外科牙齒拔除術培訓課件

1、外科牙齒拔除術外科牙齒拔除術Extraction is a surgery The extraction of teeth, however accomplished, is a surgical operation involving bony and soft tissues of the oral cavity, access to which is restricted by the lips and cheeks, and further complicated by the movement of the tongue and mandible.2外科牙齒拔除術Extraction

2、 is a surgery The ex3外科牙齒拔除術3外科牙齒拔除術 It is essential that this phase of oral surgery be given the same careful study and application of sound surgical principles as is given to surgery in any other part of the human body.4外科牙齒拔除術 It is essential that this pIndications for the extraction of teethThe

3、following are indications for the extraction of teeth. (a) teeth that are foci of infections; (b) teeth with nonvital pulps, or acute or chronic pulpitis when root canal therapy is not indicated; 5外科牙齒拔除術Indications for the extraction 6外科牙齒拔除術 6外科牙齒拔除術 (c) in cases of severe periodontoclasia in whic

4、h excessive bony support of the teeth is destroyed; 7外科牙齒拔除術 (c) in cases of severe perioIndications for the extraction of teeth(d) teeth not treatable by apicoectomy; (e) teeth mechanically interfering with the placement of restorative appliances; (f) teeth not restorable by operative dentistry; 8外

5、科牙齒拔除術Indications for the extraction (g) impacted teeth; (h) supernumerary teeth; (i) retained deciduous teeth when a succedaneous tooth is present, and in normal position to erupt; 9外科牙齒拔除術 (g) impacted teeth; 9外科牙齒拔除術Indications for the extraction of teeth(j) teeth with fractured crown; (k) malpos

6、ed teeth not amenable to orthodontic treatment; (l) roots; (m) teeth that are traumatizing soft tissues, if other treatment will not prevent this trauma.10外科牙齒拔除術Indications for the extractionContraindications:systemic diseases 11. Uncontrolled diabetes mellitus 2. Cardiac disease, such as coronary

7、artery disease. hypertension, and cardiac decompensation, e.g. postinfarction within 6 months3. Blood dyscrasias such as anemias, hemorrhagic diseases e.g. hemophilia, and the leukemias.4. Debilitating diseases of any kind making patients poor risks for further traumatic insults.5. Addisons disease

8、or any steroid deficiency, such as the patient who has been treated for any disease with steroid therapy may not have sufficient adrenal cortex secretion to withstand the stress of an extraction without taking additional steroids. 11外科牙齒拔除術Contraindications:systemic disContraindications:systemic dis

9、eases 26. Fever of unexplained origin is rarely cured and often is worsened by extraction, e.g. subacute bacterial endocarditis would be complicated considerably by an extraction.7. Nephritis8. Pregnancy: extraction is better to be done in the second trimester. Menstruation: elective exodontia is no

10、t done during the period because of less nervous stability and greater tendency toward hemorrhage of all tissues.9. Senility: greater care in overcoming a poor physiologic response to surgery and a prolonged negative nitrogen balance.10. Psychoses and neuroses12外科牙齒拔除術Contraindications:systemic disL

11、ocal contraindications 1. Acute infection with an uncontrolled cellulitis, toxemia until adequate blood level of a specific antibiotic had brought systemic factors under control and the infection had become localized, the pus was drained, and the infection had subsided to a chronic state. 2. Acute p

12、ericoronitis3. Acute infectious stomatitis 4. Malignant disease 5. Irradiated jaws may develop an acute radio- osteomyelitis after extraction13外科牙齒拔除術Local contraindications 1. Acuspecial instruments for the extractionThe special instruments for the extraction of teeth and roots are forceps, elevato

13、rs. In special cases, where bone has to be removed, other instruments required such as chisels and mallet, burs, etc. 14外科牙齒拔除術special instruments for the ex A very large variety of forceps and elevators have been devised.A few well-selected instruments will suffice all hut very extraordinary cases.

