CHAPTER I

PRELIMINARY

A. Back ground discussion

Tooth extraction is the most dental medical procedure in Indonesia. Tooth

extraction or extraction is defined as the removal of a tooth from its pocket on
the alveolar bone. In rational dental dental rational extraction is intended to
prevent further problems in the future. Some reasons that are often found by
patients who want to extract their teeth are due to tooth structure damage
(caries and fracture), poor tooth position (impaction, ectostema, and jostling),
needed to support other dental treatments (dentures and orthodontics), and
some other personal reasons. However, until now, patients are still often
forced to have a tooth extracted even though it has not been an indication of
extraction because of excruciating pain, dental treatment is considered
expensive, and long. Thus, tooth extraction is often used as a shortcut or the
fastest choice to overcome the problems that occur in teeth. This condition
makes tooth extraction irrational. However, from several reasons for irrational
tooth extraction, the main reason is the lack of awareness and knowledge of
the Indonesian people on the impact of tooth extraction.

Tooth extraction measures with certain cases required supporting

equipment that is more complete in accordance with minor surgical operating
standards. Radiographic examination is important to plan the actions and
explanations to the patient especially the local conditions that make it difficult
to remove the tooth. Patients must be ensured in a state of good public health,
if they have a systematic disease must be controlled. When forced and using
inappropriate tools and techniques often cause complications. To avoid or
reduce complications that occur in tooth extraction with complications, the
dentist must know the techniques in action. Doctors should have the ability
and skills through research. A careful history of a history of previous tooth
extractions, careful clinical examination and radiographs can estimate the

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 difficulty of tooth extraction. If a simple or intra-alveolar technique cannot
remove a tooth, tooth extraction can be used with the closed method or open
method extraction.

B. Formulation of the problem

1. What is the definition of Tooth Extraction ?
2. What is the Etiology of Tooth Extraction ?
3. What is the Sign And Symptoms Of Tooth Extraction ?
4. What is the Diagnosis of tooth Extraction?
5. What is the Clinical Manifestations ?
6. How is the phatology tooth extraction ?
7. How is the techniques of tooth extraction ?
A. Destinatin
1. To Know Definition of Tooth Extraction.
2. To Know Etiology of Tooth Extraction.
3. To Know Sign And Symptoms Of Tooth Extraction
4. To Know Diagnosis of tooth Extraction
5. To Know Clinical Manifestations
6. To Know Phatology tooth extraction.
7. To Know Techniques of tooth extraction

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 CHAPTER II
DISCUSSION

A. Tooth Extraction Definision

Tooth extraction is removing teeth. If the nerve of the tooth has died or
the tooth has been very badly infected, extraction is the only way. Tooth
extraction can be done in a simple or complicated extraction.

Tooth extraction is the process of extracting or removing teeth from

the alveolar bone, where the tooth cannot be treated anymore. Tooth
extraction is also a surgical operation that involves moving tissue and soft
tissue from the oral cavity, access restricted by the lips and cheeks, and
then connected together by tongue and jaw movements.

B. Etiology
 Cavities that cannot be repaired.
 Rocking teeth accompanied by infections such as gum infections or
tooth abscesses.
 Tooth position that is not normal, can accumulate, uneven or tilted
and cause injury to cheek tissue.
 Dental infections.
 Tooth decay due to serious injury.
 Teeth that are in abnormal tissue, such as in the jawbone fracture
line.
 Traumatic
C. Signs And Symptoms Of Tooth Extraction

The following are the signs and symptoms of tooth extraction :

1. Cavities and nerves are dead

Cavities are caused by bacterial infections. If not treated
immediately, the infection will continue to spread to the deepest layer
of teeth, the nerves. Bacterial infection in the tooth nerve can cause
tooth nerve death.

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 If the damage that occurs in these teeth has been very severe and
the teeth can no longer be treated with root canal treatment, tooth
extraction is the last option that can be done.

2. The arrangement of teeth is messy

The messy arrangement of teeth, one of which is caused by limited
space in the jaw, to accommodate all the teeth. So it is not uncommon,
dentists will recommend tooth extraction as a companion to dental care.

This removal is intended to allow the jaw to have enough space to

move when the wire is attached later.

3. There is a risk of infection

There are several conditions that make a person very vulnerable to
infection. For example, while undergoing chemotherapy or after organ
transplants. So, to avoid the risk of infection from cavities, extraction
can be done as a preventative measure for the spread of infection.

4. Gum disease that is already severe

Inflammation of the supporting tooth tissue or periodontitis, can
cause damage to the tissue around the teeth and supporting bones. This
condition can cause teeth to shake, so they cannot function optimally. If
it is so, then tooth extraction can be the right solution.

5. Damaged
Teeth that have suffered severe damage due to decay or injury and
can no longer be repaired through corrective action, must be removed.
If not removed, these teeth can bring enduring pain and discomfort.

6. Teeth Grow Improperly (Impaction)

Wisdom teeth need to be extracted if they grow abnormally or
grow in the wrong position.

