Features of the procedure and tool for complex wisdom tooth removal. Tooth extraction: execute, cannot be pardoned Brief summary of the topic of the practical lesson

The method of tooth extraction depends on several factors, the main one being the degree of destruction of the tooth being removed. Thus, teeth with a retained crown are often removed using forceps; when removing roots, the technique is completely different - elevators are used.

Tooth extraction can be: simple, complex or atypical.

• In a simple tooth extraction, only one instrument is used.
• If the doctor uses two or more instruments, then this is a complex removal (gouging out, sawing out the tooth with a drill, etc.).
• In case of atypical removal, an incision is made in the mucous membrane and a mucoperiosteal flap is cut out.

When removing a tooth with a retained crown, the doctor must sequentially perform the following steps:

• Detachment of the circular ligament of the tooth is carried out with a trowel from the vestibular and oral sides, which subsequently facilitates the application of forceps. Also, with this manipulation, the doctor checks how well the local anesthesia worked.
• Applying the cheeks with forceps - the doctor spreads the cheeks so that the crown of the tooth to be removed fits between them. The forceps must be applied in such a way that their axis coincides with the axis of the tooth.
• Advancement of the forceps - you need to move the cheeks under the gum until you feel a tight grip on the tooth.
• Closing (fixation) - the handles of the forceps are then compressed, thereby fixing the tooth with the cheeks. If the forceps are closed weakly, it is impossible to loosen the tooth; if the forceps are squeezed too tightly, the crown of the tooth can be broken.
• Tooth luxation – the doctor may rotate the tooth (rotation) or wobble it (luxation). Such movements are carried out with a gradual increase in their amplitude. Rotation can be applied to single-rooted teeth (incisors, canines and mandibular premolars) and free-standing roots of multi-rooted teeth. Luxation is indicated for teeth with multiple roots, but it can also be used for single-rooted teeth. An important point is the direction of the first movement when removing a tooth, which should be directed towards less resistance. So, when removing the teeth of the upper jaw, the tooth begins to dislocate outwards (with the exception of the first molars, when the first movement should be carried out in the palatal direction). On the lower jaw, the seventh and eighth teeth begin to loosen lingually, the rest - buccally.
• Tooth extraction - after the tooth being removed is completely separated from the retaining ligaments, it is carefully removed from the socket. The direction of movement is outward and up or down (depending on which jaw tooth is being removed).

The technique of removing teeth using elevators requires the doctor to have experience working with them. The most important thing is to find a fulcrum for the working part of the tool.

So, with a thick wall of the alveolus, they try to pass the elevator between the root of the tooth and the wall of the socket, after which they carry out rotational movements with the instrument, gradually loosening the tooth.

When removing lower molars, it is often possible to penetrate the root furcation area with a narrow elevator, after which the tooth is lifted (like a lever), removing it from the socket. Sometimes a molar breaks along the line of root connection, after which such roots are removed with forceps or an elevator.

After tooth extraction, the socket is inspected, granulations and bone fragments are removed from it, sterile swabs are applied and the patient is asked to press them tightly with his teeth or jaws. They give recommendations: keep the tampons for 20 minutes, do not heat the wound site, do not rinse the mouth during the day.

Difficult removal

Removal is considered difficult if the doctor uses more than one instrument. However, this does not mean that the tooth is technically difficult to remove. It is more convenient to dislocate the roots with an elevator and then remove them from the hole with forceps.

Also a complex technique includes tooth extraction using a chisel or drill, when the surrounding bone tissue is removed or the tooth is sawed into several parts.

Atypical removal technique

If during the removal process it becomes necessary to make an incision and cut out a mucoperiosteal flap, then this is an atypical removal. This technique is used to remove impacted (non-erupted) or supernumerary teeth, as well as to fracture the root tips.