14、 15外科牙齒拔除術 A very large variety of forceStraight elevatorPhysical characteristics 1. Large, bulbous handle. 2. Working end resembles a sharp, narrow, elongated spoon. 3. Straight shank, parallel to the working end. Use 1. To separate and loosen the tooth in its alveolus. 2. To remove large tooth fra

15、gments. Application Positioned between the tooth and its alveolus.16外科牙齒拔除術Straight elevatorPhysical charMaxillary posterior forcepsUniversal maxillary forcepsPhysical characteristics 1. Plierslike appearance. Beaks have smooth edges that allow them to fit around the bifurcated areas of all maxillar

16、y molar teeth. a point on the buccal beak that allows them to fit into the buccal bifurcation area. Use To extract maxillary posterior teeth from their alveoli.17外科牙齒拔除術Maxillary posterior forcepsUnMaxillary premolar forceps/universal forcepsPhysical characteristics1. Plierslike appearance. 2. Instr

17、uments with bayonet-shaped beaks are Universal.Use To remove premolar teeth from their alveoli in the maxillary arch.18外科牙齒拔除術Maxillary premolar forceps/uniMandibular posterior forceps Physical characteristics 1. Plierslike appearance. 2. Universal design and therefore functional in either quadrant

18、of the arch. 3. Often referred to as a cowhorn forceps.UseTo remove mandibular posterior teeth from their alveoli sockets.19外科牙齒拔除術Mandibular posterior forceps PMandibular incisor and premolar extraction forcepsPhysical characteristics l. Plierslike appearance. 2. Beaks designed to remove all mandib

19、ular teeth, but most often used on incisors and premolars. UseTo extract mandibular incisor and premolar teeth.Pedodontic extraction forceps Physical characteristics 1. Design identical to forceps manufactured for use on permanent teeth. 2. Smaller in size than standard forceps.UseTo remove primary

20、teeth from the oral cavity.20外科牙齒拔除術Mandibular incisor and premolBone chisel/ surgical Mallet Physical characteristics Chisel 1. Length and width of the shaft vary. 2. Cutting end available in single-bevel and double-bevel designs. Mallet1. Hammer shaped.2. Head available in lead or nylon. UseTo tri

21、m or reshape bone to section teeth. 21外科牙齒拔除術Bone chisel/ surgical Mallet PINSTRUMENT STERILIZATIONA profession engaged in delivering health care must be concerned with infection. It is imperative that sterilization of dental instruments be a routine procedure in every dental office. Various methods

22、 of disinfection and sterilization can be employed to reduce the probability of infection and crosscontamination.It is mandatory that the dental team understand and properly use these methods.22外科牙齒拔除術INSTRUMENT STERILIZATIONA proSterilizationSterilization is the act of destroying all forms of life.

23、 The most accepted methods in dentistry and medicine for achieving true sterilization are extended periods of high heat and steam heat.23外科牙齒拔除術Sterilization23外科牙齒拔除術DisinfectionDisinfection only inhibits the growth of disease-causing microorganisms and is not nearly as effective as sterilization. O

24、nly dental instruments that cannot withstand the high temperature of heat sterilization should be placed in a disinfectant solution.Some of the chemicals available for use as disinfectants are benzalkonium chloride, hexachlorophene, and rubbing alcohol. A more popular term for chemical disinfection

25、is cold sterilization.” The instruments are placed in an open disinfectant bath for the required length of time. 24外科牙齒拔除術DisinfectionDisinfection onlyIMPACTED TEETHA tooth is spoken of as being impacted when its eruption is partially or wholly obstructed by bone or some other teeth.25外科牙齒拔除術IMPACTE

26、D TEETH25外科牙齒拔除術Impacted TeethClassification of Mandibular Impacted TeethThe classification of mandibular impacted teeth may be stated simply as (l) mesioangular, (2) horizontal, (3) vertical, and (4) distoangular. In addition, the tooth may be displaced to the buccal or to the lingual. Furthermore

27、it may be located at a high occlusal level (near the ridge surface) or a low occlusal level. 26外科牙齒拔除術Impacted TeethClassification 27外科牙齒拔除術27外科牙齒拔除術EtiologyMany pathologic conditions bring about retarded eruption, displacement and impaction of teeth. The growth of the jaws and the movement of the t

28、eeth are in a forward direction; consequently, anything which interferes with this forward movement or growth will cause impaction of the teeth. Acute infectious fevers of childhood, such as scarlet fever and measles, may interfere with the forward movement by producing a deposit of dense bone. 28外科

29、牙齒拔除術EtiologyMany pathologic conditEtiologyLocal increase in the density of the bone may also be brought about by inflammation of the peridental membrane, extending into the alveolar process. Severe traumatism to the jaws may cause a deposit of lime salts in the cancellated bone tissue and thus brin

30、g about impaction.Ankylosis of the mandibular joint in childhood, resulting in arrest of growth of the jaws, may leave insufficient space for the eruption of all teeth. Too early extraction of deciduous teeth may cause arrested development of the jaws and malpositions of the permanent teeth, this le