7. Other conditions
In addition to the four reasons above, tooth extraction can also be a
treatment option for the condition:

a. Teeth are broken to the roots and nerves die from impact or trauma
b. Supernumerary teeth or conditions where the number of teeth
exceeds normal conditions
c. Economic difficulties not to reach other treatments

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D. Diagnosis of tooth extraction
Diagnosis of tooth extraction, namely :
Clinical and radiographic diagnosis Periapical lesions are common
due to the death of the pulp in between are, periapical granulomas and
cysts radicular. The clinical symptoms of these two lesions are difficult to
distinguished, for the diagnosis supporting examination is needed.
Periapical granuloma Periapical granuloma or dental granuloma is a
shaped lesion round with slow development Stomatognatic (J.K.G Unej)
which is close to the apex of the root teeth, usually a complication of
pulpitis. Consists of inflammatory tissue mass chronicles that proliferate
between capsules fibrous which is an extension of a ligament periodontal.
Dental granuloma is chronic forms of inflammation due to infection
periapical marked formation granulation tissue in the alveolar bone in
apical area of the tooth. Granulation tissue is a fibroblastic response and
proliferation young capillaries together. Network this along with
macrocytic cells and lymphocytes are also cell proliferation for cells
forming a replacement network is typical sign of chronic inflammation. If
a factor injuries remain (persistent), then the response chronic
inflammation will persist a long time without a resolution process
network, this is what causes it to happen apical granulomas of non vital
teeth.

E. Clinical Manifestations
Clinical manifestations of extraction, namely:

1. Bleeding
A slight bleeding after extracting a tooth is normal. Bleeding that
still occurs after 30-60 minutes of pressing by biting the tampon requires
further treatment this is called primary bleeding (primary hemorrhage).
Bleeding can also occur after several days of extraction called secondary
hemorrhage (secondary hemorrhage).

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 Therapy :

Cleans blood clots

Irrigation in the socket with isotonic saline

Bleeding from the gums is treated by suturing

Bleeding from the bone can be treated with a tight suture and added to the
pack

Bite the tampon for 15-30 minutes

Coagulant drugs are given.

2. Echymosis and hematoma

A slight echymosis can occur after tooth extraction, especially in
elderly patients If there is echymosis and hematoma can be treated with ice
compresses on the first day and then with heat therapy.

3. Swelling
It usually occurs after trauma, if the condition continues there is
usually an infection and needs to be treated with antibiotics.

Sometimes if there is an infection accompanied by a state of

difficulty opening the mouth (trismus), when this happens it is necessary
to be given training to open the mouth and given heat therapy. If trismus
continues, it is necessary to provide diathermy therapy and open mouth
exercises.

4. Drysocket
This situation often occurs and causes prolonged pain after tooth
extraction. Dry socket is characterized by loss - damage to the blood clot
in the socket, starting with a grayish blood clod and followed by damage
to the blood clot so that the socket looks dry.

Therapy :

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 irrigation with H2O2 or normal saline

application of local applications to the socket: alvolgyl, iodoform

5. Root fracture
This situation often occurs in plucking, in teeth that die because of
brittle, bent tooth roots, or the presence of hypercementosis etc. If the
fractured root is very small and is located deep in the bone, it can be left
with the patient's note being told of the condition.

6. Alveolar bone fracture

Can occur during difficult tooth extractions. If you feel that
alveolar bone fractures should be separated from the teeth first broken
bone, then proceed with retraction.

7. Fracture of the maxillary tuberosity

Occurs when the extraction of maxillary third molars. It should be
avoided because tuberosity is needed as retention in making false gIgi.

8. Maxilaris Sinus Perforation

Occurs in the removal of premolar teeth or maxillary molars. This
situation is easier to occur in teeth with a state of infection at the apical
because the bone between the roots and sinuses is involved in chronic
inflammation that is damaged. Usually this is characterized by the
presence of fluid that comes out through the nose when the patient gargles
or drinks, sometimes when the extraction is not known either by the doctor
or the patient if there is perforation. If it is immediately overcome by
closing the socket with a tight stitch if necessary buccal bone is reduced so
that the traction can be done on the mucosa of the buccal to close. Patients
are advised not to blow their nose for about one week, don't rinse the
mouth too hard.

9. Encouraged roots in Sinus Maxillaris

If it happens, you can try to take the part by:

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 Patients are told to blow with the nostrils closed

Taken with the tip of a suction tip (suction tip) on the socket)

If unsuccessful, surgery is needed by referring the patient to an expert

doctor.

10. Bleeding
Sometimes it can occur at the time of extraction, this is overcome
by applying pressure to the area.

11. Subcutan emphysema

Rarely, it usually occurs due to air pressure entering the connective
tissue or spacia on the face from the use of hand pieces with high air
pressure. Occurs very quickly, there is swelling, will recover in 1 to 2
weeks without treatment.