First, an incision (usually trapezoidal) is made in the projection of the tooth to be removed, after which the flap is separated from the bone using a smoother or rasp. Then they begin to remove the bone plate using burs (always with cooling!). If an impacted tooth is removed, all the bone around its crown is cut out, after which it is dislocated with an elevator. If the broken root tip is removed, most of the alveolar wall is cut off, after which the tip is removed with an excavator or a narrow elevator.

After removal, the hole is washed with antiseptic solutions, hemostatic sponges or the drug “Alveogyl” are left in it, sutures are applied and recommendations are given to the patient.

METHODOLOGICAL DEVELOPMENT FOR TEACHERS No. 2

TO CONDUCT A CLASS ON

4th COURSE OF DENTAL FACULTY IN CHILDREN'S CARE

ORAL MAXILLOFACIAL SURGERY

TOPIC: TOOTH EXTRACTION OPERATION IN CHILDREN.

Time 3 hours 30 minutes

LEARNING AND EDUCATIONAL GOALS

1. Study the characteristics of the child’s body and indications for tooth extraction in children.

2. Study the features of tooth extraction in children.

3. Study the basic principles of deontology when working with children.

2. MATERIAL EQUIPMENT: tables, slides, phantom, tools for tooth extraction. The lesson is held in the maxillofacial surgery hospital, the surgical room of the children's dental clinic

3. QUESTIONS WHICH KNOWLEDGE IS NECESSARY TO STUDY THIS TOPIC:

1. Anatomy of the dental system.

2. Indications for tooth extraction.

3. Stages of tooth extraction.

4. Tools for removing teeth.

5. Errors and complications of tooth extraction.

QUESTIONS TO BE STUDYED IN CLASS

1. Anatomical features of teeth and jaws in children.

2. Periods of tooth change.

3. Indications for tooth extraction in children.

4. Stages of tooth extraction in children.

5. Features of the technique of tooth extraction in children.

6. Errors and complications of tooth extraction in children.

CALCULATION OF STUDY TIME

1. Introduction – 10 min.

2. Test control of the initial level of knowledge – 20 minutes.

3. Oral interview on class issues - 40 minutes.

4. Carrying out the tooth extraction operation on a phantom – 20 minutes.

5. Work with patients – 120 minutes.

6. Analysis of situational problems on the topic of the lesson - 20 minutes.

7. Review of case histories - 30 minutes.

8. Final control, homework – 10 minutes.

GENERAL GUIDELINES

After checking those present, the teacher introduces students to the tasks and topic of the practical lesson. The significance of the topic is determined by the peculiarities of the operation of tooth extraction in pediatric surgical dentistry. Control of the initial level of knowledge is carried out in the form of test and situational tasks. In the classroom, students perform tooth extractions on phantoms. In the dressing room and surgical room, students, 3-4 people in each subgroup, become familiar with the operation of tooth extraction in pediatric dentistry. Students, under the supervision of a teacher, perform dental extractions on pediatric patients. The teacher corrects practical skills. The final level of knowledge on a given topic is determined through a survey, during which the teacher evaluates students’ knowledge and corrects it. In conclusion, the teacher gives a description of the group’s work. The degree of preparedness of students is noted. An assignment is given for the next lesson.

PROGRESS OF CLASSES

INDICATIONS FOR TEETH EXTRACTION IN CHILDREN:

I. Temporary bite (up to 6 years).

1. Temporary teeth that erupt at birth.

2. Acute odontogenic diseases (purulent periostitis, osteomyelitis, lymphadenitis, abscesses and phlegmon).

3. Ineffective treatment of chronic granulating periodontitis when the process spreads to the follicle of a permanent tooth.

4. Resorption of more than half the length of the root and tooth mobility of II – III degrees.

5. Removal due to injury or traumatic dystopia of incisors during root resorption.

II. Changeable bite (from 6 to 11 years).

1. Acute odontogenic diseases (purulent periostitis, lymphadenitis, abscesses and phlegmon):

· with resorption of more than half the length of the root of a temporary tooth;

· if the tooth is not subject to conservative treatment.

