Exodontia. Prof. Ragab Shaaban. Text book. Contemporary Oral and Maxillofacial surgery Peterson-Hupp. Surgical Removal of Teeth. (Transalveolar Extraction). Indications For TRANS-ALVEOLAR EXTRACTION. Any tooth that resists simple extraction. Brittle teeth:
Prof. Ragab Shaaban
Contemporary Oral and Maxillofacial surgery
-Teeth w’ bulky fillings.
- Endodontically ttt. teeth.
- Teeth w’ internal decay.
3. Teeth withinsufficient crowns (severe attrition).
Teeth with widely divergent roots.
Hooked or curved roots.
2. To make room for orthodontic manipulation
11. Retained roots.
12Teeth fractured during extraction.
.13. Teeth with root resorption.
Standard Operative Plane:
A mucoperiosteal flaps.→
* Use a new knife with sharp blade [ for clean undamaged incision].
* Be assertive [ be confident].
* Use firm, continuous strokes.
* Repeated soft strokes increase amount of damaged tissues & amount of bleeding.
* Watch where you are going.
* Consider closure.
To expose all the area of operation.
To be retracted without tension on tissues during reflection.
To avoidlaceration & promote healing.
To cover the operative field after surgery, with the edgesof the flapresting on sound bone.
6. The vertical (oblique) incision should not alter thecontourof the gingival papillae to prevent necrosis of the soft tissues & alv. bone.
7. Excess flabby tissues in edentulous ridge must be excised to avoid soft flabby ridge.
A variety of intra-oral soft tissue flaps.
1.Simple to incise and reflect.
2.Close to the apical area of the tooth.
3.Requires minimal anesthesia.
4.No gingival recession.
5.Gingiva around crowns is not disturbed giving good esthetic result.
6.Patient can maintain good oral hygiene.
1. It gives minimal access & visibility.
2.Misjudging the size of the lesion may result an incision crossing the lesion or the surgical defect causing dehiscence.
3.Clefting can occur if the incision is made
too close to the gingival margin.
4.Incision crosses bony eminences where
the tissues are thin ; scar is more prominent.
5. No reference points in the flap; replacing is difficult & may result stretching on one edge & puckering on the other on suturing.
which is vascular (may cause bleeding during surgery) & highly mobile (soreness & delayed healing are not uncommon).
A horizontal gingival incision made in the gingival sulcus joined by a relaxing vertical incision.
6.Gingival contour around existing crowns may change resulting in poor esthetic result.
A horizontal gingival incision joining two vertical relaxing incisions.
1.Excellent access & visibility.
2.No tension on the released flap.
3.It has good reference points for repositioning.
4.Access for root repair is increased.
5.periodontal curettage or alveoloplasty can be done simultaneously if needed .
6.Multiple tooth treatment can be done.
1. Elevation is difficult to initiate.
2. Diminished blood supply to the flap.
3. Stripping of the gingival fibers may lead to clefting and/or poor esthetic results if the teeth involved in the flap were crowned.
4.Interdental sutures are needed which is more difficult.
5.Oral hygiene is difficult to maintain.
6.Extension of the vertical incisions into the alveolar mucosa causes soreness & delayed healing.
A horizontal incision in the gingival sulcus involving many teeth.
The incision must be done with a firm, continuous stroke.
It is composed of a handle & a blade