Dental Corner: How to perform a nonsurgical extraction
May 01, 2005
A dental extraction should be considered an end-stage procedure. When teeth are salvageable, we can go to great lengths to avoid extraction. Unfortunately, in many cases extraction is advisable and necessary. Extraction is indicated for teeth with end-stage periodontal disease, fractured teeth with an exposed pulp (when endodontic treatment is not possible), retained deciduous teeth, teeth with feline odontoclastic resorptive lesions, crowded or malpositioned teeth, and other select cases.
Nonsurgical, or simple, extraction refers to the extraction of single-rooted teeth including the incisors, first premolars, deciduous canines, and mandibular third molars. The extraction of canine or multirooted teeth, which is considered a surgical extraction, will be discussed in a future article. A nonsurgical extraction may become a surgical extraction if complications such as root fracture occur. To avoid misunderstandings, always get a client's consent before extracting.
KEY CONCEPTS TO KEEP IN MIND
A dental elevator is used to stretch the periodontal ligament. Wiggs winged elevators are an excellent choice for most extractions (Figures 1A & 1B). The thin, sharp working end is not intended for severing the ligament but rather helps you work the elevator into a position where leverage or rotational force can generate micromovement of the tooth and stretch the periodontal ligament.
NONSURGICAL EXTRACTION TECHNIQUE
Step 1: Provide analgesia and obtain pretreatment radiographs
A dental extraction is a painful procedure, and appropriate measures should be taken to provide analgesia for the patient. Administer an analgesic preoperatively and perform regional nerve blocks. Antibiotic therapy is indicated in patients with concurrent periodontal or endodontal infection. Antibiotics are ideally administered for several days before an extraction if the periodontium is infected to improve the health and healing characteristics of the gingival tissues.