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
The goal of a dental extraction is to remove the tooth, including the root, from the alveolus. The root is attached to the
alveolus by hundreds of thousands of tiny fibers collectively called the periodontal ligament. A dental extraction is not possible until these fibers have been severed. The periodontal ligament can withstand sudden,
sharp, and jerky forces, and it is because of this that teeth can absorb and survive the forces placed on them by mastication
and other dental functions. However, the periodontal ligament cannot withstand prolonged, steady stretching forces. So the
key to dental extraction is to create a gentle and sustained stretching force on the periodontal ligament that will cause
it to fatigue and ultimately sever.
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.
Radiography is indicated before all dental extractions. Radiography alerts you to unforeseen complications such as root dilaceration
(a curve in the root), root resorption, ankylosis, and extra roots (e.g. a third root is occasionally observed in the maxillary third premolar). Pretreatment radiographs also document the pathology
that dictated the extraction.