2. Odontogenic osteomyelitis of the jaws.

3. Acute pulpitis and periodontitis of temporary molars in children 9–10 years old.

4. Ineffectiveness of treatment of chronic periodontitis of temporary and permanent teeth.

5. Spread of inflammation to the interroot septa of multi-rooted temporary and permanent teeth.

6. The presence of a temporary tooth or its roots when the permanent one has erupted.

7. Delayed resorption of the roots of a temporary tooth, which prevents the timely eruption of a permanent tooth.

8. All types of traumatic fractures of the root of a temporary tooth and fracture of the root of a permanent tooth when it is impossible to use it under a pin tooth.

9. Fracture of the crown of a tooth due to resorption of its root.

10. Removal of temporary teeth due to trauma.

11.Temporary and permanent teeth located in the jaw fracture line.

III. Permanent bite (11 – 15 years).

1. Teeth that are the source of odontogenic osteomyelitis (mainly molars).

2. Teeth with chronic granulating or granulomatous periodontitis that is not amenable to treatment (conservative or surgical).

3. Significant destruction of the coronal part of the tooth when it is impossible to use its root for prosthetics.

4. Complications associated with dental treatment (perforation of the bottom of the pulp chamber or tooth root during exacerbation of the inflammatory process).

5. Supernumerary, impacted teeth that do not have the conditions for eruption.

6. Temporary teeth that have survived up to 15 years in the presence of correctly positioned permanent teeth (according to x-ray data).

7. Teeth located in the jaw fracture line:

· intact, making it difficult to reposition fragments;

· teeth with a chronic inflammatory process in the area of ​​the root apexes, which do not prevent the reposition of fragments.

8. Comminuted or longitudinal fracture of the root.

9. Orthodontic indications.

10. Supernumerary, as well as complete, severely dystopic teeth, which cannot be moved to their normal position using modern orthodontic and surgical methods.

STEPS OF TOOTH EXTRACTION OPERATION

1. Separation– separation of the circular ligament from the neck of the tooth and the gum from the alveolar process.

The basic rule: thoroughness.

2. Applying forceps to a tooth.

Basic rule: the axis of the cheeks of the forceps must coincide with the axis of the tooth.

3. Advancing the cheeks of the forceps.

When removing teeth with a retained crown, the cheeks of the forceps are advanced to the neck of the tooth. When resolving the bone around the tooth, it is permissible to move the forceps deeper, to the upper part of the root. When removing tooth roots, forceps are applied to the edge of the alveoli.

Basic rule: the axis of the cheeks must coincide with the axis of the tooth.

4.Fixing or closing the forceps.

The forceps and the tooth being removed must form a “single whole”. The tooth and forceps form common lever arm.

5. Dislocation tooth

There is a rupture of periodontal fibers connecting the tooth to the walls of the socket.

There are two possible methods of dislocation:

Luxation – rocking (pendulum-like) movements in the vestibular-oral direction;

· rotation – rotational movements around the tooth axis by 20-28 0 in one direction and then in the other direction. Rotation is possible with dislocation of: 11, 12, 13, 21, 22, 23 and separated roots 14, 24, 17, 18, 26, 27, 28;

Basic Rules:

a) the first dislocation movement should begin in the direction of least resistance (where the wall of the socket is thinner);

The vestibular wall of the alveolar process is usually thinner than the palatal wall. Therefore, the first dislocation movement when removing teeth and roots of the teeth of the upper jaw should be done in the vestibular direction (outward). The exception is teeth 16 and 26, because at the level of these teeth there passes the zygomaticalveolar ridge, thickening the outer wall. Therefore, when removing these teeth, the first dislocation movement is carried out in the palatal direction. When removing lower teeth, the presence of an external oblique line in the area of ​​​​the molars leads to the fact that when removing these teeth, the first movement must be made in the oral direction.

b) make the first dislocation movement weak; the amplitude of oscillations should be gradually increased.

