 Hello everyone, welcome back to another session in dentistry and more today's topic in oral surgery is principles of Exodontia and its techniques So as per definition Exodontia is a painless removal of the whole tooth or root with minimal trauma to the investing tissues so that the wound heals unevenfully and No post-operative prosthetic problem is created so removing the tooth without damaging the supporting structures and to make it painless as much as possible that is Exodontia and we have two types of tooth removal or Exodontia the first one is intra alveolar type that is our most common type which is done by the forceps or which is also known as forceps extraction and the second one is Trans alveolar which is a surgical extraction Trans alveolar or surgical so where we retract the flap and using Micromotor or aerotour we cut the bone and Sometimes we'll split the tooth or sometimes we'll take the tooth as a whole So it is a surgical extraction that is trans alveolar intra alveolar is a normal forceps extraction So what are the indications of? intra alveolar extraction that is it could be due to severe caries severe paranormal disease failure of any endodontic treatment orthodontic purpose or Prosthodontic purpose teeth from fracture line Or economically failure to preserve the tooth see all these conditions indicates tooth extraction and Sometimes the tooth extraction is contraindicated. It can be systemic and local causes So systemic causes One is severe uncontrolled lab dismilitus then severe myocardial infarction then uncontrolled leukemia and lymphoma and if patient has any bleeding disorders and Pregnancy that is most commonly first and Third trimester the procedure can be done Safely during the second trimester. So this is a systemic causes or systemic contraindications Whereas a local contraindications includes tumor at the site of extraction Severe infection severe infection So when we have a severe infection the respective tooth the LA won't be effective. So we cannot proceed a Proper extraction. So these are the system. We can local contraindications of exodontia and how do we start the Exodontia that is a pre-operative assessment Pre-operative assessment That is assessing a Person Whether a person is ready for an extraction or not So first thing is we need to take a proper history of the patient history taking That is a medical history We need to ask about hypertension history, jaundice history, kidney diseases, rheumatic Problems, cardiac diseases, asthma, bleeding disorders With respect to dental history. So that was medical History regarding the dental history We need to ask about history of previous extraction or any other complications or any uncontrolled bleeding Which phased in the previous extraction procedure So after history taking we need to start clinical examination So clinical examination we need to check for proper Mouthopening that is accessibility then the tooth mobility then crown condition of the tooth Sometimes the crown might be in a very bad state because of the caries or restoration or fracture or cervical caries And we need to check the oral hygiene status of the patient then presence of infection at the site of injection After that we can go for radiographic radiological examination So in radiological examination We need to assess the vital structures which is related to the extraction site most commonly the axillary sinus when we try to extract the upper posterior teeth and the inferior alveolar nerve the lower molars and Root configuration to make sure that there is no diversion or dilacidated tooth which might create Breaking off tooth while extraction. So we need to Make sure that it is not Divergent if it is so we need to be very cautious or we need to go for a Transalveolar extraction So make sure that there is no dilacidation Convergent ankylost or hypercementosis or any periapical radiolucency and Contesion of the bones of the jaw also should be assessed radiographically After that the surgeon preparation. Okay, the surgeon should be prepared for the extraction surgeon He need to wear the hand gloves mask I wear with shield surgical gown sterilization of all that mentioned Materials after the surgeon is ready. Meanwhile, we need to make the patient Ready that is we need to give prophylactic antibiotics if the patient is having Myocardial infarction or in such cases antibiotic profile axis amoxicillin should be given and Prophylactic mouth cleaning should be done before any extraction that will reduce a postoperative infection that is basic scaling polishing and proper rinsing with antiseptic mouthwash and Also, we need to drape the patient that is keeping a towel on the patient's chest So once the patient and surgeon is ready. We need to arrange the Trey that is the armamentarium We need to have mirror tweezer the probe elevators that is straight and angular elevators the forceps Wherever it is required that is upper forceps anterior posterior right and left So whichever tooth is we need to select forceps accordingly Then cryo strangle elevator. So root forceps also we can make it ready So if it is not Intraalvella extraction if it is a transalvella extraction, we need to arrange bone file Runger the cure it and all other things Also, we need to Make ready the local anesthesia bottle syringe cotton pellets future materials and needle holding forceps And now the important part that is a positioning of the patient. So proper positioning of the patient will reduce the fatigue of the Surgeon or the dentist the maxilla and mantable Positioning is different from axilla The chair should be tipped backward as you see here It should be tipped backward and the maxillary occlusal plane is at 60 degree To the floor. So this is the