Dentistry Extractions 1 & 2 Flashcards
(57 cards)
1
Q
What are the parts of teeth? (anatomy)
A
- Crown (one or more cusps)
- Enamel (HARD) - protects inside ; cemento-enamel junction
-Dentine -> bulk of mature tooth, porous
-PULP
2
Q
Cementum?
A
- avascular bonelike mineralised connective tissuen
- produced throughout life & thickens with age
3
Q
Pulp? describe?
A
- Divided into pulp chamber in crown and root canal in root
- Tissue not ‘nerve’ but contains connective tissue, blood vessels, lymphatics and nervous tissue
- Pulp becomes inflamed just like any other tissue which causes pain
- Pulp ‘horns’ follow the outline of the crown
4
Q
Root apex?
A
- Initially open with single large canal
- Closes at 7-11 m-o to form the Apical Delta, a group of 10-20 microscopic openings which allow the neurovascular communication of the pulp with the periodontal ligament
5
Q
Gingiva?
A
- This is the oral mucosa that covers the underlying bone of the alveolar process
- Mucogingival Junction
- Divided into Attached Gingiva and Free Gingiva
- The Free Gingiva forms the Gingival Sulcus
- Sulcular Epithelium and Junctional Epithelium
6
Q
periodontal ligament?
A
- Occupies the periodontal
space along with blood
vessels, nerves and
lymphatics - Interconnected,
interwoven bundles of
fibres, anchored to the
cementum and bone - Attach the tooth to the
bone and act as a shock
absorber during
mastication
7
Q
ALveolar bone?
A
- Formed by the alveolar process
perforated by the dental
sockets or alveoli - Bone that responds according
to Wolff’s Law - Cancellous bone surrounded by
Cortical bone - Lamina dura is the radiodense
line demarcating the alveolus
8
Q
Diphyodont?
A
Two sets of teeth = deciduous + permanent
9
Q
Describe tooth development
A
- Tooth development occurs within the jaw
- Enamel is formed by the time of eruption
- Apex open
- Apexogenesis
10
Q
Dogs how many teeth?
A
42
11
Q
How do we talk about teeth ?
A
Medial/lateral is called mesial and distal
Buccal/labial, lingual (inside off tooth lower jaw a,d palatal inside on top jaw)
12
Q
TRIADAN NUMBERING?
A
- First n° is quadrant (Right upper 1, RL 2, LL 3, RL 4)
- 2nd number is tooth
CANINE IS ALAWAYS 04
Maxiallary carnassial PM4 (08)
Mandibular carnassial is M1 (09)
Cats missing some!
13
Q
Dental probing?
A
- Periodontal probe to assess the pocket of gingival space
- Sharp explorer probe - looking for damage to tooth (resorption, fractures, caries)
14
Q
How to tell what the brown at the top of the tooth is?
A
If pulp exposure -> instrument will fall into it
If it’s tertiary dentine from having over-use /wear of teeth -> will feel smooth
15
Q
Describe the gingivitis index?
A
- No inflammation
- Mild gingivitis: mild reddening
and swelling of gingiva but no
bleeding when probed - Moderate gingivitis: gingival
inflammation with reddening
and swelling and will bleed
when probed - Severe gingivitis: significant
swelling of gingiva, sometimes
with ulceration. Will bleed
spontaneously
16
Q
Gum disease vs gingivitis?
A
gingivitis - inflammatory reaction
gum dx - body’s reaction leading to gum loss and bone loss
17
Q
what values for periodontal probing depth?
A
- Measurements are made at 4-6
locations around the tooth - Normal values
- Dog: 1-3mm
- Cat: 0.5-1mm
7Mm or more => needs extraction - Measurements greater than this
without gingival enlargement are
indicative of apical migration of
the gingival attachment
18
Q
How to measure gingival recession?
A
- Measure with periodontal probe
- Measurement made from cemento-enamel junction to the free gingival margin
19
Q
Periodontal index ?
A
This is calculated by adding the periodontal probing depth to the
gingival recession. The index is this figure represented as a
percentage of the root length. This figure is used as a guide to
decide when to extract a tooth.
20
Q
what total values for periodontal infdeces?
