EXODONTIA

PRACTICE
EXODONTIA
PRACTICE
Abhay N Datarkar BDS, MDS, DNB (Gold Medalist)
Associate Professor and PG Teacher
Dept. of Oral and Maxillofacial Surgery
Sharad Pawar Dental College and Hospital
Datta Meghe Institute of Medical Sciences
(Sawangi) Wardha (Maharashtra) India
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Exodontia Practice
2007, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any
means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the
publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy
of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all
legal matters to be settled under Delhi jurisdiction only.
First Edition: 2007
ISBN 81-8448-050-4
Typeset at JPBMP typesetting unit
Printed at Ajanta offset
This book is dedicated in
loving memory of
Ma Mandar J Kadu
You will forever be in our thoughts and in our hearts
Foreword
Before privatisation of Dental education, there were few Dental Colleges in India. Dental
surgeons were having restricted practice in restricted population. Dentist population ratio
was very high. As on today there are approximately 80,000 Dentists registered in India.
Every year approximately 15,000 new Dentists are coming in practice. This has brought
down Dentist population ratio. In coming years India will have complete coverage of
population for Dental treatment.
Exodontia remains a major bulk of oral surgery practice. It is the surgical practice which
build confidence of patient in a Dental surgeon. Painless and uneventful extraction of
tooth is a skill based on knowledge. Having comprehensive book on knowledge of exodontia was a need of
time. Practitioners cannot afford to go to exhaustive text books and hence needs to have a comprehensive
book. For skillful exodontia one has to keep on referring to basics, complications and advances. This view has
been taken care by Dr Abhay and Dr Satheesh while writing this book.
Extensive experience of Dr Abhay in India and Dr Satheesh in UK has put a value in this book. This book
will therefore particularly appeal to the general dental practitioners who will find mine of information and will
appreciate the value and clarity of the advice it contains concerning the management of all types of patients
requiring exodontia treatment.
The exhaustive contents of this book in short form will be beneficial for undergraduates in India too. The
description of exodontia as a whole has been made in simple understandable language for undergraduates
of dentistry supported by diagrammatic and photographic presentations. Basic procedures, fundamentals, principles
behind them, complications and their prevention and management are the highlights of this book. I recommend
the book for both general practitioners and undergraduates in dentistry.
Professor RS Dolas
Dean and Professor of Oral and
Maxillofacial Surgery
DY Patil Dental College and Hospital
Pimpari, Pune-18.
Contributors
Dr Satheesh Prabhu Irvail MDS, FDSRCS, MbCHb, FRCS
Consultant Maxillofacial Surgeon
Manchester (UK)
Dr Nitin D Bhola BDS, MDS
Assistant Professor
Dept. of Oral and Maxillofacial Surgery
Sharad Pawar Dental College
Datta Meghe Institute of Medical Sciences
(Swangi) Wardha (India)
In all fine arts, SURGERY is the queen of arts. Art is for the sake of art. In surgery it is the real need because
upon the finesse and perfection of its artistry, the success of surgical procedure entirely depends.
As the super soul of all living entities, The Lord has bestowed all his blessings to give me this beautiful
life and invaluable opportunity to serve mankind with all my deeds and skills. His divine bliss has always helped
me to sail through all endeavours of my life.
I am deeply indebted to my teachers Dr RS Dolas, Dr RM Borle, Dr VK Hazarey, Dr Mrs PV Hazarey for
their valuable suggestions and guidence for bringing out this text.
Thank you to Dr AD Bhagatsingh, Dr KH Chaoji, Dr A Betharia, Dr R Vasant, Dr Dinesh Varma, Dr Ritesh
Rajan, Dr Biju Papachain, Dr Prabhu, Dept. of Oral and Maxillofacial Surgery for invaluable critiques and
encouragement.
My senior teachers and well wishers Prof. JN Khanna, Prof. RS Madan, Prof. Neelima Malik, Dr Rajesh Dhirwani,
Dr MK Gupta, Dr Prashant Pandilwar, Dr Rama Shenoi, Dr DG Adwani, Dr Neelam Andrade and Dr M Naphade
needs special mention for their invaluable guidance and timely help.
