INDICATIONS

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

INSTRUMENTATION AND EQUIPMENT

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

SURGICAL TECHNIQUE

1. Anesthesia
   1. Local only
   2. Intravenous sedation/local
   3. General anesthesia/local
2. Simple Extractions
   1. Luxate tooth with elevator
   2. Atraumatic forceps delivery with controlled force; do not attempt to "muscle" the teeth out
3. Difficult Extractions/Impacted Teeth
   1. Grossly carious; no clinical crown
   2. Ankylosed
   3. Unerupted (impacted) teeth
      1. Visualize tooth and root morphology on x-ray (Panorex, periapicals)
      2. #15 scalpel blade to develop full thickness mucosal flap
      3. Subperiosteal dissection
      4. Remove bone as needed; be as conservative as possible
      5. Section teeth if required
      6. Curette extraction socket
      7. Irrigation
      8. Primary mucosal closure
      9. Consider antibiotics: degree of difficulty, length of procedure, associated infection
4. Preradiation Extraction/Radical Alveoloplasty
   1. Appropriate radiographs
   2. Adequate exposure: gingival dental incisions with #15 blade
   3. Develop full thickness buccal/lingual mucosal flaps
   4. Subperiosteal dissection
   5. Avoid releasing incisions
   6. Extract teeth: dental elevators, forceps, high-speed drills
   7. Perform radical alveoloplasty
      1. Remove alveolar bone to level of basal bone with rongeurs and bone files
      2. Create smooth, convex alveolus
      3. Remove all bony undercuts and irregularities
      4. Trim excess mucosal tissue from flaps
   8. Curette alveolar sockets
   9. Thorough irrigation
   10. Achieve water-tight primary mucosal closure
   11. 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)