INDICATIONS AND CONTRAINDICATIONS OF EXTRACTION INDICATIONS FOR EXTRACTION

  • Slides: 17
Download presentation
INDICATIONS AND CONTRAINDICATIONS OF EXTRACTION

INDICATIONS AND CONTRAINDICATIONS OF EXTRACTION

INDICATIONS FOR EXTRACTION 1. Periodontal disturbances: When the teeth are periodontally involved, clinician must

INDICATIONS FOR EXTRACTION 1. Periodontal disturbances: When the teeth are periodontally involved, clinician must decide whether to extract the tooth or not. Loss of more than 40% of periodontal support warrants extraction. The final decision depends on (a)the success of periodontal therapy (b) patient’s attitude towards the concept of conserving such teeth (c) economic and time factors

2. Dental caries: • When tooth is extensively damaged by caries, dental surgeon must

2. Dental caries: • When tooth is extensively damaged by caries, dental surgeon must evaluate the feasibility of conserving the carious tooth. • Even if the patient and the dental surgeon desires to save the tooth it is indicated for extraction if all the conservative procedures have failed. • Sometimes the sharp margins of the teeth repeatedly ulcerate the mucosa or multiple carious teeth result in deteriorating oral hygiene. In such cases removal of teeth will improve the oral hygiene.

3. Pulp pathology: If the endodontic therapy is not possible, extraction is indicated 4.

3. Pulp pathology: If the endodontic therapy is not possible, extraction is indicated 4. Apical pathology: If the teeth fail to respond to all the conservative measures to resolve apical pathology, either because of technical reasons or because of the systemic factors, such teeth are indicated for extraction.

5. Orthodontic reasons: Can be due to any one of the following reasons –

5. Orthodontic reasons: Can be due to any one of the following reasons – v. Therapeutic extraction: to gain space for the realignment of malposed teeth v. Malposed teeth: if the tooth in the dental arch is malpositioned, orthodontist may find it difficult to realign them. Under such circumstances, extraction is indicated. v. Serial extraction: during mixed dentition period, dental surgeon may have to extract a few deciduous teeth in a chronological order to prevent malocclusion, as the child grows.

The decision for extraction of teeth for orthodontic reasons should be based on: •

The decision for extraction of teeth for orthodontic reasons should be based on: • Orthodontic assessment • Genetic evaluation, if needed • Evaluation of the soft tissues like tongue, lips etc. 6. Cracked tooth: Cracked tooth or fractured tooth are also indicated for extraction

7. Prosthetic considerations: • Extraction of teeth are indicated for providing efficient dental prosthesis.

7. Prosthetic considerations: • Extraction of teeth are indicated for providing efficient dental prosthesis. • At the same time caution is required if the patient requests the dental surgeon to extract a few remaining teeth to enable the patient to have complete dentures since atrophy of the bone results in decreased denture stability. • Hence careful evaluation by the prosthodontist is necessary for extraction in such cases.

8. Impactions: Retention of unerupted teeth may be responsible for vague facial pain, periodontal

8. Impactions: Retention of unerupted teeth may be responsible for vague facial pain, periodontal disturbances of the adjoining teeth, TMJ problems, bony pathology like cysts, and pathological fracture of the jaws 9. Supernumerary teeth: These teeth may be malpositioned or unerupted. Such teeth may predispose to malocclusion, periodontal disturbances, facial pain, bony pathology or may even predispose to esthetic problems

10. Tooth in the line of fracture: The present concept is to extract the

10. Tooth in the line of fracture: The present concept is to extract the tooth in the line of fracture if, (a) it is a source of infection at the site of fracture (b) the tooth itself is fractured (c) the retention may interfere with the fracture reduction or with healing of the fracture.

11. Teeth in relation to bony pathology: If they are involved in cyst formations,

11. Teeth in relation to bony pathology: If they are involved in cyst formations, neoplasm or osteomyelitis, extraction is indicated. 12. Root fragments: They may remain dormant for a long time. As a general rule, very small fragments may be left alone and the patient is to be kept under periodic observation. All the other root fragments are indicated for extraction

13. Teeth prior to irradiation: Irradiation is one of the modalities of treating oral

13. Teeth prior to irradiation: Irradiation is one of the modalities of treating oral carcinomas. Only teeth which cannot be maintained in a sound condition require removal. 14. Focal sepsis: Sometimes teeth may appear apparently sound. But radiological evaluation is a guiding factor to decide whether any teeth are to be considered as foci of infection.

15. Aesthetics: • Due to compelling reasons, some teeth may require aesthetic considerations. •

15. Aesthetics: • Due to compelling reasons, some teeth may require aesthetic considerations. • If it is not possible to mange such tooth orthodontically due to time constraints, extraction is indicated for such teeth followed by immediate prosthetic restoration in a shorter duration.

16. Economic consideration: Sometimes the dental surgeon and the patient are faced with economic

16. Economic consideration: Sometimes the dental surgeon and the patient are faced with economic constraints, even though technically, conservation of teeth is feasible. In such cases extraction may be the only alternative method of choice.

CONTRAINDICATIONS OF EXTRACTION They are categorized into: Absolute • Systemic Relative Absolute • Local

CONTRAINDICATIONS OF EXTRACTION They are categorized into: Absolute • Systemic Relative Absolute • Local Relative

Systemic contraindications 1. Absolute • Metabolic disorders like uncontrolled diabetes • Severe uncontrolled cardiac

Systemic contraindications 1. Absolute • Metabolic disorders like uncontrolled diabetes • Severe uncontrolled cardiac diseases. eg; MI and unstable angina pectoris. • Uncontrolled leukemia and lymphomas • Renal failure • Liver disorders like cirrhosis of liver

2. Relative • Diabetic and hypertensive patients under medication • Patients who are on

2. Relative • Diabetic and hypertensive patients under medication • Patients who are on medications like steroid therapy, immunosuppressants, chemotherapeutic agents • Endocrine disorders • Pregnancy; 1 st and the 3 rd trimester. • Bleeding disorders • Patients on anticoagulant therapy • Medically compromised patients like epilepsy, COPD, GI disturbances, mild cardiac problems etc. • Mentally challenged patients.

Local contraindications They are generally relative factors: • Irradiated jaw • Teeth that are

Local contraindications They are generally relative factors: • Irradiated jaw • Teeth that are located within an area of malignant tumour • Severe pericoronitis • Acute dentoalveolar abscess and acute infections • ANUG • Central haemangioma (absolute contraindication)