By summarizing the experience in oral clinical work, six key elements that should be noted during tooth extraction surgery are proposed: the patient's mouth shape, the position and texture of the affected tooth, the shape of the tooth root, the condition of the periodontal ligament, and the amount of bone surrounding the tooth root. Combined with good communication between doctors and patients, it is beneficial for the implementation of tooth extraction surgery.
Tooth extraction surgery is a complex process of mutual cooperation and joint efforts between doctors and patients, which involves both the technical factors of the doctors and the cooperation factors of the patients. The emphasis on 'cooperation' here not only refers to the behavior of both parties, but also includes psychological aspects. Good doctor-patient communication before tooth extraction can reduce patients' anxiety about tooth extraction surgery, make them trust doctors, and be willing to actively cooperate with doctors in their work. Therefore, both doctors and patients can cooperate with each other from both psychological and behavioral aspects, and the difficulty of tooth extraction surgery will be greatly reduced.
Tooth extraction surgery is a technical engineering (ignoring anesthesia methods and effects here), which includes many aspects. After practical experience, the author summarizes six elements that should be paid attention to during tooth extraction operation.
1、 Patient's mouth shape
Open the mouth wide for easy access to instruments; Otherwise, it is not conducive to the operation of the instrument entrance.
2、 Location of the affected tooth
Generally speaking, anterior teeth are easier to remove than posterior teeth. It is also difficult to distinguish between teeth that are upright or tilted during extraction. After practice, the author believes that inclined individuals are easier to remove than upright individuals. Because the tilted teeth have a certain angle, it is easy to operate the lower teeth collar, while for upright individuals, especially those with posterior teeth (such as the first, second, and third molars), if the patient's mouth is limited, the lower teeth collar operation is very difficult.
3、 The texture of teeth
To remove most teeth with hard dentin, it is recommended to use a tooth collar of appropriate width, starting from the correct pivot point and applying appropriate force. Generally, the periodontal ligament fibers will be torn off, the teeth will become loose, and it is easy to remove the affected teeth. A small number of teeth suffer from long-term necrosis of the dental pulp, which cannot provide nutrition to the teeth. At the same time, the periodontal membrane provides weak nutrition to the affected teeth, leading to brittle tooth texture. No matter what kind of instrument is used, if the force is slightly too strong, the crown or root of the tooth will break. This will bring great difficulties to tooth extraction, especially for the extraction of posterior teeth. Therefore, a thorough evaluation of the texture of the affected tooth should be conducted before tooth extraction.
The shape, length, and number of tooth roots:A single tooth, with a short, hard and straight root, can be easily extracted by applying appropriate force to the tooth collar. The root of the tooth will move in the opposite direction to the collar, making it easier to remove. When extracting multiple teeth with long roots and curved root tips, attention should be paid to the possibility of root fracture if excessive force is applied. Extracting the severed root (tip) is often difficult, with complex intraoperative procedures and significant postoperative pain for patients. If multiple tooth roots are connected and mutually constrained, it is not easy to remove them as a whole. At this point, multiple teeth should be divided into several individual teeth in sequence, and then extracted one by one. For those with root tip curvature, the operation must be cautious. First, use a gingival separator to decompose the soft tissue resistance, and then use a dental brace to apply appropriate force in the direction of root tip curvature. If no root looseness is found, apply slight force in the direction of the root tip and around it, gradually increasing the gap, and then apply force in the direction of the root tip. Repeat this process until the root is loose, and then take the root. To prevent root fracture in patients with root tip curvature, especially during posterior tooth extraction, preoperative imaging should be taken, carefully reviewed, and the shape of the root tip should be observed. The operation should be cautious, and the resistance around the root should be fully decomposed. The root should be removed after the root has loosened.
4、 The condition of periodontal ligament
The reason why normal teeth are strong is that the numerous periodontal ligament fibers in the alveolar cavity tightly bind them in the cavity, so tearing the periodontal ligament is an important step in extracting the affected tooth. For young people, the periodontal ligament fibers of their teeth are fresh and resilient. When the external force exceeds the tolerance range of the periodontal ligament fibers, the periodontal ligament will be torn, the affected tooth will loosen, and it is easy to remove. For dead pulp teeth with long-term pulp necrosis, there is no source of nutrition. The periodontal ligament fibers have degenerated and absorbed. Over time, the root of the tooth and the socket are firmly adhered together, and the alveolar bone gradually becomes loose. At this point, the difficulty of tooth extraction will increase. Sometimes the extraction of affected teeth with a small amount of alveolar bone is precisely for this reason. If the tooth texture becomes brittle, a slight force can cause the root of the tooth to break. At this point, the operator must first remove a certain amount of alveolar bone around the affected tooth to reduce the resistance around the tooth. After the exposed tooth material becomes hard, the instrument can be used to increase the gap and gradually loosen the affected tooth for extraction.
5、 The amount of bone surrounding the tooth root in the alveolar bone
The essence of tooth extraction is to separate the tooth from the surrounding alveolar bone. The longer the root of a tooth, the more bone mass it contains, making it more difficult to remove. On the contrary, the shorter the tooth root, the less bone mass is embedded, making it less difficult to remove. So before tooth extraction, an X-ray should be taken to observe the bone mass of the buried tooth (root) and roughly estimate the difficulty of the operation. For a tooth completely embedded by alveolar bone (such as a fully horizontal low impacted tooth or buried tooth), the removal of bone mass during surgery is excessive, resulting in bleeding from the wound and affecting the surgeon's field of view, making it difficult for the surgeon to operate. After surgery, the patient experiences severe pain and significant reactions. Therefore, in such tooth extraction surgeries, a certain amount of alveolar bone should be selectively removed to reduce periodontal resistance, which is beneficial for loosening the affected teeth and avoiding the use of violence. The anatomical structures adjacent to the affected tooth in the alveolar bone should be fully understood, and these tissues (such as the alveolar nerve tube, maxillary sinus, etc.) should be protected during the operation. If the affected tooth is adjacent to certain structures, the operation should be slow and gentle. Once the relationship between the two is clarified or the affected tooth becomes loose, appropriate force should be applied to remove the tooth. Do not operate blindly.
6、 Summary
Tooth extraction is the most commonly used treatment technique in dentistry. Tooth extraction can cause damage to local tissues, leading to reactions such as bleeding, swelling, and pain. It can also cause fluctuations in blood pressure, body temperature, and pulse, so it must be treated with caution. Special attention should be paid to patients with cardiovascular and hematological diseases, otherwise serious consequences may occur. Tooth loss can cause alveolar bone atrophy, displacement or elongation of adjacent and opposing teeth, leading to chewing disorders. The loss of front teeth directly affects pronunciation and appearance. Premature loss of baby teeth in children can cause dental and maxillofacial developmental abnormalities. Therefore, it is necessary to strictly control the indications for tooth extraction, and only consider extraction when the teeth have adverse effects on health and cannot be effectively treated and preserved.
The process of tooth extraction is a comprehensive test for doctors, which includes both their professional knowledge and skills, as well as their ability to flexibly apply their knowledge and skills. The above elements are a summary of my experience in the work process, which discusses the entire process of tooth extraction from several levels. The process of tooth extraction is a comprehensive application of many factors, so considering the above factors comprehensively before tooth extraction and being cautious and flexible in operation can cope with various common clinical cases, taking the ability of tooth extraction surgery to a new level.
