EXODONTIA (an outdated synonym extraction of teeth) — the surgery consisting in extraction of tooth from a tooth socket by separation of a root or fangs from the holding fabrics.
Distinguish absolute and relative indications to At. h. Absolute indications are: acute periodontitis (see), hl. obr. multi-rooted teeth, at impossibility of creation of outflow of pus some other way; otly crowns with a part of a fang (see Teeth); «causal» tooth at acute osteomyelitis of a jaw (see Jaws)’, hron. periodontitis at the patients having diseases in a pathogeny to-rykh an important role play infectious allergi-cheskiye factors (an iridocyclitis, myocarditis, rheumatism, hron. nephrite, etc.). However it is necessary to consider that absolute indications to At. h. are defined by those conditions, in to-rykh this question decides. In particular, in the presence of specialized stomatol. the help of the indication to At. h. can be sharply narrowed since modern conservative methods of treatment allow to keep in most cases teeth by means of reliable sterilization of the infected channels of fangs and recovery of integrity of a coronal part.
Relative indications to At. h. are various. At. h. it is shown at loss of their functional and cosmetic value, considerable destruction of tooth and impossibility to use the remains of a crown and root for prosthetics (see Dentures). Incorrectly cut through and impacted teeth at impossibility to move them to the correct situation and especially in case of development of a pas tolite are subject to removal. signs (pain, an inflammation, etc.) - teeth are subject to Removal, roots to-rykh are on the line of a fracture of jaw and prevent comparison of fragments. In some cases it is necessary to extract teeth for prosthetics. At periodontosis (see) removal of those teeth is shown, to-rye are strongly loosened and painful during the chewing.
Teeth with an inflammation of a periodontium are subject to removal, roots to-rykh contact to a bottom of a Highmore's bosom when they are the reason of dontogenous antritis (see). Removal of milk teeth is made when they become mobile owing to a rassasyvaniye of roots or are late longer than the put term and interfere with secondary dentition, and also at inflammatory processes in the field of their roots posing a threat of spread of an infection on the fabrics located around rudiments of second teeth. In all other cases premature removal of milk teeth is inadmissible since can lead to disturbance of formation of dentition.
Contraindications to At. h. in essence are relative, however the malignant tumor and an intra bone hemangioma in the tooth which is subject to removal are absolute contraindications since the odontectomy at such patients (without the corresponding preparation) can lead to serious complications. It is not recommended to extract teeth at patients with acute inf. diseases (flu, quinsy, scarlet fever, etc.)? inflammatory diseases of a mucous membrane of an oral cavity (ulitis, stomatitis, etc.). The exodontia at patients with diseases of blood (hemophilia, a leukosis, etc.), and also suffering from dekompensirovanny dysfunctions of cardiovascular system, after a myocardial infarction is made only according to absolute indications after the corresponding preparation, as a rule, in the conditions of a hospital.
Operation differs in the nek-ry features caused by strong fixing of teeth, limitation of a surgery field, impossibility completely to exclude its infection.
For At. h. use special tools: nippers and elevators
(elevators) of different types, sometimes use a drill (see) and a chisel (see. Dental tools).
At. h. make usually under local anesthesia (infiltration or conduction), is more rare — under anesthetic. The choice of a type of anesthesia is solved individually (see Anesthesia local, the Anaesthesia).
At At. h. the correct position of the patient and doctor is important. If At. h. make on an upper jaw, seat the patient in the dental chair (see) with the head which is slightly thrown back back so that the oral cavity of the patient was located at the level of a shoulder joint of the doctor. The doctor costs on the right, a little in front from the patient. At At. h. on a mandible the head of the patient shall be in the vertical or slightly inclined forward family way, and the mandible — to be at the level of an elbow of the doctor. Depending on on what side of a jaw there is an extracted tooth, the doctor costs in front of or behind the patient. At At. h. on a mandible at the left the doctor becomes ahead of the patient, and on the right half of a jaw — behind the patient on the right and covers the left hand his head.