floor. So it should be at 60 degree 60 degree and The height of the dental chair should be 8 centimeter below the shoulder level of the operator So if the operator is as you can see here from the shoulder level of the operator, it should be 8 centimeter below for the mantibular Teeth extraction The mantibular teeth the patient should be positioned as a occlusal plane is parallel to the Floor okay, this is at 60 degree. This is parallel and the chair should be 16 centimeter below the level of operators elbow 16 centimeter Below elbow operators elbow that is a dentist elbow This is 8 centimeter below the operators shoulder So this is how we position the patient with respect to maxilla and mantibular teeth extraction Now the surgeon position so where exactly the surgeon should be seated So for all maxillary teeth okay, all maxillary teeth and Anterior mantibular teeth and Teeth of third quadrant okay Quadrant all these cases the surgeon should be at right friend position and for the fourth quadrant The patient I mean the surgeon should be at right back position okay So fourth quadrant is nothing but the mantibular right side, okay So this is mantibular left side and maxillary teeth and anterior mantibular teeth patient should be at right friend And fourth quadrant patient should then this should be at right back position So this is how the surgeon should be seated as you can see the picture here. So once we are done with the Pre-surgical procedures there is a proper positioning of dentist proper positioning of the patient and all armamentarium is ready Then we can start the procedure. So we need to follow the basic principles of Extraction so now let's learn the principles of tooth extraction. So the first one is Expansion of The bony sockets as you see here can see the procedure how to expand the bony socket that is expansion by use of the wedge-shaped Beaks of the forceps so beaks will be positioned as apacly with good pressure to expand the crystal bones and to displace the center of rotation as Apacly as possible. So as you see here should be positioned as apacly as possible Okay, so this center of rotation should be more apacly then the force will be less and we can easily Remove the tooth if it is coming more coronally The high chances of breakage of tooth So the basic moments Moments should be towards buckle and palatal buckle or palatal So buckle moments the pressure applied to the tooth will expand the buckle cortical plate towards the crystal bone With some lingual expansion at a pickle end of the root if we move to Buckle side. Okay, this is a tooth Okay, when we move to buckle side, there will be expansion here and also expansion at the apacal end of the lingual side and Similarly or lingual and palatal movements pressure will expand the lingual cortical plate So this is a buckle and this is lingual so when we move towards the lingual there will be expansion of the lingual cortical plates and Slightly expand the buckle apacal area because when this move here This route will be slightly to the opposite side so for The tooth second molar lower second molar. We need to do this lingo buckle moments lingo buckle moments for second molar Mantibular second molar Okay Whereas the rotational force we can go for rotational force For the conical roots most commonly the maxillary central incisors They have the conical roots so we can go for a rotational that is a rotational movements and Tractional forces are useful for final removal of the Tooth from socket so they should always be small forces because teeth are not pulled Okay, so we need to apply the trans Tractional forces not sorry no transaction Tractional forces For the final removal, okay So the final we draw the moment of most of the upper and lower teeth is an outward occlusal direction except for the lower third molar which should be in a lingual occlusal way and Maxillary third molar should be distal buckle So most of the cases when we remove it as you see here when we remove it finally it should be a outward occlusal direction but few exceptions on one for the Mantibular third molar that is the lingo occlusal way and distal buckle way in maxillary third molar cases and the proper use of Forceps in lexation and removal of teeth. So the extraction moments are essentially three moments which are outward inward and Rotatory these are the three moments So outward is a buckle or label moment is the initial moment of all teeth except lower second and third molar Where the buckle plate of bone is reinforced by the external oblique ridge? Okay So that is the outward or buckle label moment then inward That is lingual or palatal so buckle moment should not be done on lower second and third molar because of the presence of oblique ridge and Lingual or palatal moment is the initial moment during the extraction of the lower second and third molar So these outward moment should not be done on lower second and third molar where the initial moment should be lingual or palatal force and Primary rotatory moment is the initial moment used in upper central incisor and lower second premolar upper Just upper central incisor and lower Second premolar, okay, so these teeth should be started with Initial moment as a rotatory moment if a resistance is felt in primary rotation a bucklingle moment should be started Okay, and if rotatory moment continued a spiral fracture of the tooth root may occur So if resistance is there we should go for a bucklingle moment Then once the alveolar bone has expanded sufficiently and the tooth has been lexated a slight traction forces Should be applied. So usually directed buckling. Okay, so once we get the proper lexation We can start using the traction force So final moment is the moment by which