6. Extracting a tooth from its socket. It occurs when the connection between the tooth and the tissues that hold it in the socket is completely lost. It is carried out smoothly, without jerking.

7.Socket curettage.

The basic rule: the curettage spoon must be the same size as the hole. In the upper jaw, one should remember the presence of the maxillary sinus.

8.Ensuring the formation of a complete clot and bringing the edges of the socket closer together using gauze swabs.

Basic rule: the clot must be complete, i.e. do not go beyond the hole (do not be loose, overlapping the edges of the hole).

Wisdom teeth are the last in a row of molars that erupt between the ages of 18 and 25, and sometimes 40 years.

Often it is these elements of the jaw row that cause people a lot of trouble, so their removal in most cases is justified.

However, this procedure has several features compared to the removal of incisors or fangs, since the figure eights have a rather complex structure and location.

Indications

Complex tooth extraction is a procedure in which it is not possible to get rid of a damaged or destroyed element of the jaw row using the classical technique.

This is often due to the development of an inflammatory process or the occurrence of an infection, but there are other reasons.

Dentists identify the following indications for removal:

• identification of a dystopic tooth, that is, an element whose growth is directed towards neighboring units of the row, lingual or buccal area, which prevents its normal eruption and participation in the chewing process;
• development of pericoronitis– a pathology characterized by difficult eruption, resulting in inflammation of the periodontal tissue and gum hood that covers the growing molar, swelling of the gum tissue and its suppuration are possible;
• severe destruction of the jaw row element as a result of carious lesions that cannot be eliminated therapeutically;
• permanent mechanical injury the mucous membrane of the oral cavity due to the inconvenient location of the figure eight, which can lead to the occurrence of non-healing ulcers with their further degeneration into a malignant neoplasm;
• absence of eruption of the third molar, accompanied by pain, inflammation of the gums, displacement of the remaining elements of the row;
• destruction of a neighboring element in the process of eruption of the last molar in the row;
• not wide enough jaw, as a result of which there is no free space for full eruption and correct placement of the wisdom tooth;
• cyst formation at the root, flux or fistula due to infection;
• the presence of curved and excessively long roots, which can lead to their fusion with the bone tissue of the jaw or penetration into the maxillary sinus.

Contraindications

Despite the complications that can arise from keeping figure eights if they are not grown and placed correctly, experts note that there are conditions where removing these elements can lead to more serious problems.

Absolute contraindications prohibiting extraction of third molars include the following conditions:

• malignant tumors in the root area;
• the presence of hemangioma - a benign tumor that is prone to progression and germination into surrounding tissues;
• chronic diseases of the cardiovascular system.

In addition to absolute contraindications, there are conditions that require elimination before wisdom tooth extraction. These include the following diseases:

• psychoneurological disorders in acute condition;
• viral infections;
• suffered a heart attack, stroke, hypertensive crisis in the recent past;
• high blood pressure that cannot be stabilized with medications;
• infectious lesions of the oral mucosa - herpes, gingivitis, stomatitis;
• period of therapy with drugs that affect blood clotting;
• pregnancy and lactation.

Diagnostic measures

Complex wisdom tooth removal requires a thorough preliminary examination of the patient’s oral cavity using certain diagnostic methods.

This allows you to find out all the nuances of the placement of the third molar in the soft tissue, its interaction with neighboring elements and the placement of the root system.

A complete diagnosis of a wisdom tooth includes the following procedures:

• external examination of the oral cavity patient to determine the condition of the gum tissue, the state of the bite, identifying the integrity of the visible part of the molar and its susceptibility to carious lesions:
• taking an x-ray in order to determine the number, shape and location of the roots, the direction of tooth growth, planning further extraction with determining the sequence of actions and the necessary instruments;
• orthopantomography– taking an x-ray in 3-D format to most accurately determine the structure of the third molar and select a method for its removal.