F. Phatology

Tooth extracted because of several the reasons, including caries1,

Dental caries is a disease tooth tissue that is marked by damage tissue,
starting from the tooth surface (pit, fissures and interproximal regions)
extend to direction of the pulp. The infected pulp will causes long-standing
pulpitis can eventually lead to death the pulp due to the pulp gangrene.
Infection from the gangrene pulp will extend out of the apical foramen
goes in the periapical direction causing lesions in the periapical area2.
Widespread caries and not being treated can result in loss crown of the
tooth completely and remains root (remaining root) or also referred to as
Radical gangrene. Radical gangrene usually have chronic periapical
lesions with no symptoms or acute exacerbations due to secondary
infections that are cause pain.

G. Tooth Extraction Techniques

1. Open Method Method Extraction

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 Tooth extraction open method extraction technique is the technique
of removing teeth by surgery by cutting teeth or bones. The principle of
this technique is the making of flaps, removing some bones, cutting teeth,
removing teeth, smoothing bones, curettage, and suturing.

2. Single Root Tooth Extraction Technique

Open method extraction extraction technique is performed on a

single root tooth if intra alveolar extraction or closed extraction fails, or
the root fracture is below the cervical line. The first stage of this technique
is to make a mucoperiostal flap with a flap envelope design that extends to
two anterior teeth and one posterior tooth or by extension to the buccal /
labial. After the open mucoperiostal flap is free then bone is taken in the
buccal / flabial area of the tooth to be extracted, or it can also be extended
to the posterior portion of the tooth to be extracted. If the root pliers or
elevators allow entry into the periodontal ligament space, then the root
pliers can be used to extract or it can also use elevators from the mesial or
buccal teeth to be extracted. If the tooth root is located under the alveolar
bone and the root forceps or elevator cannot enter the periodontal ligament
space, it is necessary to take a portion of the alveolar bone. Bone removal
is kept to a minimum to avoid large surgical wounds. Intake of alveolar
bone can be done in several ways. First, bone removal is done with the tip
of the buccal root pliers pinching the alveolar bone. Second, removal of
the buccal bone with a bur or chisel as wide as the size of the mesio-distal
root and half to two-thirds the length of the root. Extracting root teeth can
be done with elevators or root pliers. If this method is unsuccessful, then
the buccal bone removal is deepened near the root tip and notched with a
bur for elevating the elevator. After the root of the tooth has been
removed, it smoothes the edge of the bone, curettage debris or tooth
socket. irrigate and sew the flap edges in place

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 Figure 1: Extraction of an open method extraction technique with partial
removal of buccal bone.

3. Technique for Extracting Multiple Roots or Divergent Roots

Extraction of multiple root teeth and diverging root need to be

taken one by one after separation on the bifurcation. First to make a
mopoperiostal flap with an expanded flap envelop design. Next, cut the
crown of the linguo-buccal direction with the bur until the roots are
separated. Removal of the tooth roots and their crowns one by one with
pliers.

Figure 2: Technique of the open method extraction by cutting the crown of

the teeth in a linguo-buccal direction

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 Another way is to take some of the buccal alveolar bone to the
bottom of the cervical teeth. The crown is cut with a horizontal bur below
the cervix. Then the tooth roots are separated with a bur or elevator, and
one by one the tooth roots are removed. Sharp edge of bone or interdental
septum is smoothed. Then the socket or debris is curated and irrigated and
the edges of the flap are in place

Figure 3: Extraction of lower molars using the open method

extraction technique, which involves cutting the crowns and roots of the
teeth.

Figure 4: Extraction of the upper molar teeth by cutting the crown

and taking root one by one.

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 CHAPTER III

CLOSING

A. Conclusion
Tooth extraction is removing teeth. If the nerve of the tooth has
died or the tooth has been very badly infected, extraction is the only way.
Tooth extraction can be done in a simple or complicated extraction. A
previous history of tooth extraction difficulties can be used as a material
for assessing the likelihood of difficulties returning to subsequent tooth
extractions. A careful clinical examination of the tooth to be extracted
along with supporting tissue and important structures nearby can provide
valuable information in determining the difficulty of tooth extraction.

If with a simple technique or intra alveolar can not remove the

teeth, tooth extraction can be used closed method or open method
extraction technique. Tooth extraction with complications can be done
with the open method extraction technique, this technique if done correctly
can be a good solution for the extraction of teeth with complications cases
and can avoid unwanted risks for both the patient and his dentist. This
technique requires appropriate surgical support equipment in addition to
the ability of trained operators.

B. Suggestion
A dentist in performing a simple tooth extraction action may face
the condition of bleeding complications. Therefore, knowledge of the
factors that cause and how to overcome them becomes an important thing
in dealing with these conditions.

Avoid or minimize complications after tooth extraction with the

basic principle of establishing a clear extraction plan, using good and
correct techniques, and giving written informed consent about the risks
and complications that might occur.

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 REFERENCES

https://id.scribd.com/document/232634665/Makalah-Pencabutan-Gigi.

http://norkamalia13.blogspot.com/2016/11/ekstraksi-gigii_1.html.

https://dokumen.tips/documents/ekstraksi-gigi-makalah-gabungan.html

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