Flashcards in Intro to Extractions Deck (22):
How can luxators and elevators be distinguished?
- luxators thinner working end with sharp blade (softer metal)
- elevators have rounded end, blade spoon shaped
Why may different sized luxators and elevators be required?
- different sized teeth
- crown and root apex requires different sizes
Why are winged elevators more useful? What are the disadvantages?
- Thinner shaft for visualisation
- well adapted to tooth shape
- metal thin at wings so can chip/blunt easily
What tool is used to remove the tooth following luxation and elevation?
What kind of analgesia should be used for extractions?
- regional nerve blocks preoperatively
- multimodal opioid and NSAID if no contraindicatin perioperatively
Give 2 tools for the retrieval of root fragments
- root tip picks/elevators
- root tip extraction forcepts
What 2 periodontal attachments must be severed before the tooh can be extracted? What tools should be used?
- gingiva (scalpel or luxator, stab don't sweep, ensure reaches alveolar bone crest)
- periodontal ligament (luxator) *most difficult step*
Outline the method of entering the periodontal ligament space
- hold luxator at 30* angle towards tooth
- tip should feel slightly wedged in when periodontal ligament space has been entered
- walk luxator around tooth, cutting ligament and widening gap
- ensure within alveolar bone crest not just between bone and gingiva
How should an elevator be used?
- Insert into gap until it feels "wedged"
- Rotate around long axis
- Avoid digging and tilting action
- Count to 10 while holding under tension in rotated position
Which are the most useful aspects of the tooth to use an elevator on?
Mesial and distal
How should incisors be elevated?
How should exraction forceps be used?
- reach as far apically as possible
- apply MODERATE pressure (may fracture tooth)
- slowly rotate and apply traction
- hold for a few seconds
Which aspect of the maxilary tooth should not be elevated? Why?
Buccal - maxillary bone very thin, may fracture
What should always be carried out following an extraction?
Check apex of root for completeness and roundnesss
- suspect root fragmentation is sharp edges present
In what situations may ^ amounts of bone be left attached to extracted tooth?
- surgical extraction
- Post-mortem extraction
Is bone being left attached to extracted tooth an issue?
Not really, alveolar bone not required if no tooth present
How should multi-rooted teeth be removed?
1. cut gingival attachement
2. tapered fissure cutting burr help with modified pen grasp
3. transsect tooth at furcation making slight V shape so that elevator easier to insert later
4. check sections move independently (insert elevator at 90* into cut surface)
How should dental drills be used?
- fully activate foot pedal before touching tooth
- alternate 2 seconds of pressure, 1 second easing off
How does sectioning of 3-rooted teeth differ to 2 rooted?
- Furcation mesial/rostral to centre of crown (start at furcation rather than occlusal surface)
- in 109/209 cut between palatal and 2 buccal roots first, then second cut between 2 buccal roots will find natural stoping point
Which tooth requires special consideration?
maxillary 4th PM
- very closely adhered to 1st molar
- use tapered fissure burr to remove distal overhang of crown to make space for elevator
- be careful not to cut molar 1
Give 4 possible complications of extraction
- root fragmentation
- jaw bone necrosis (usually power tool overheating realted)
- iatrogenic jaw Fx
- oro-nasal fistula