In some cases Consultation with related specialists may be required– periodontist, orthodontist. They will help determine the possibility of preserving the problematic element or confirm the need for its extraction.

Differences from simple extraction

Wisdom tooth extraction has certain difficulties compared to the classic procedure for removing an incisor or canine. Despite the same result that needs to be achieved, these two operations have many differences.

Tools used

To carry out the procedure, the dentist requires a large selection of specialized instruments. Let's look at the main devices used.

Nippers, excavator, elevator

To pull out the destroyed elements of the jaw row and roots, the following tools are used:

• Forceps. They can be straight or curved and S-shaped. With their help, the specialist extracts from the soft tissue the preserved sections of the crown part of the tooth, as well as the processes of the root system.
• Excavator– a tool for extracting parts of a molar remaining in the gum tissue after its fracture. One of its surfaces is inserted into the hole between the remaining tooth fragments and the alveolus, and allows them to be pulled out.
• Elevator helps to loosen the fragment and carefully remove its remains and roots. The instrument is used in the presence of dystopic molars and fragments with a shallow fracture of the base or roots.

Bit

This instrument is used when it is necessary to remove the walls of the alveolar process in the event of a fracture of the tooth body.

Dentists often use a chisel with high bone density and the impossibility of threading the elevator between the root and the alveolus.

The technology for using a chisel when removing a wisdom tooth is as follows:

• placing the working part of the instrument in the space between the socket and the root of the molar;
• performing several gentle blows on the chisel with a special hammer;
• advancing the instrument into the space between the roots and the alveoli;
• dislocation of the molar and its extraction.

Drill

The use of a drill is required when removing large and dystopic molars, the presence of broken row elements with many roots, or the need to saw teeth during other complex extraction procedures.

Depending on the location of the unit a specialist can cut it into two or three fragments, and then remove from soft cloth.

The sawing process is carried out under anesthesia, so the patient does not experience pain or discomfort during the procedure.

Order of conduct

Removing a wisdom tooth is a rather complex procedure, consisting of a certain sequence of actions.

It begins with an initial examination, during which the dentist finds out the patient’s complaints and examines his oral cavity using suitable equipment.

If there are any diseases of the oral cavity, they are eliminated, after which the specialist can begin the extraction procedure.

Complex third molar extraction is performed as follows:

• The patient is given an anesthetic drug, which completely anesthetizes the area of ​​the oral cavity where the operation will be performed in 3-5 minutes.
• An incision is made into the gum tissue detachment from the bone to provide access to the problematic unit and its root system.
• To remove a tooth, a hole is drilled in its body or the element is sawn into several parts, after which it is removed from soft fabric. Then the roots of the teeth are removed if they have been broken.
• The hole is cleared of blood and carefully examined check for any broken pieces or roots.
• If necessary, the wound is cleaned of purulent contents by installing drainage, after which it is treated with antiseptic drugs.
• Sutures are placed on the gum tissue made of self-absorbable material.

The first examination is scheduled 2-3 days after the operation. The dentist examines the treated surface to make sure there are no signs of inflammation.

Possible complications

In the first week after tooth extraction, the patient may experience some discomfort associated with the operation. The most commonly observed complications are:

1. Pain– reaction to making an incision in the gum and removing a tooth. Most often it goes away within 3-4 days. To reduce discomfort, you must take painkillers prescribed by your doctor.
2. Swelling. It occurs as a result of damage to soft tissue during surgery, but may indicate the development of an allergy. Dentists recommend applying ice to the swollen area of ​​the jaw and taking an allergy medicine.
3. Bleeding from the socket. A small amount of blood appears due to damage to the soft tissue and the vessels in it. To reduce bleeding, it is worth placing a gauze swab into the socket of the extracted tooth.
4. Temperature increase It is considered a natural reaction of the body to surgical intervention. If it does not go away within a few days, you should contact a medical facility.
5. Suppuration of the hole. The cause of this complication may be poor oral hygiene or the presence of tooth remains in the soft tissues. The situation requires immediate contact with the dentist.
6. Loss of sensation in the jaw area. This can occur when the facial nerve is affected during surgery. Most often, the symptom disappears 4-5 months after surgery, but in some cases surgery may be required.
7. Alveolitis– inflammatory process in bone tissue. Requires referral to a specialist and treatment in a hospital setting.

