Technique for Multiple Extraction
The surgical procedure for removing multiple adjacent teeth is modified slightly. The first step in removing a sin- . gle tooth is to loosen the soft tissue attachment from around the tooth (Fig. 8-5 1, A and B). When performing multiple extractions, the soft tissue reflection is extended slightly to form a small envelope flap to expose the’ erestal bone only (Fig. 8-51, C). The teeth are luxated with the straight elevator (Fig. 8-51, D) and delivered with forceps in the usual fashion (Fig. 8-51, E). If removing any of the teeth is likely to require excessive force, the surgeon should remove a small amount of buccal bone to prevent fracture and bone loss. After the extractions are completed, the buccolingual plates are pressed into their preexisting position with firm pressure (Fig. 8-51, F). The soft tissue is repositioned, and the surgeon palpates the ridge to determine if any areas of sharp bony spicules or obvious undercuts can be found. If any exist, the bone rongeur is used to remove the larger areas of interference, and the bone file is used to smooth any sharp spicules (Fig. 8-51, G). The area is irrigated thoroughly with sterile saline. The soft tissue is
cont’d F,Alveolar plates are compressed firmly together to reestablish presurgical buccolingual width of alveolar process. Because.of mild periodontal disease, excess soft tissue is found, which will be trimmed to prevent excess flabby tissue on crest of ridge. G, Rongeur forceps is used to remove only bone that is sharp and protrudes above reapproximated soft tissue. H, After soft tissue has been trimmed and sharp bony projections removed, tissue is checked one final time for completeness of soft tissue surgery. I, Tissue is closed with interrupted black silk sutures cross papilla. This approximates soft tissue at papilla but leaves tooth socket open. Soft tissue is not mobilized to achieve primary closure, because this would tend to reduce vestibular height. ), Patient returns for suture’ removal 1 week later. Normal healing has occurred, and sutures are ready for removal. The broad band of attached tissue remains on ridge, similar to what existed in preoperative situation (see A) inspected for the presence of excess granulation tissue. If any is present it should be removed, because it may prolong postoperative hemorrhage. The soft tissue is then – reapproximated and inspected for excess gingiva. If the teeth are being removed because of severe periodontitis , with bone loss, it is not uncominon for the soft tissue flaps to overlap and cause redundant tissue. If this is the situation, the gingiva should be trimmed so that no overlap
occurs when the soft tissue is apposed (Fig. 8-51, H). However, if no redundant tissue exists, the surgeon must not try to gain primary closure over the extraction sockets. If this is done the depth of the vestibule decreases, which may interfere with denture construction and wear.
Finally, the papillae are sutured into position (Fig. 8-51, I and” f). Interrupted or continuous sutures are used, depending on the preference of the surgeon. . In some patients a more extensive alveoloplasty after ultiple extracons is necessary. Ch-‘l.~ter 13 has an in- ?epth discussion of this technique. –