For the purpose of the prevention of a possible rupture of a gingiva around the extracted tooth at an application of forceps, and also for destruction of the circular ligament of tooth holding tooth in a tooth socket by means of a gladilka, the raspatory or an elevator otslaivat edge of a gum from tooth, at the same time break off a circular sheaf at a depth apprx. 5 mm. After mobilization of edge of a gum start directly an odontectomy, a cut it consists of an application of forceps, their pro-moving and fixing, a vyvikhivaniye (lyuksation or rotation) tooth and its extraction (traction). After extraction of tooth make the toilet of a wound including a scraping of a hole a looped spoon for the purpose of removal of granulations, splinters of tooth and a bone of an alveolus and also a skusyvaniye of keen edges of a bone. At an extensive rupture of a gingiva and soft tissues they are sewn up. After filling of a hole with blood of edge of a hole it is necessary to squeeze and press a gauze ball before formation of a blood clot. The patient during 2 hours after operation should abstain from meal. If from a hole later At. h. pus is emitted, appoint rinsing of a mouth antiseptic solutions 3 — 4 times a day. Healing of a hole later At. h. occurs at the expense of the organization of a blood clot and further substitution of the formed connecting fabric a bone.
Sometimes At. h. by nippers it is complicated owing to strong destruction of a crown and a fang or limited opening of a mouth as a result of pain or hypostasis of fabrics. In these cases use elevators. Sometimes at the wrong position of tooth as a result of disturbance of its eruption, anomalies of a structure of fangs or at break off tops of a fang at At. h. apply cutting out of walls of a bone tooth socket a drill. The gouging by means of a chisel and the hammer is not recommended because of danger of breakdown of tooth, formation of a crack in a bone. Most often resort to cutting out during removal of the third lower painters (wisdom teeth), especially in the presence of deviations in development of their roots or an arrangement of teeth in the thickness of a bone as a result of a delay of eruption (retention). Thus after anesthesia cut a mucous membrane, bare a vestibular surface of an alveolar shoot. The outside wall of a tooth hole is deleted by means of a drill, baring a surface of a root or not cut through tooth, to-ry take an elevator. After operation make a curettage of a tooth socket, take in a mucous membrane.
At hron. periodontitis of single-root teeth, hl. obr. cutters and canines, it is possible to keep tooth, having applied a radectomy (an apical resection). Operation consists in opening patol. the center at a top of a fang, removal of its contents together with the resected top of a root (see Periodontitis).
During operation U. h. there can be a number of complications. Carry a syncope to complications of the general character (see), a collapse (see), shock (see). Among local complications are possible: a change of roots, dislocation and a fracture of the next teeth, shift of teeth in soft tissues. There is otly an alveolar shoot of a jaw, dislocation and a change of a mandible less often. During removal of small and first big molars on an upper jaw perforation of a bottom of a Highmore's bosom and pushing through of a fang in it can be observed. The rupture of adjacent soft tissues is sometimes observed. Injury of the lower alveolar nerve at At. h. can lead to disturbance of sensitivity (paresthesia, a hyperesthesia, anesthesia).
Later At. h. there can be bleeding from a hole of the extracted tooth, a cut, depending on the reason, stop or by suture on soft tissues, or by means of a hard tamponade of a hole. Other widespread complication later At. h. the alveolitis (alveolar pains) arising at infection and disintegration of a blood clot or its absence and also as a result of traumatic intervention is. At the same time in the field of a hole of the extracted tooth there is severe pain with irradiation in an eye, a temple, an ear, the putrefactive smell from a mouth appears, subfebrile temperature is sometimes observed. The mucous membrane around a hole is edematous, hyperemic, submaxillary limf, nodes are increased and painful. At active treatment, a cut includes removal of necrotic fabrics, processing of a hole antiseptic agents and its tamponade, recovery occurs, as a rule, in
5 — 7 days.
Bibliography: Vernadsky Yu. I.
Fundamentals of surgical stomatology, page 47, Kiev, 1983; 3 and at with and e in V. I.
, etc. Surgical stomatology, page 95, M., 1981; The Guide to surgical stomatology, under the editorship of A. I. Evdokimov, page 73, M., 1972; R y and -
to about in A. I. Mistakes in out-patient dental practice, M., 1976;
Sabot E. Out-patient surgery of teeth and an oral cavity, the lane with Wenger., page 13, Budapest, 1977; With t and r about and N with to and y I. M. Surgical stomatology of the polyclinic doctor, M., 1977. T. G. Robustova.