Indications

• Caries/Periodontal Disease
• Infection/Abscess
  • Periapical pathosis
  • Osteomyelitis
• Trauma
  • Dentoalveolar: nonsalvageable
  • Mandibular: tooth in line of fracture
• Tumors
  • Benign
  • Malignant
  • Prevention of osteoradionecrosis in high-risk patients requiring radiotherapy
    • Poor oral hygiene
    • High caries index
    • Severe periodontal disease
    • Noncompliance

Instrumention and Equipment

1. Light
2. Suction
3. Dental Syringe
   • 27-gauge needle
   • 2% xylocaine with 1: 100,000 epinephrine
4. Dental Elevators and Forceps
5. Rongeurs
6. Bone Files
   • Hand
   • Motor driven
7. Irrigation
8. Suture
   • Plain gut
   • Chromic
   • Vicryl (needs to be removed in seven to 10 days)
   • Surramid (needs to be removed in seven to 10 days)

Surgical Technique

1. Anesthesia
   • Local only
   • Intravenous sedation/local
   • General anesthesia/local
2. Simple Extractions
   • Luxate tooth with elevator
   • Atraumatic forceps delivery with controlled force; do not attempt to "muscle" the teeth out
3. Difficult Extractions/Impacted Teeth
   • Grossly carious; no clinical crown
   • Ankylosed
   • Unerupted (impacted) teeth
     • Visualize tooth and root morphology on x-ray (Panorex, periapicals)
     • #15 scalpel blade to develop full thickness mucosal flap
     • Subperiosteal dissection
     • Remove bone as needed; be as conservative as possible
     • Section teeth if required
     • Curette extraction socket
     • Irrigation
     • Primary mucosal closure
     • Consider antibiotics: degree of difficulty, length of procedure, associated infection
4. Preradiation Extraction/Radical Alveoloplasty
   • Appropriate radiographs
   • Adequate exposure: gingival dental incisions with #15 blade
   • Develop full thickness buccal/lingual mucosal flaps
   • Subperiosteal dissection
   • Avoid releasing incisions
   • Extract teeth: dental elevators, forceps, high-speed drills
   • Perform radical alveoloplasty
     • Remove alveolar bone to level of basal bone with rongeurs and bone files
     • Create smooth, convex alveolus
     • Remove all bony undercuts and irregularities
     • Trim excess mucosal tissue from flaps
   • Curette alveolar sockets
   • Thorough irrigation
   • Achieve water-tight primary mucosal closure
   • Postoperative antibiotics

Postoperative Considerations

1. Gauze Packs
2. Suction
3. No Smoking or Spitting
4. Liquid/Soft Diet
5. Oral Hygiene
   1. Brushing
   2. Oral rinses (salt water, Peridex, Cepacol)
6. Diet Consult (if indicated)