INDICATIONS AND CONTRAINDICATIONS OF EXTRACTIONS Department of Oral

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INDICATIONS AND CONTRAINDICATIONS OF EXTRACTIONS Department of Oral and Maxillofacial Surgery Dentistry Explorer

INDICATIONS AND CONTRAINDICATIONS OF EXTRACTIONS Department of Oral and Maxillofacial Surgery Dentistry Explorer

CONTENTS • • • INTRODUCTIONS INDICATIONS CONTRAINDICATIONS CONCLUSION REFERENCE Dentistry Explorer

CONTENTS • • • INTRODUCTIONS INDICATIONS CONTRAINDICATIONS CONCLUSION REFERENCE Dentistry Explorer

INTRODUCTIONS • EXTRACTIONS: • “Painless removal of whole tooth or tooth-root , with minimal

INTRODUCTIONS • EXTRACTIONS: • “Painless removal of whole tooth or tooth-root , with minimal trauma to the investing tissues so that the wound heals uneventfully and no postoperative prosthetic problem is created. ” - Geoffrey L. Howe Dentistry Explorer

INDICATIONS • Unrestorable caries • Severe periodontal disease • Severe attrition, abrasion , erosion

INDICATIONS • Unrestorable caries • Severe periodontal disease • Severe attrition, abrasion , erosion • Acute / chronic pulpitis/ pulpal necrosis due to trauma or infections Dentistry Explorer

 • Teeth with periapical lesion- cannot be treated endodontically • Overretained deciduous teeth

• Teeth with periapical lesion- cannot be treated endodontically • Overretained deciduous teeth blocking the eruption of permanent teeth • Supernumerary teeth • Malposed teeth • Impacted teeth Dentistry Explorer

 • Tooth in the fracture line • Teeth with vertical fracture/ crack tooth

• Tooth in the fracture line • Teeth with vertical fracture/ crack tooth syndrome • Prophylactic extraction (endocarditis, rheumatic fever, prior to cataract surgery) • For Orthodontic treatment Dentistry Explorer

 • For prosthetic purpose • Supraerupted tooth • For orthognathic surgical procedures Upper

• For prosthetic purpose • Supraerupted tooth • For orthognathic surgical procedures Upper 3 rd molars –Lefort I osteotomy Lower 3 rd molars - saggital split osteotomy Premolars – anterior subapical osteotomy • Radiation therapy Dentistry Explorer

Contraindications SYSTEMIC C/Is : 1) Severe uncontrolled metabolic diseases -Diabetes mellitus -End stage renal

Contraindications SYSTEMIC C/Is : 1) Severe uncontrolled metabolic diseases -Diabetes mellitus -End stage renal diseases 2) Uncontrolled leukemia and lymphoma 3) Severe uncontrolled cardiac diseases -myocardial ischemia -unstable angina pectoris -myocardial infarction Dentistry Explorer

 • 4) Malignant hypertension: -persistent bleeding -acute myocardial insufficiency -Cerebrovascular accidents Dentistry Explorer

• 4) Malignant hypertension: -persistent bleeding -acute myocardial insufficiency -Cerebrovascular accidents Dentistry Explorer

5) Pregnancy: - Relative C/Is 1 st and last trimester are more crucial period,

5) Pregnancy: - Relative C/Is 1 st and last trimester are more crucial period, safe period: 2 nd trimester (latter part of 1 st trimester and 1 st month of last trimester – uncomplicated extractions) • First 3 months-process of organogenesis/ fetal development takes place • 3 rd week to 8 th week- process of differentiation, - avoid drugs for potential risk - avoid dental invasive procedures Dentistry Explorer

 • 3 rd trimester- supine hypotensive syndrome keep in left lateral position- allow

• 3 rd trimester- supine hypotensive syndrome keep in left lateral position- allow venous return 6) Bleeding and Platelet disorders: - hemophilia - von willebrand diseases Dentistry Explorer

 • Medications: -systemic corticosteroids -immunosupressive agents - Bisphonates -cancer therapeutic agents Dentistry Explorer

• Medications: -systemic corticosteroids -immunosupressive agents - Bisphonates -cancer therapeutic agents Dentistry Explorer

Local C/Is: 1)Therapeutic radiation - result in osteoradionecrosis, extraction must be done with extreme

Local C/Is: 1)Therapeutic radiation - result in osteoradionecrosis, extraction must be done with extreme caution. 2) Tumor - disseminate malignant cells thereby seeding metastases. Dentistry Explorer

3) Severe pericoronitis: -non surgical t/t include irrigations, antibiotics and then removal of mand.

3) Severe pericoronitis: -non surgical t/t include irrigations, antibiotics and then removal of mand. 3 rd molar. 4) acute dentoalveolar abscess, acute cellultis Dentistry Explorer

REFERENCES: �Howe Geoffrey L. The Extraction of Teeth. 2 nd edition �Contemporary oral and

REFERENCES: �Howe Geoffrey L. The Extraction of Teeth. 2 nd edition �Contemporary oral and maxillofacial surgery, 6 th edition • Oral and maxillofacial surgery, Neelima Anil Malik , 4 th edition Dentistry Explorer