocking then wait, wait, wait Resume rocking then wait, wait, wait Dental fulcrum
3 Extraction Technique Extraction Pack off alveolus to control bleeding with saline soaked gauze Pull pack Instill Bio-cell or Gel-foam in socket Add antibiotics (SMZ-TMP, metronidazole, Biotene oral gel) Seal with dental wax or STAT-soft acrylic Pull STAT plug in 7 days Alternative Flush alveoli socket daily with Chlorhexidine gluconate dilute solution Then seal with Bio-cell NOTE: Gel-foam may be a holding place for bacteria
4 Control Bleeding Pack with wet saline gauze Gel Foam (Pfizer)/Bio-stat (A/cell) Dental wax/stat-dental impression acrylic Electrocautery Daily dental packs Surgical-oxidized regenerated methylcellulose (binds platelets and releases fibrin) (Surgicel-Johnson and Johnson) Topical thrombin (Thrombostate, Pfizer) saturate with Gel-foam Microfiber collagen (Avitene, Dacroln) either colluplug or collatape (Sulzer Calcitek) Dental hemostatic powder/paste
5 Problems with Clotting Salivary enzymes Clot dislodgment with tongue/chewing motions Bleeding disorders Liver or kidney disease Drugs Aspirin-platelet interference Antibiotics-decreased Vitamin K production Anticoagulants Alcohol/mycotoxins-causes hepatopathy Hypertension
6 Healing Process of Extraction Extraction Blood flow from alveolar bone and gingiva Blood clot formation Forms barrier to debris, food, irritants, bacteria Forms a supporting structure for granulation tissue Local tissue damage from extraction site Evokes an inflammatory reaction local expansion of blood vessels WBC s and fibroblasts invade the connective tissue at the alveolus until granulation tissue is formed Leukocytes digest the blood clot as granulation tissue is formed
7 Healing Process of Extraction Bone is layed down by osteoblasts Coarse, trabecular, and compact bone is used in bone remodeling
8 After Extraction Pain medication (bone) Augenal Benzocaine NSAIDS such as phenylbutazone and banamine Antimicrobials Iodofoam packing gauze Aluyjel (Septodont)-a fibrous product Biotene oral gel (A/cell)-enzyme that releases iodine and lactoferrin Calcium sulfate (plaster of paris) antibiotic plugs SMZ-TMP Metronidazole Amikacin
9 Complications with Extractions 50% of extractions have complications X-Rays should be taken before ALL extractions Improper extraction tools Dental Elevations Extraction Tools Molar, incisor, canine, wolf teeth-long thin blade screw driver, trephines (Michelle and Mallet) and assorted dental punches Strong peridental supporting structures
10 Complications with Extractions Abnormal root morphology-divergent, hooked, locked, ankylosed, germinated, misshaped, tumors of the tooth Hypercementotic teeth Teeth that are weakened (eg-dental decay that has been repaired) Teeth with abfraction or deep caries Desiccated teeth or brittle teeth associated with endodonic treatment Patients with inflammatory disorders associated with alveolar bone disease or Cushing s disease
11 Complications with Extractions Patients with limited opening or trismus (lock jaw) Oro-sinal fistula Broken off root tips Fractured bone Invasion into sphenoid bone-possible bacterial meningioencephalitis Sepsis systemically Dry socket or non-healing socket Sinusitis Pain Bleeding
12 Factors causing a Dry or NonHealing Extraction Exzyme fibrinolytic production Alveolar infection Especially anaerobes, but can be aerobes Streptococcus Fusospiral Treponema Bacteroids Immunocompromised patient Systemic disease
13 Non-Healing Site Non-Healing Site Betadine flush Chlorhexidine gluconate Antibiotic tablets or calcium sulfate antibiotic plugs SMZ/TMP + metronidazole Tetracycline PO or IV Clindamycin Mix capsule with calcium sulfate or gelfoam (drug of choice for anaerobes) Soak gauze with Clindamycin mixure and fill in alveolar socket Open caspules and place in alveolar socket Look for systemic disease
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44 Dental Extractions Dr. Martin C. Langhofer
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