extractions Flashcards by Charlotte Watkins

why is radiographic assessment important before extraction?

important anatomy eg.

teeth close
root curvature
sinus

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why might teeth be unrestorable?

gross caries
advanced perio
tooth/root fracture
severe tooth surface loss
pulpal necrosis
apical infection

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what are the indications for extractions?

symptomatic partially erupted teeth
traumatic position
orthodontic indications
interference with constructed dentures

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straight upper anterior forceps

perfectly straight for upper anterior
canine-canine
central incisors & canines best
tip is wide for laterals

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upper universal forceps

tip same as upper straight
handle curved
most upper teeth
not molars

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why is the handle of upper universal curved?

allows further into mouth w/o stretching

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upper molar forceps

same handle as universal
tip
one side same as universal for palatal root
buccal side surface to engage root
-point in middle to go in gap between buccal roots called beak

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how many roots do upper molars have?

2 buccal, 1 palatal

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why is there left and right upper molar forceps?

roots of molars are mirror images

cant use same forceps as need to engage furcation on one side

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how are lower forceps held?

90 degree angle

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describe cowhorn

lower
very pointy tips
smooth
no concave edges
not good grip
for extracting with squeezing force
only used in teeth with good furcation and soft bone- younger px

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how many roots do lower molars have?

2
mesial distal
so anatomy same

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upper bayonet 3rd molar forceps

upper posterior
z-shape - allows good reach into mouth
for wisdom teeth 
tip like upper universal
no beak- bad grip

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upper bayonet root forceps

pointy tip for grabbing roots of upper molars
fractures, if enough root to grab
narrow tip for fine root

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where should you stand for lower right quadrant?

behind px

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where should you stand for lower premolars?

behind to the right
direct vision of area
non-dominant hand supports jaw & moves soft tissues

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where should you stand for lower left quadrant and all uppers?

in front of px, on the right of px

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what should you change for upper anteriors?

lie px back

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what are elevators used for?

facilitated extractions
to mobilise before forceps to prevent fracture and easier extraction
always use first

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coupland’s elevators

3 sizes
bigger number= wider tip
half tip of universal
in correct place & rotate correctly can elevate tooth
if used incorrectly will damage adjacent teeth

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cryer’s elevators

par
when holding concave surface facing ceiling, pointing up
right hand= right, left hand = left
point toward each other
to elevate root
eg fractured root
rotate to lift

warwick james elevators

pair
like cryers also straight
small couplands
-elevating lower wisdom teeth, small
hold in hands w/ concave facing ceiling, pointing at each other
pointy, but less

what are upper roots used for?

roots

what are upper straights used for?

centrals, laterals, canines

what are upper left & right used for?

molars

what are upper 3rd molar bayonette used for?

8's

how do you know the difference between upper root and upper universal?

upper root have thinner beak than upper universal

how do you know the difference between upper straights and upper universal?

straights handle in line with beak, forceps straight from handle to tip universal curved handle and beak at angle to handle

what are lower roots used for?

retained roots

what are lower universals used for?

incisors, canines, premolars

what are lower molars used for?

molars

what are lower cowhorn used for?

broken down molars

how do you tell the dif between lower root vs universal?

hold side by side | root much thinner beak

how do you tell the dif between lower cowhorn vs molar?

hold side by side cowhorn thin, pincer like beak to get into furcation molar pointed beak to engage furcation

how should a patient be positioned for upper teeth?

comfortable height supine position 45-90 degrees

how should a px be positioned for lower teeth?

more upright position | 0-45 degrees

how should the operator be positioned for LR?

behind right shoulder

how should the operator be positioned for UR, UL, LL?

stand in front | on px right side

describe extraction technique

ensure soft tissues clear of forceps apply forceps as far down root as possible w/o traumatising gingivae place thumb and finger of left hand on alveolar bone for support apply apical pressure apply movements for extraction if lower molar support mandible

what are the movements for extraction for a multirooted tooth eg molar?

figure 8

what are the movements for extraction for a single rooted tooth?

rotation

what are the movements for extraction for multi-rooted premolars?

rotation

what should you do post-extraction?

check tooth apices are intact check if socket clear if retained root/bone easy to remove then do so if not easy call for help place dampened gauzze in site and as px to bite leave 5-10 mins then check haemostasis achieved give post-op instructions get checked

what are luxators used for?

to sever and tear pdl | create mobility

describe the tip of a luxator

rounded

what are elevators used for?

create space

how are elevators used?

wedge, lever or wheel/axel

describe the tip of an elevator

sharp

describe warwick james elevators

left, straight, right point inwards good for wisdom teeth

describe cryers elevators

left, right | point inwards useful in furcation of molars

how should you hold an elevator/luxator

palm of hand curl thumb and fingers round handle index finger on shank for support & control

how should you use a luxator

position same as forceps place left thumb and finger on alveolar bone -supports bone, prevents fracture, retracts tissues, supports mandible luxate in buccal sulcus from mesial to distal