[Theory and practice of tooth extraction].
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Comprehensive oral examinations carried out over a period of about 10 years on participants in the Veterans Administration Dental Longitudinal Study were evaluated to identify teeth extracted during this time and to ascertain the apparent reason for these extractions. The study population included 736 dentulous adult males, 49% of whom experienced 1,142 extractions. Caries was judged to be the primary cause of tooth loss, responsible for 33.3% of the teeth extracted. Extractions in preparation for a prosthesis (31.3%) and periodontal disease (18.7%) were the other major causes of tooth loss. Thus, dental caries was the prime cause of tooth extraction in this sample of US male adults, while a second major cause was preparation for a prosthesis which included the extraction of sound teeth and teeth with carious lesions which could have been restored. Periodontal disease was clearly not the major cause of tooth loss and was responsible for only 18.7% of the extractions in this population. The results of this study demonstrate that dental caries is a major problem in adults, leading to greater tooth loss than periodontal disease. A large percentage of the tooth loss in these individuals was clearly preventable. The same emphasis placed upon caries prevention in children should be applied to the adult population.
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This study evaluated the time of eruption of maxillary and mandibular premolars after the premature loss of the antecedent; the contralateral side was used as the control. Although environmental factors seem to influence tooth emergence, they appear to have little influence on tooth maturation.
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Three cases are presented that illustrate the potential for accelerating the healing phase with fixture-based treatment. Depending on the clinical circumstances, techniques may include radical alveolectomy, the use of fresh extraction sockets, and fixture placement in inter-radicular bone.
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A rare complication involving hypoglossal nerve paralysis after extraction of third molars is reported. The possible pathophysiology of the condition is discussed. The paralysis was temporary and resolved within one week of surgery.
Extraction therapy can be applied only under strict observation of indications. It requires thorough knowledge of the laws governing the migration of teeth after extraction, the normal development of the orofacial system and normal eruption of teeth. Careless extractions performed without thorough prior analysis cause irreparable harm instead of improving the situation. In the majority of cases extraction must be followed by appliance therapy to achieve controlled closure of the spaces, align the teeth in the dental arch and restore proper occlusion. The mode and extent of this treatment must be planned at the outset.
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