What Are the Principles and Techniques of Dental Exodontia

Exodontia is the area of dentistry that revolves around tooth extractions. As the most common form of oral procedure, tooth extractions are a critical service for dentists to offer. Performing exodontia services requires a thorough understanding of the specific instruments, best practices, and operation workflow involved in the procedure.

Tooth extractions don’t have to be an anxiety-inducing experience for patients. The more emphasis you put on mastering even the most basic principles of exodontia, the better care you can provide for your patients. Learn more about the principles and techniques of dental exodontia and apply these practices to your own clinic to better serve clients and improve your skills as a dental professional.

The Importance of Preoperative Assessments

As with any medical procedure, exodontia must start with a preoperative patient assessment. Gathering information such as patient medical history, current medications, and ideal pain management strategies helps you obtain the knowledge needed for a smooth and successful operation.

The preoperative assessment should also include a thorough examination of the tooth you’re going to extract, as well as the surrounding intraoral and extraoral areas. Diagnostic methods, such as a radiograph, will give you a clearer image of the tooth and its root configurations. This is also the time to note and prepare for any complications, such as excessive decay, cracks or chips in the tooth, and other factors that you need to be aware of during the procedure.

Assistance With Procedures

Staffing is a crucial part of a successful exodontia procedure. Partnering with an assistant gives you an extra set of eyes and hands to catch mistakes, handle instruments, and so much more. Well-trained staff can help you keep track of patient files and information, including obtaining consent forms and organizing critical information like allergy profiles.

During the procedure itself, assistants help improve efficiency and organization by handling instruments and anticipating which tools you’ll need next. Assistants can also help with lighting, suction, irrigation, and other critical components. These services allow you to focus more on your patient and the operation, making the procedure easier and more comfortable for everyone involved.

Comfortable Operator and Patient Positioning

You must pay attention to positioning. The arrangement of yourself, the patient, the operating chair, and everything else in your workspace plays a key role in a smooth and comfortable procedure. In addition to patient comfort, pay attention to your own posture. Minimize bending, twisting, and other uncomfortable positions, as these can lead to ongoing pain and injury in the long run.

Visibility and control are also critical. Ensure the patient’s positioning allows for easy access to their mouth, and arrange your lighting to illuminate the mouth without interfering with your line of sight.

Best Practices for Using Elevators

Elevators are simple yet essential tools that allow you to loosen the tooth before using forceps to remove it. Mastering the use of elevators makes tooth extractions easier and minimizes the risk of complications, such as a fractured crown. You can also use elevators to remove parts of the roots that you have already sectioned off.

There are many variations of the elevator tool, but they all consist of three main parts: a handle for proper grip and control, a blade to transmit the force you exert on the tool onto the tooth, and a shank connecting the handle and the blade. Elevators use the principles of three simple machines—wedges, levers, and wheels—to exert different types of force onto the tooth and loosen it in its socket.

Wedge Principle

Elevators that use the wedge principle usually have a straight blade that is in line with the shank and grip. The straight blade helps loosen the tooth by placing pressure between it and the jawbone—much like a wedge splits or displaces the material you place it into. Dentists place the elevator blade between the tooth and bone at an angle parallel to the long axis of the tooth. This separates the tooth from its socket, effectively loosening it for extraction later in the operation.

Lever Principle

Certain elevators can also work as levers to loosen the tooth. This works best with an elevator with an angled blade. You will also need an indent in the tooth where the blade can find purchase and apply force without slipping. By using the jawbone as a fulcrum, dentists can turn small movements on the grip of the elevator into a large force on the blade, thus lifting the tooth from its socket.

Wheel and Axle Principle

The wheel and axle principle is ideal for loosening or removing sections of roots from the socket. Once again, an elevator with an angled blade—such as a Cryer elevator—is the ideal tool for applying this type of force. The blade acts as a wheel, while the handle acts as an axle. By turning the grip, you can exert a rotational force on the end of the tool. This, in turn, allows you to lift the root up and out of its place with minimal disturbance to the surrounding tissue and bone.

Best Practices for Using Forceps

Forceps—the basic instrument dentists use to access and remove the tooth during an extraction—also use the principles of simple machines to achieve results. Like a pair of hardware pliers, forceps consists of a handle, a hinge, and a beak.

However, there are several variations with different beak shapes for accessing and removing teeth from different parts of the mouth. Additionally, forceps come in two patterns: English and American. English Pattern forceps have a hinge that angles vertically away from the handle, creating a clear fulcrum next to the working end of the tool for greater leverage. American Pattern forceps have a hinge that is in line and horizontal with the handles.

Forceps allow dentists to apply pressure to the tooth in sequential motions until it is free from the socket. This process starts with apical pressure as the dentist places the beaks on either side of the tooth. Next is buccal and palatal pressure as the dentist moves the tooth in a side-to-side motion. The dentist will then apply rotational force to turn the tooth in its socket. Bear in mind that rotational pressure only works for teeth with single, conical roots that won’t fracture within the socket. Finally, tractional force allows the dentist to pull the tooth from its socket.

Ensuring the Best Care for Your Patients

Though tooth extractions use simple principles, mastering the ins and outs of these techniques takes dedication and experience. That’s why Simply Implants Institute offers hands-on extraction courses for practicing dentists. With the chance to learn new skills and gain in-person experience with real patients, you can bring the best principles and techniques of dental exodontia to your own practice.