For a quick and painless rehabilitation period, the patient must follow the following recommendations:

• remove the gauze swab from the hole 15-20 minutes after surgery;
• refrain from eating for three hours after surgery;
• apply ice to the cheek to prevent the development of swelling;
• during hygiene procedures, be careful not to remove a blood clot from the socket;
• do not touch the hole with your hands or tongue, do not eat hot, spicy, hard foods and dishes;
• refrain from smoking, drinking alcohol, and visiting the sauna.

Price

The complexity of the wisdom tooth removal procedure affects not only the duration of the operation, but also its cost.

Depending on the prestige of the dental center and the clinical situation, you will have to pay from 1,500 to 5,000 rubles for the extraction of a third molar.

Moreover, in addition to the removal operation itself, the patient often has to pay for related procedures:

• consultation can be either free or cost 300-500 rubles;
• carrying out an x-ray examination often costs 600-700 rubles;
• performing anesthesia– 200-300 rubles.

The process of extracting an impacted wisdom tooth on the lower jaw is presented in the video.

The term “extraction”, which is still used, incorrectly characterizes the nature of the tooth extraction operation. As is known, teeth are firmly connected to the jaw bone by periodontal fibers, and to the gums by means of fibrous bundles. Tooth extraction becomes possible only after tooth dislocation movements break the periodontal and gum fibers holding it and disrupt the connection of the tooth with the alveolus and gum. Thus, the main technique that determines the effectiveness of this operation is tooth dislocation; only after this should it be removed.

The operation of tooth extraction is performed with special tools: forceps and elevators (lifts). In addition, there is another method of removing teeth by gouging and sawing out.

Before proceeding with the operation, the doctor must carefully examine the tooth to be removed in order to outline a plan for the intervention and select the appropriate tools. It is necessary to remove hard and soft deposits from the teeth. The latter should be done at least on the teeth to be removed and on the teeth adjacent to it, so that when moving the forceps under the gum cheeks, these infected deposits will not be pushed into the wound and surrounding soft tissues.

Position of the doctor and the patient. Of great importance for a successful tooth extraction operation is the correct position of the doctor and the patient, as well as the use of the doctor’s left hand.

To remove the upper teeth, the patient is seated in a chair with his head slightly tilted back so that the entire upper row of teeth is clearly visible. The chair is raised depending on the height of the doctor and the patient so that the tooth to be removed is at the level of the doctor’s shoulder joint. The doctor stands to the right and in front of the patient.

There is no need to raise the chair to remove lower teeth. The patient is seated in such a way that the head is in a straight or slightly tilted forward position, and the lower jaw is at the level of the elbow joint of the doctor's lowered arm. When removing teeth on the right half of the lower jaw, the doctor stands to the right and slightly behind the patient (Fig. 24), and when removing teeth on the left half, he stands to the left and slightly in front of the patient (Fig. 25). If tooth extraction is performed with the patient lying down, it is necessary that when removing the lower teeth the assistant slightly raises the patient’s head. It is necessary to carefully ensure that the dislocated tooth, especially when working with elevators, does not slip out and enter the patient’s respiratory tract.

Rice. 24. Removal of a tooth on the right half of the lower jaw.


Rice. 25. Removal of a tooth on the left half of the lower jaw.
Rice. 26. The position of the doctor when removing a tooth in the upper jaw.

The position of the free left hand when removing teeth on the upper jaw is as follows: with one of the fingers of the left hand, the index or thumb, the upper lip is pushed back, and the other finger is placed on the palatal surface of the alveolar process in the area of ​​the tooth being removed (Fig. 26).