31、ading in turn to impaction of unerupted teeth.29外科牙齒拔除術EtiologyLocal increase in the Disturbances caused by impacted teethImpacted teeth may be present without giving rise to any symptoms whatever. Others cause many complications such as some of local and general effects.30外科牙齒拔除術Disturbances caused

32、 by impacte(I) Local effectsAn impacted third molar may press against the crown of the second molar and cause decay of the tooth, or itself becomes the seat of caries around the point of contact. It may also cause pressure absorption of the root of the second molar. Exposure and devitalization of th

33、e pulp from these causes may give rise to neuralgia. Neuralgia may be caused in another way by pressure of the impacted tooth on the inferior dental nerve or its branches.31外科牙齒拔除術(I) Local effectsAn impacted t(I) Local effects -cont.Sometimes, especially in the case of the lower third molar, perico

34、ronal infection, pericoronal abscess, cellulitis and osteomyelitis are set up, often accompanied by trismus. In any patient suffering from acute cellulitis in the back part of the mouth and inability to open the mouth, an impacted lower third molar should be suspected.32外科牙齒拔除術(I) Local effects -con

35、t.Someti(Il) General effectsImpacted teeth may be the cause of obscure headaches. Cases of more serious nervous or even mental disturbance have been at times traced to this cause. In such conditions as epilepsy, chorea and dementia precox, impacted teeth may at least be a contributing factor. In the

36、se cases there may be no local signs of trouble.33外科牙齒拔除術(Il) General effectsImpacted t外科牙齒拔除術培訓課件TreatmentIf treatment is indicated, it consists as a general rule in removal by operation of the impacted tooth35外科牙齒拔除術TreatmentIf treatment is indicPrinciple of Removal of Mandibular Impacted TeethThe

37、 underlying principle in the removal of mandibular impacted teeth is a sectioning technique. Bone is removed to expose the crown. The tooth is split with a fresh sharp chisel so that a good portion of the crown is separated from the tooth. When this portion is removed, space is obtained so that the

38、remainder of the tooth can be elevated into the defect. Before this technique was developed, space for elevation was obtained by more extensive bone removal and consequently more trauma.36外科牙齒拔除術Principle of Removal of Mandib37外科牙齒拔除術37外科牙齒拔除術Complications of extraction of teeth(1) Loosening of adja

39、cent teeth is caused by inappropriate use of forceps and elevators.(2) Fracture of adjacent teeth and restorations occasionally occurs during a routine extraction procedure. This most commonly occurs with the inappropriate use of elevators. Teeth can be fractured if the tooth being extracted suddenl

40、y yields to uncontrolled force and the forceps strike the opposing teeth.38外科牙齒拔除術Complications of extraction ofComplications(3) Fracture of the buccal or labial plate may occur. The surgeon who frequently fractures the buccal or labial plate must analyse his techniques, since this is considered hea

41、vy handed surgery in the light of more appropriate refined techniques.(4) Teeth or roots into the maxillary sinus is possible either during forceps extraction or root retrieval. It is quite easy to displace roots of upper molar teeth into the maxillary sinus. 39外科牙齒拔除術Complications(3) Fracture of tI

42、njury to the inferior alveolar nerve(5) Injury to the inferior alveolar nerve may occur when the inferior alveolar nerve is closely associated with roots and sometimes with the crown of the mandibular third molar. Operations in this region can easily damage the nerve. Perhaps the easiest way of dama

43、ging the nerve is during sectioning of a horizontally impacted third molar lying directly above the mandibular canal.This complication can be prevented by surgeons precaution and refined techniques.40外科牙齒拔除術Injury to the inferior alveolaPostoperative hemorrhages leading causes(6)Postoperative hemorr

44、hages leading causes are: patients manipulation of the wound. foreign body in the socket, such as bone or tooth fragments. sharp bone margins and fractured socket walls. excessive granulation tissue not removed at time of surgery. hypertension. clotting deficiency or vascular disorder.41外科牙齒拔除術Posto

45、perative hemorrhages leaPostoperative pain (7) Postoperative pain which the patient experiences after the second and third postoperative days should be carefully examined, since this is not a normal postoperative course. It is caused by dry socket or sharp bone spine. 42外科牙齒拔除術Postoperative pain (7)

46、 PostopeDry sockets clinical appearance (8) Dry sockets clinical appearance is well known. Two or three days after removal of the tooth, the blood clot disintegrates. The alveolus is empty, with completely or partially denuded, very sensitive blanc surfaces, covered by a grey-yellow layer of detritus and necrotic tissue. The surrounding gingiva often shows an inflammatory reaction.43外科牙齒拔除術Dry sockets clinical appearanSymptoms of