SURGICAL EXODONTIA

SURGICAL EXODONTIA

All dental practitioners should be conversant with the principles of
surgical exodontia, which is employed for the management of difficult
erupted teeth, retained roots and impacted teeth. Surgical exodontia
should not be undertaken lightly, and unless the clinician has had the
opportunity to develop his or her surgical skills under supervised
instruction, then general dental practice is not place to start. The
aim of this chapter is to introduce the basic principles of surgical
exodontia.

Terminology:
Surgical exodontias-the removal of tooth fragments via the
transalveolar approach, whereby access to and delivery of the tooth or
its fragments are achieved via a surgically created pathway.
Transalveolar approach-where the alveolar bone and soft tissues
surrounding the tooth or its fragments are surgically breached to
create a pathway required to undertaken a surgical exodontias.
Difficult erupted teeth-teeth with crowns fully visible in the mouth
which-for whatever reason-cannot be completely removed by the
intra-alveolar approach alone.
Impacted tooth-a tooth that fails to erupt for whatever reason, into
the dental arch within the expected time frame.
The basic steps of surgical exodontia:
The surgical extraction of teeth and tooth fragments consists of six
fundamental steps:
1. Raising s flap.
2. Removal of bone.
3. Tooth division.
4. Removal of tooth or tooth fragments.
5. Wound toilet.
6. Primary closure.

Not all surgical extractions need to go among each of the six steps. In
many cases a tooth may be surgically extracted simply by raising a flap
without having to remove bone or divide the tooth.

Raising a flap:
A flap is a tongue tissue comprising a base and a distal segment which
is raised from its surrounding tissue bed.

Function:
A flap server two fundamental purposes:
To provide access to the surgical site.
To serve as the primary dressing to cover the surgical defect that is
created.

Types:
Many types of flaps are used in surgery, but in minor oral surgery the
most common is a mucoperiosteal flap, i.e. oral mucosa and periosteum
that cover the alveolar process.
Flaps may be described in terms of their physical shape or outline or
more often according to the site from which the flap is procured, e.g.
buccal flap, palatal flap or lingual flap.

Technical notes:
1. The incision must be made in one continuous stroke through to bone
at right angles to the surface of the mucosa.
2. The base of the flap, where the blood supply is derived, must always
be wider than its distal segment in order to maintain the viability of
the flap when it is raised from its tissue bed
3. The dental papilla should

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