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The basic tooth extraction technique is used for a single rooted
tooth (not a canine). All other tooth extraction techniques are
derived from this.
Pre-extraction Radiograph
This establishes the morphology of the root and warns of any fractures
or other problems in the target root or with adjacent structures.
Gingival Incision
Sever the epithelial attachment of the gingiva to the tooth at
the bottom of the sulcus (sulcar incision), with a #15 or #11 scalpel
blade at a reverse bevel angle of 20 degrees to the tooth. The aim
is to separate the gingival tissues from the tooth. The incision
should stop at the alveolar bone crest.
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Luxation
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Hint: Initially the soft tissue feels
spongy. Carry the blade through this tissue until the bone
is felt.
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Select an appropriate size of luxator or elevator.
Apply the tip to the area between the tooth root and the alveolar
bone. Feel for the periodontal ligament space and move the blade
into it using controlled force. If the space cannot be found, create
a channel with a small (¼ or ½ round) burr used down
the long axis of the root.
Push the luxator blade in an apical direction, with controlled
force. Also, rotate blade axially around the root severing the
periodontal ligament. Allow haemorrhage to occur. The hydraulic
pressure will help push the tooth out of the alveolus.
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Initially it may be difficult
to find the periodontal ligament space. Hold the luxator onto
the root and wiggle while still under controlled force, but
without removing it from the tooth. This will often have the
desired effect.
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Continue alternating pushing apically and
rotating axially until the tooth becomes loose in the alveolus.
Removal of Root
Remove the loose tooth, with small forceps, using rotational and
apical force. This force should not be excessive but is best to
be continuous.
Management of Alveolus
Clear sockets of debris by flushing with saline. An alveoloplasty
is the smoothing of the bone crest and is necessary to allow the
soft tissues to be sutured over the site without tension. Reduce
any bony abnormalities with a round bur (with water irrigation)
or a bone file. If necessary, fill the alveolus with an osseopromotive
material to maintain the ridge (Consil™: Vetoquinol UK).
Suture
The gingival tissues should be sutured. The sutured edges should
be brought together without tension. Use absorbable single interrupted
sutures, spaced no more than 1.5mm apart.
Advantages
- Prevents contamination of the site by food and other debris.
- Prevents loss of blood clot leading to post-operative haemorrhage.
- Protects bone and other underlying tissues.
- Creates gingival collars for adjacent teeth unaffected by the
disease process.
- Substantially improves patient comfort.
Disadvantages
- Possibility of trapping contaminated tissue under flap (unlikely
if alveolus managed correctly).
Post Extraction Radiograph
This confirms that all tooth tissue has been removed and that no
collateral damage has been created to adjacent teeth or other structures.
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