When removing teeth on the lower jaw on the right, the doctor covers the patient’s head with his left hand; with the index finger of the left hand, pulls back the lip or cheek and fixes this finger on the alveolar process in the area of ​​the transitional fold; pushes the tongue back with the thumb and covers the alveolar process from the lingual side; the remaining fingers are located outside and fix the jaw. When removing the lower left teeth, the doctor stands to the left and slightly in front of the patient; The index finger moves the lip or cheek near the tooth being removed, the middle finger is located on the lingual side. The other fingers are on the outside.

If the doctor, while removing teeth on the left side of the lower jaw, stands to the right and in front of the patient, then his freedom of movement is constrained and the surgical field is darkened. When removing teeth using elevators, the position of the left hand is the same as when removing teeth with forceps.

Correct use of the free left hand allows for a clear view of the surgical field, protects soft tissues (lip, tongue, floor of the mouth, etc.) from injury from forceps or elevators, makes it possible to fix the alveolar process during surgery and, finally, allows you to fix the lower jaw , which facilitates tooth extraction and protects against the possibility of dislocation of the lower jaw.

The stages of a tooth extraction operation consist of successive stages:

ligamentotomy;

forceps delivery;

moving the cheeks of the forceps under the gum;

closing the forceps (fixation);

tooth dislocation (luxation or rotation);

extracting a tooth from the socket (traction).

Ligamentotomy. The circular ligament is separated from the neck of the tooth and the gum from the edge of the alveoli using a smoother or a narrow flat rasp. Careful separation of the circular ligament and gums facilitates the advancement of the cheeks of the forceps under the gums and prevents rupture of the mucous membrane during the intervention.

Applying forceps to the tooth; The axis of the cheeks of the forceps must coincide with the axis of the tooth. Incorrect application of forceps leads to root fracture during tooth dislocation.

Moving the cheeks of the forceps under the gum.

Closing the forceps. The tooth to be removed must be firmly fixed in the forceps. When moving the forceps, the tooth should also move at the same time.

Tooth dislocation. When a tooth is dislocated, the periodontal fibers are torn.

Reception is carried out in two ways: swinging (luxation) outward and inward and rotation (rotation) around the axis of the tooth by 20-25°.

Luxation and rotation should be carried out gradually, without rough movements or jerks. The tooth is rocked in the direction of least resistance, where the wall of the socket is thinner. In the upper jaw, the outer (vestibular) wall of the alveolus is weaker and thinner, so the first dislocation movement is carried out in the vestibular side (with the exception of the first large molar). On the lower jaw, the front teeth are dislocated to the vestibular side, the remaining teeth to the oral side.

Rotation is performed when removing teeth that have one cone-shaped root (incisors and canines of the upper jaw, small molars of the lower jaw and separated roots of the first small molar and large molars of the upper jaw).

Extracting a tooth from the socket (traction). The tooth is removed from the socket smoothly, without jerking.

After removing the tooth from the socket, it is inspected, making sure that all the roots of the tooth are completely removed, growths of granulation tissue, fragments or remaining granuloma at the bottom of the socket are removed, and the gums that were exfoliated during the operation are put back in place. The protruding areas of the bone are bitten off with forceps, and the edges of the gums are also brought together by squeezing on both sides with fingers through a gauze pad. If there is a large wound, stitches are applied. Stop the bleeding. The patient is warned about the need to maintain oral hygiene.

Complications during extraction: bleeding, fracture of the crown or root of the tooth being removed, fracture and dislocation of the adjacent tooth, pushing the tooth root into the soft tissues, trauma to the soft tissues of the oral cavity, fracture of the alveolar process, dislocation and fracture of the lower jaw, perforation of the bottom and pushing the root into the maxillary sinus , neuritis of the inferior socket nerve, tooth aspiration, development of alveolitis, osteomyelitis of the tooth socket.