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Module 6 - Oral Surgery > Difficulty of Extraction > Flashcards

Difficulty of Extraction Flashcards

1
Q

4 clinical features that make extractions in elderly patients more difficult.

A
  1. Teeth become more brittle (predisposed to fracture).
  2. Heavily restored (increase risk of fracture).
  3. Loss of tissue elasticity (teeth, alveolus, tuberosities).
  4. Polypharmacy.
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2
Q

Which populations tend to have thicken alveolar bone?

A

Afrocaribbean and asian.

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3
Q

Why do lone standing molars increase the difficulty of extraction (2).

A
  • Subject to occlusal force, there is THICKENING OF THE ALVEOLAR BONE AROUND THE TOOTH + THICKENING OF THE PDL + PNEUMATIZATION OF THE MAXILLARY ANTRUM.
  • Increases risk of alveolar fracture, tuberosity fracture, oro-antral communication.
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4
Q

What is a characteristic that can make a tooth EASIER to remove?

A

Periodontal disease

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5
Q

10 clinical features that increase the difficulty of extraction?

A
  1. Age.
  2. Ethnic background (quality/quantity of bone).
  3. Access (crowding, tilting, rotation, impaction).
  4. Lone standing molar.
  5. Abrasion cavities.
  6. Endodontically treated/ post crowned teeth.
  7. Extensive caries.
  8. Retained roots.
  9. Unerupted teeth.
  10. Submerged teeth.
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6
Q

Define Impaction

A

The tooth is prevented from achieving a functional occlusal position

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7
Q

4 commonest impacted teeth?

A
  1. Manidbular molars.
  2. Maxillary canines.
  3. Maxillary incisors.
  4. Second premolars.
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8
Q

As a general rule, which teeth are the ones to be most likely impacted?

A

The ones that erupt LATEST

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9
Q

Flap of gum overlying a partially erupted tooth?

A

operculum

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10
Q

What special forceps can be used to extract a maxillary 3rd molar when there is limited space available?

A

Bayonets.

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11
Q

Why do large abrasion cavities increase the difficulty of extraction?

A

Predisposes the crown to fracture so if the beaks of the forceps are not firmly on solid root then the crown will fracture off.

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12
Q

Why is removal of canine roots difficult?

A

Long and oval shaped roots.

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13
Q

When can luxators and elevator be used?

A

When enough of the root is fractured ABOVE the level of the alveolus so that a POINT OF APPLICATION can be created.

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14
Q

What happens when a root fractures BELOW the level of the alveolus?

A

Commits you to SURGICAL extraction.

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15
Q

3 reasons impacted teeth would be removed?

A
  • Orthodontic reasons (ex. orthodontic realigning aka uncover impacted tooth and bond to impacted tooth to realign it).
  • Restorative/ aesthetic reasons (ex. implant placement).
  • Pathology (ex. cysts).
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16
Q

2 causes of submerged teeth?

A
  • Deciduous molar teeth that are retained, often when there is no permanent successor OR due to ankylosis (less common).
  • Growth and eruption of adjacent teeth causes the alveolus to change position, leaving the submerged deciduous tooth behind.
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17
Q

8 radiographic features of difficulty of extraction?

A
  • bulbous roots.
  • dilacerated/ divergent/ convergent roots.
  • fused roots.
  • multi-rooted teeth.
  • hypercementosis.
  • ankylosis.
  • lone standing/ last standing molar.
  • deeply impacted 3rd molars.
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18
Q

What are bulbous roots? How are they caused?
How can these be extracted?

A
  • The apical portion/end of the tooth is wider than the neck of the tooth.
  • Genetic or due to hypercementosis.
  • Require SURGICAL removal.
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19
Q

Is it easier to take out a more “challenging” multi-rooted tooth with divergent roots on a younger or older patient?

A
  • on a YOUNGER patient as their bone is more ELASTIC.
  • Older patients have more brittle teeth and bones –> risk of fracturing the tooth or alveolus or tuberosity.
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20
Q

What condition causes an opaque cloud-like appearance in the mandible/maxilla?

A

cemento-osseous dysplasia

21
Q

How is cemento-osseous dysplasia managed?

A

SURGICAL removal of tooth + associated displastic tissue in maxilla/mandible.

22
Q

6 types of osteolytic lesions?

A
  • Cysts.
  • Odontogenic tumors.
  • Primary cancers.
  • Metastatic cancers.
  • Metabolic bone disorders.
  • Fibro-osseous lesions.
23
Q

How to differentiate radiographically between a benign or malignant osteolytic lesion?

