A customary extraction is of the first four
premolars to create space to allow the movement of orthodontic teeth. Others use the extraction of the first molars
when they are decayed and try to prevent the retention of third molars. The
extraction of retained wisdom teeth, even those not specifically a health
problem, is a common practice in great demand by the orthodontist to prevent
recurrences of a treatment already done.
Directly related to the Orthodontics is the serial extraction to guide the
eruption, described the late forties and used in Spain since the sixties. It
includes the removal of canines to provide a temporary site to the lateral
incisors, after the first molars, and in the same act, accelerating the removal
of the first premolar by removing its pericornal jacket or extracting directly
from their physiological inclusion. The technique attempts to make room for
tooth alignment.
Contraindications of
dental extractions
Currently contraindications are minor. Improving
patient study in the postoperative period, the psychophysical state, protection
of antibiotics, anesthesia techniques, the environment and adequate staff…all
make for rare situations where the tooth can not be safely extracted.
Classically contraindications can be described in absolute and relative terms.
Today they are practically not considered.
In reality there would be local or general conditions requiring a delay
in surgical treatment until they are covered or normalization of the potential
risks or complications.
Contraindications
local
Most are of infectious origin, and are referred to the patient or require the
extraction of neighboring tooth tissue.
Within the orthodontic infections fall periodontitis, abscesses and cellulitis,
the presence of which can cause acute dental problems. With appropriate antibiotic protection
techniques and anesthesia treatments, away from the infectious process, today
extractions can be practiced without harm.
Prosthetic
indications: when you perform the design of prosthesis, some teeth are situated
incorrectly, with extrusions indicted for lack of antagonism, or isolate,
etc. These must be eliminated to get a
good occlusion, stability necessary or better aesthetics. Thus, at the jaw, it follows a more
conservative approach given the difficulty of stability of the prosthesis. In the upper jaw, it is easier to get raw and
aesthetics. It may be advisable,
therefore, to withdraw an isolated tooth and build a complete prosthesis.
Orthodontic indications: the orthodontist often uses the resource of extraction
to prevent or correct dental malocclusion.
Given this attitude one can understand the extraction of teeth, temporary
or permanent, including, landlocked or normally erupted; either aligned or in a
bad position.
Aesthetic indications: there are cases of
malpositions, or teeth that interfere with a prosthesis, in which extraction
can be effective for aesthetic reasons. We must not forget that there are
patients who do not allow for orthodontic treatment or who put it to the functional
aesthetic.
Social indicators: although it seems unjustifiable, beyond question there is
the existence of certain economic conditions that can bind the extraction. Of course, decayed teeth are infected and
conservative treatments are likely, such as root canal, which allows its
retention in the alveolar process. There
are, in these cases, patients who can not bear the financial burden that these
treatments represent and that, moreover, are not covered by existing benefits
for Social Security.
The so-called simple
extractions, those using closed forceps in the technique, require only three
elements: anesthetic, forceps and elevators. Surgical extractions are more
complicated, requiring, in addition to these three items, instruments needed to
practice a surgical procedure in the mouth, including the phases of incision,
sweeping, sectioning, and suturing.
However, the psychophysical state of the patient
can lead to lack of control of infectious disease allowing it to spread. This poses the danger of increased toxemia
adding to the difficulty of the surgical technique. Postponement of the extraction until
conditions are adequate may be advised.
The third molar or oral mucus membranes can also produce the infections.
In cases where the teeth processes are involved in a malignant tumor extraction
of the isolated tooth is contraindicated because of the dangers of bleeding,
poor wound healing, and the growth and spread of the tumor. In these cases, the
extraction will always be in the block of the tumor mass with the recommended
safety margins.
Contraindications
general
There are disorders or
alterations at the systemic level that require a review by the medical
internist and delaying intervention due the danger or appearance of
complications that worsen the overall picture.
In this regard it is of vital importance to take into
account: diabetes mellitus, the sick and hypertensive heart, liver, kidney,
hyperthyroid, epileptics, those with adrenal insufficiency, bleeding,
hemophilia, leukosis, agranulocytosis, fever of unknown origin, psychoses and
neuroses, the mentally handicapped, pregnant or menstruating women, and the
senile and sick.
Instruments used in dental extractions
In the dental extraction that involves the tooth and tissues that surround it,
there is a generic instrument for oral surgery, one specifically and
technically regulated.
False teeth,
Orthodontics extractions