My explicit acknowledgement to Dr AJ Pakhan Sir, Dean SPDC Sawangi and Dr SR Johrapurkar Sir, Director
of PG Courses DMIMS Sawami Wardha.
I wish to extend my heartiest thanks to my colleagues Dr Pravin Lambade, Dr Madhumati Dhawad, Dr Prashant
Pillai, Dr D Barde, Dr Rajshekhar, Dr GSV Prasad, Dr D Parulkar, Dr R Patil and Dr R Kamble for encouraging
me to my best.
My friends Dr SM Balaji, Dr Satheesh Prabhu, Dr P Rajesh, Dr Anil Ghom, Dr Gopalkrishnan, Dr Pravin
Reddy and Dr Harsh Arya needs special thanks for keeping me on track during this project.
Thanks to my postgraduate students Dr Nitin, Dr Praphull, Dr Sujhit, Dr Smruti, Dr Nishit and Dr Kedar
who were each instrumental in bringing this work to fruition.
I should not forget to thank Dr Rajat, Dr Sachin, Dr Guru, Dr Nishant, Dr Raman and Dr Indir for helping
me during this project.
Life would have been meaningless without my most caring and affectionate parents Shri Nilkanthrao, Sau
Kamal and my inlaws Shri Janardan Kadu and Sau Vandana Kadu, who are always the source of inspiration
for me.
My heartfelt thanks to my beloved wife Dr Ujwala for standing by me on several moments of despair and
disillusionment. Her innumerable sacrifices have brought me to the position where I stand today.
I am thankful to my brothers Mr Yogesh and Mr Nitesh, My kids Devanshi and Shrinesh, Shri Sharad, Shri
Santosh, Mr Rajesh, Mrs Ashwani, and Mrs Pallavi. Their prayers were great incentive in completing my book.
I am thankful to Shri JP Vij, Mr Tarun Duneja, Sunita and Mr Gujar from Jaypee Brothers without their
support this book would not have been published.
Acknowledgements
The ultimate test of all dental education is to see how well it prepares the practitioners to serve the patient. Exodontia
a routinely performed procedure in dental office, a procedure known to every body but understood by few.
It is very important for students and practising dentist to have a thorough understanding of this subject as
it will improve the quality of services rendered and ultimately provide benefit to the patients. Exodontia is an
art and science, if mastered can make a great deal of difference in clinical practise.
When I entered my clinical posting as a student in Third and Final BDS, I found myself burdened by a number
of textbooks on exodontia to be read before performing an extraction. Though there was a myriad of textbooks
available hardly was any one able to fulfill a students demand. I always found the literature running away from
the basic requirements of students. It was at that time I harboured a wish to write a book which would meet
a students demands.
Now after being into dental profession for more than a decade, I have given colours to my dream of writing
a guide book on exodontia. This book is descriptive, comprehensive yet simple to understand to be a true companion
of student and dental practitioner while doing extractions. The purpose of this book is to present the students
and dental practitioners an easy to use compilation of the techniques of exodontia.
This book is organised into sections of Armamentarium, Anatomical Considerations, Principles and Techniques
of Exodontia, Exodontia in Special Situation and Complications of Exodontia.
I have given my sincere effort and hard work in writing this book. I hope this will be helpful to one and
all.
Abhay N Datarkar
Preface
Contents
1. Introduction .......................................................................................................................... 1
2. Armamentarium ................................................................................................................... 5
3. Anatomical Considerations ................................................................................................ 21
4. Indications and Contraindications ..................................................................................... 31
5. Principles of Exodontia ...................................................................................................... 37
6. Intra-alveolar Extraction (Simple Exodontia) ..................................................................... 45
7. Transalveolar Extraction (Complicated Exodontia) ............................................................ 61
8. The Root Piece Removal (The Fractured Root).................................................................. 85
9. Pediatric Exodontia ............................................................................................................ 93
10. Exodontia for Medically Compromised Patients .............................................................. 103
11. Extraction Under General Anesthesia.............................................................................. 119
12. Healing of Extraction Socket ........................................................................................... 125
13. Complications of Tooth Extraction................................................................................... 129
Index .................................................................................................................................................... 145