A

Benign lesions are unlikely to cause extensive osteolytic lesions or extensive resorption of nearby teeth.

24
Q

3 extrinsic obstacles to extraction?

A

Proximity to:
- Adjacent teeth (ex. if tooth displaced, ectopic, tilted or rotated).
- IAN/ ID canal
- Maxillary antrum.

25
Q

3 intrinsic obstacles to extraction?

A
  • Bulbous root.
  • Multirooted & convergent/divergent/fused.
  • Marked curvature
  • Dilacerated.
26
Q

What is the 7 step plan made from the radiograph for a surgical extraction?

A
  1. Determine path of least resistance.
  2. Extrinsic obstacles.
  3. Intrinsic obstacles.
  4. Bone removal.
  5. Sectioning.
  6. Point of application.
  7. Flap design.
27
Q

5 things to include in a referral letter to a specialist oral surgeon?

A
  • Complaint and HPC
  • Past medical history
  • Past dental history
  • Justification for referral.
  • Up to date radiograph
28
Q

You attempted an extraction in general practice but part of the root broke off when attempting to extract. What must you do prior to sending a referral letter to a specialist?

A
  • Take a peri-operative/ post-operative radiograph detailing what is left in situ.
29
Q

Why is access for XLA of maxillary 3rd molars difficult (2)?

A
  • Because mouth opening brings the CORONOID PROCESS into the space lateral to the maxillary 3rd molar.
  • Teeth are often slightly buccally inclined.
30
Q

Why do endodontically treated teeth increase the difficulty of extraction?

A
  • Teeth are more BRITTLE and thus more likely to FRACTURE.
31
Q

How do caries/ condition of the crown increase the difficulty of extraction?

A

Inadequate tooth tissue to engage the beaks of the forceps.

32
Q

What can be used to extract carious teeth?

A

Cowhorns.
Elevators.

33
Q

How do we use elevators?

A

Point of application between the root surface and the alveolus.

Do NOT use adjacent teeth.

34
Q

3 cases where application of forceps may cause the crown to come off.

A
  • Caries of the crown
  • Grossly fracture teeth
  • Postcrown
35
Q

Why may we wish to refer for XLA of teeth with postcrowns?

A

Postcrowns often also have caries down the length of the post, thus coronal part of the root retaining post may also be carious.

36
Q

What is the most common pathology impacted teeth develop?

A

Cysts

37
Q

How are submerged teeth treated?

A

Requires SURGICAL REMOVAL, would not be undertaken in primary care.

38
Q

How are unerupted teeth removed?

A

All unerupted teeth require SURGICAL MANAGEMENT.

39
Q

What determines the path of withdrawal of a tooth?

A

The shape of the root determines the path of withdrawal of that root. Thus if 2 roots have different POW, need sectioning and removal.

40
Q

Cause and effect of internal root resorption on difficulty of extraction?

A
  • Inflammatory aetiology.
  • More CHALLENGING XLA as the tooth structure is compromised. Forcep XLA would lead to crown fracture, leaving crown behind.
41
Q

Cause and effect of external root resorption on difficulty of extraction?

A
  • Inflammatory aetiology.
  • Less challenging XLA.
42
Q

3 types of periradicular infections and their effect on degree of difficulty of XLA?

A
  • Periapical.
  • Periodontal
  • Osteomyelitis.

Cause OSTEOCLASTIC BONE RESORPTION, making XLA EASIER.

43
Q

What is ankylosis?

A

Tooth fuses to bone and cannot be mobilized using forceps.

44
Q

How is XLA of ankylosed teeth done?

A
  • Cannot be XLA using forceps.
  • Will have to be done in SECONDARY CARE.
45
Q

3 reasons to take radiograph of lone standing maxillary molar if going to XLA?

A
  • Assess proximity to antrum
  • Root morphology (convergent, bulbous, divergent, fused).
  • Assess risk of OAC or fractured tuberosity.
46
Q

What is the path of least resistance?

A

Natural path of extraction/ natural path of eruption of the tooth.

47
Q

What is good practice to do before sectioning teeth?

A

Lift a MUCOPERIOSTEAL FLAP.
- Gives GOOD VISUAL ACCESS and can take away bone where needed before sectioning teeth.

48
Q

What is used to section teeth? Why?

A
  • Never use a high speed handpiece to section roots as it causes surgical emphysema and introduces air in to the tissue and can lead to cellulitis
  • There are surgical handpieces that do not introduce air into the tissues
49
Q

Where can difficult extractions be reffered to? (3)

A
  • Oral surgery specialist.
  • Maxillofacial department.
  • Oral surgery department

Module 6 - Oral Surgery (11 decks)

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