A
- No attachment loss
- Up to 25% attachment loss
- Between 25-50% attachment loss => depending on owner compliance may decide to extract
- Greater than 50% attachment loss => needs extraction
21
Q
Furcation exposure staging?
A
- No furcation exposure
- The furcation can be felt with
the periodontal probe. Bone
loss would typically be <1/3
width of furcation - The periodontal probe can be
placed >1/3 of the width of
the furcation - The periodontal probe can be
placed through the furcation
from the buccal to the
lingual/palatal side
22
Q
What is furcation?
A
if more than one root - area where they meet -> how much of it is exposed?
23
Q
Tooth mobility?
A
- No mobility
- Single root: horizontal mobility <1mm
- Single root: horizontal mobility >1mm
Multiple roots: horizontal movement <1mm
- Single root: horizontal and vertical movement
Multiple roots: horizontal movement >1mm and/or vertical
movement
24
Q
What dental tools?
A
- Luxators -> sharp instrument cutting flat blade to sever periodontal lig
- Dental elevators -> used as a lever, transmitting rotational force from handle to blade
25
Hybrids?
These hybrid instruments have a sharp cutting edge but are made of more robust steel so they can be used for elevation too
26
Extraction forceps?
Extraction forceps are used after elevation or luxation to grasp the loosened tooth and remove it from the alveolus.
27
Periosteal elevators?
to elevate mucoperiosteal flaps
28
Rotary instruments?
Rotary instruments are used in
oral and maxillofacial surgery
for sectioning teeth, removing
and smoothing alveolar bone,
cutting bone and drilling into
bone.
A high-speed hand-piece with a
carbide crosscut fissure bur is
indicated for sectioning multirooted teeth into single-rooted
units.
29
Indications for extraction?
* Periodontitis
* Pulp Necrosis
* Dental Fractures
* Tooth Resorption
* Chronic Gingivostomatitis/Chronic
Ulcerative Paradontal Stomatitis
* Persistent Deciduous Teeth
* Malocclusion
* Supernumerary, malerupted,
unerupted Teeth
* Caries
* Teeth Associated with Pathologic
Lesions
30
Types fo extractions?
- CLOSED vs surgical
Closed: other than within gingival sulcus not incising anything
31
Indications for closed extractions?
* Small, single-rooted teeth (incisors and 1st premolars)
* Maxillary 2nd molars in the dog often have two/three partly fused roots, so
these teeth are also usually extracted using a closed technique.
* Significant bone loss and the resulting increase in mobility associated with
periodontal disease usually leads to uncomplicated tooth extraction.
32
Indications for surgical extraction?
* Most multi-rooted teeth.
* Canine teeth in most cases; non-surgical extraction predisposes to
oronasal fistula.
* Periodontally healthy teeth where considerable resistance to
extraction may be encountered.
* If radiographs reveal dilaceration or other abnormalities in
root morphology
33
ADJACENT STRUCTURES?
34
Foramina and canals?
- infraorbital foramen & canal!
- Middle mental foramen
- Mandibular canal!
35
patient / surgeon prep?
pharyngeal gauze pack is recommended regardless of patient positioning to protect the airway.
* Removal of CALCULUS prior to extractions
* RINSING the oral cavity with a 0.12% chlorhexidine gluconate solution
prior to the procedure
36
Types of gingival/mucogingival flaps?
-Envelope flap
- Extended envelope flap
- Triangle flap
- Pedile flap
37
Envelope flap?
* An envelope flap is a gingival flap (i.e. not extending apical to the
mucogingival junction) created by making a sulcular incision and
elevating some of the attached gingiva on the lingual and buccal
aspects and no vertical releasing incisions.
38
Extended envelope flap? (mucoperiosteal)
* An extended envelope flap is useful for extraction of several
adjacent teeth. They are mucogingival flaps, i.e. incisions extend
apical to the mucogingival junction. Flaps used for extraction
procedures are full-thickness flaps that also include the periosteum.
39
Triangle flap?
mucogingival flap consisting of a sulcular incision
and one vertical releasing incision
40
Pedicle flap?
a sulcular incision with two vertical releasing incisions, this flap provides the best exposure
41
Local flaps?
* outlined by a surgical incision
* contains its own blood supply
* allows access to underlying
tissues
* can be replaced in its original
position
* expected to heal after being
sutured in place.
42
Technique for mucogingival flap?