the tooth is removed from the bony socket So it should be always directed outward and occlusal to avoid the Traumatizing the opposite tooth. So we just cannot pull it out because it might injure the opposite tooth Okay, so the extraction forceps the blade should be applied to the Carious side first and the first moment made towards the caries. Okay, not away from the caries Because there will be fracture of the tooth now we have the basic principles of tooth extraction And the first one is the fulcrum or liver principle So this is a liver Elever is a mechanism for transmitting a modest force with a mechanical advantage So the usage of elevators. Okay are basically work on these principles so That is the to obtain maximum mechanical advantage of the elevator the fulcrum should be near to the point of resistance Okay, should be near to the point of resistance and The effort arm effort arm should be longer than the Resistant arm. This is a effort arm should be longer than the resistant arm So this is the principle of class one liver. Okay class one liver and Rules of using elevator there should be palm grip. Don't use a neighboring tooth as fulcrum Don't use a buckle or lingual plate of bone as fulcrum use a left hand for reflection guarding and supporting take care of the surrounding vital structures and always Follow the root curvature So principles of use of elevators the first one is wedge principle wedge Okay, wedge principle then the liver principle and Axel and wheel principle So the elevators are differ Which is based on the principle they use because a wedge principle Commonly the straight elevator straight elevator whereas the liver principle co-plant elevator and Axel and wheel principle the cry elevator The wedge principle Is like some elevators are designed primarily to be used as a wedge like a pexo elevator or co-plant These elevators are forced between the root of the tooth and the Investing bony tissue parallel to the long axis of the tooth as you see here Whereas the liver principle It is on applying this principle the elevator is a lever of the first class Okay, the position of the fulcrum is between the effort and resistance in order to obtain a mechanical advantage and The last one is wheel and axle principle. Okay, so we Axel so we land axle principle It is as you see here the wheel and axle is a simple machine the effort is applied to the circumference of a wheel Okay, circumference of a wheel Effort is applied to the circumference of a wheel Which turn the axle so as to raise a weight it could be used as a soul work principle and remove the tooth Or it is also used in conjunction with wedge or lever principle So these are the three principles The liver principle and the wedge principle and wheel and axle principle basically basically it is for the elevators So what are the dangers in use of elevators? The first thing is loosening or extracting the adjacent teeth So we should now keep the adjacent teeth as fulcrum or buckle or wringle plate And there are chances of fracture the alveolar process or fracturing the mandible Penetrating the maxillary sinus and forcing the root into the maxillary sinus And forcing a root of mandibular third molar through the lingual plate of the mandible And damage the soft tissues by slipping the lip of the elevator And what is the role of operators other hand? Okay, if he's a right-handed person the other hand person's left hand is a very crucial importance because that hand plays an important role in supporting and Stabilizing the lower jaw when mandibular teeth are being extracted and the opposite hand supports the alveolar process and provides tactile Information to the operator concerning the expansion of the alveolar process. So we need to support the structures, especially mandible and the alveolar process while using the other hand That is very much crucial because otherwise there will be Fracture of a mandible or other supporting structures So once To this extracted we need to irrigate the socket with normal saline or other antiseptic solution Then curatage of the socket to remove any bony fragments or granulation tissue breakdown of the bony sharp edges at the socket and The interadicular bone skeusing of the socket mouth rinsing with antiseptic solution and suturing only if it is required So we need to give proper post Operative instructions that is removal of the cotton or goes back at least one hour later and Take cool and soft at for at least 24 hours avoid the hot and hot that for 24 hours Never to use straw for drinking anything because the straw create negative pressure on it creates bleeding So do not rinse first fully and do not breast the site of extraction at least for 24 hours because during this 24 hours the cloud formation Happens and the proper healing Should take place Then we should not disturb the cloud site for at least 24 hours if it is Disturbed then there's chances of dry socket and Instruct the patient to maintain the oral hygiene If Suturing is done. We need to remove it after one week. So these are the basic Principles of Exodontia we discussed in detail the principles the pre-assessment pre-surgical assessment post extraction instructions and positioning of the dentist and positioning of the patient and armamentarium and all other things So if you understood this Exodontia concept to an extent. It's not a complete picture of Exodontia But it will definitely help you in writing your exams because there are lots of questions been asked from Exodontia principles of Exodontia then the V-Lanaxa principle wedge principle liver principle then positioning of the dentist and patient So everything is very important on exam point of view So I'll come up with a new topic in our surgery. Thank you