- Incise through gingival sulcus
- If a mesial vertical releasing incision is to be made and incision is placed at the distobuccal line angle of the adjacent tooth through the mucogingival junction and extending into the alveolar mucosa
- A second distal vertical releasing incision may e made beginning at the mesiobuccal line angle of the adjacent tooth
- Incisions should extend apical to the mucogingival junction, so that the flap is as long as the root of the tooth
43
Bone removal step ?
(Alveolectomy)
* Using a round diamond (or carbide) bur in fine,
sweeping motions, the buccal alveolar bone is
removed beginning at the alveolar margin and
moving as far apically as desired.
* Minimal alveolectomy is often required for teeth
affected by periodontitis,
* Removal of up to 75% of the buccal alveolar
bone will facilitate extraction of teeth with little
to no bone loss, or ankylosed teeth.
* A small round bur may be used to cut the
periodontal ligament and make space for an
elevator or luxator
44
next step?
Sectioning multi-rooted teeth with burr
45
Luxation technique?
Luxator used as a wedge -> parallel to root tooth surfae
- Start at the periodontal lig space then advanced until apex is reached
- Go to opposite root surface and tear periodont lig
AVOID positioning luxator on buccal aspect of tooth as slippage mroe likely
46
Elevation techniques for when?
robust roots - canines and carnassias
47
Describe the elevation technique
Use as LEVER
- Place blade into periodontal space parallel to long axis of tooth
- Gently rotate to push the root away from the elevator, tearing the periodont lig and expanding the alveolar bone slightly
Use as WHEEL and AXLE lever
- Between the furcation of roots
- Placed at alveolar margin perpendicular to long axis and rotated with concave surface against the tooth
- Care not to wedge elevator against adjacent teeth
48
Bone removal (Alveoplasty) ?
* Sharp bone edges present after luxation and/or elevation will delay
healing of the gingival flap and lead to postoperative discomfort.
* Alveoplasty (the removal of these sharp bone edges) is performed
with a round diamond bur on a high-speed hand piece or bone
rongeurs.
49
Management of the alveolus,?
Following alveoloplasty, the empty
alveolus is cleared of debris. In
cases of advanced periodontitis,
gentle curettage of the alveolus
should be performed to remove
pocket epithelium and any
remnants of subgingival calculus
50
suturing ?
* Size 5-0 and 4-0 poliglecaprone
(Monocryl) is currently the most
compatible suture material for intraoral
use.
* Monocryl loses 20 to 30% of its original
tensile strength after 2 weeks, and is
completely absorbed by hydrolysis in 90
days.
51
suture needles?
The reverse-cutting needle which has a flat surface along its inner curvature prevents the inadvertent cutting of tissue and is the most commonly used needle in
oromaxillofacial surgery.
52
suturing the flap?
* No tension on the suture line.
* If necessary, bluntly dissect the flap submucosally towards the lip
margin in order to gain more tissue.
* Free the edge of the palatal/lingual mucosa by gently inserting the
periosteal elevator between the bone and soft tissue. .
* Lowering the margin of remaining alveolar bone using a round
diamond bur will also help reduce tension.
* The periosteum, may be incised if necessary, to ensure closure
without tension.
53
Periop Analgesia?
* Opioids (pre-op and post-op)
* Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
* Local anaesthesia (regional nerve blocks)
54
Important structures (nerve)?
Trigeminal CN V
- Sensory - emerges from trigeminal canal in the petrosal bone
- Divides into 3:
1. Ophthalmic
2. maxillary
3. mandibular
ALSO Maxillary nere
Mandibular nerve
INTRAORBIAL
55
Infraorbital local?
* Insert needle into infraorbital
canal and inject local
anaesthetic
Or…
* Deposit local anaesthetic at
opening of the canal
(infraorbital foramen)
56
What other local of maxilla?
Caudal maxillary - > * Insert needle into soft tissuescaudal to the dental arcade
and inject local anaesthetic
57
What regional local locations for mandible?
Mental
* Insert needle into mental foramen and inject local anaesthetic
Or…
* Deposit local anaesthetic at opening of the mental foramen
Mandible (inferior alveolar)
* Place index finger on angular
process
* Align the main cusp of the
mandibular 1st molar tooth with
the angular process
