lecture 3 Flashcards by Luke Lloyd

indications for extraction

have to have an assessment - this is a 50 year old male, we are taking out number 5 for this reason

severe caries
pulpal necrosis
severe periodontal disease
orthodontic reasons 
mal-opposed teeth
cracked teeth
pre-prosthetic extactions 
impacted teeth
supernumerary teeth

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potential contraindications for extractions

uncontrolled systemic conditions

pregnancy - 1st and 3rd trimesters don’t want to do anything -
2nd trimester if we have to get them out

bleeding?meds

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local contraindications for extraction

previous head/neck radiation

previous systemic anti-resorptive therapy

acute pericoronitis - gum on the distal of the 3rd molar - we get in under control before we take it out

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potential anatomic considerations for extraction

IAN proximity
Sinus
Adjacent teeth

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chair and operator position for standing surgeon :

maxillary

maxillary teeth:
~maxillary arch level with surgeon’s elbow or below
~turn head to quadrant of extraction is visible
~lateral protrusive position of the mandible

patient lays down

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chair and operator position standing surgeon

mandibular

upright so when mouth is open,. arch is parallel to floor
bite block
lower chair
turn head so quadrant of extration is visible
some prefer behind the patient approach

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what kind of patients do we do pre-radiation

patients with head and neck cancer we do pre-radiation

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radiographic eval for extractions:
~proper exposure
~proper date/name - less than _ old
~entire root visible
~relationship to vital structures (sinus, IAN)
~configuration of roots (length and morp, RCT)
~condition of surrounding bone (density, PDL,patholgy)

less than 1 Have to either have a periaplic, a pan or CBCT

Film has to be within a year

Things we want to look at when we get the film
Sinus, root, bone year old

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what do we use as a “throat screen”

gauze

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optional “behind the patient” position for _ extractions (which arch?)

mandibular extractions - especially when performing solo

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basic principles of extraction:
~CONTROLLED FORCE
- all about _, not strength
-do not use excessive force
-recognize when it won’t work easily and processed to surgical extraction
-place finger/thumb around _ to stabilize

NEVER _ the Tooth

all about mechanical advantage. not strength

place finger/thumb around alveolus to stabilize

never “pull” the tooth
push, rock, rotate

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simple machines - basis of extraction techniques

_ instrument fulcrum on bone and lifts tooth out(crier the east west or flag)

lever action

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simple machines - basis of extraction techniques

wedge to break off the _

break off the periosteum

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simple machines - basis of extraction techniques

wheel and axle

look up in book

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elevators:

_ technique - safer, more controlled force

straight
root tip

wedge

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elevators:

_ technique likely to break fragil elevators or teeth and bone
-cryer, cogswell, straight

lever-mechanism

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elevators:

_ technique we use a cryer for

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wheel and axle

purpose of _

primary purpose - loosen teeth in preparation for extraction with forceps

create space for forceps
may be primary mechanism for extraction 3rd molars

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elevators

Always use elevators first

Sometimes only need an elevator

Primary - loosen it up

secondary - remove parts of tooth/root

secondary purpose of elevators

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remove parts of tooth or root

usually the initial instrument used

primary use- for expansion of alveolus and loosening of tooth/PDL

-Good force, don’t damage adjacent teeth

Loosen of bone and pdl

often used incorrectly: do not fulcrum off the adjacent tooth
care must be used to avoid damage to adjacent teeth
use with working end pointed from _ toward the _ or _

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straight elevators

working end pointed from facial toward the lingual or apex

NOT A CROW BAR

straight elevator:

proper use is counter intuitive for _

wedges the apical edge of the elevator against _ and _ the tooth
avoids force on adjacent tooth

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counter intuitive for mobilization

against crestal bone and pushes the tooth(does not scoop)

If isolated - Turn into the tooth not scoop out

If scoping out - we will elevator the adjacent

Can do this if doing full quad extract

straight elevator:

when used to “scoop” the tooth out, significant force is placed on the adjacent tooth, do not do this routinely, use when _

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used when taking out several adjacent teeth

_ elevators:

lever and/or wheel and axle forces

care as can fracture tooth and bone

primary use- removing residual roots from multi-rooted teeth

sharp tip removes interseptal bone providing access to the retained root

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cryer elevators

primary use- removing residual roots from multi-rooted teeth

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cryer elevators

sharp tip removes interseptal bone providing access to the retained root

cryer elevators primary use - removing residual roots from multi-rooted teeth

_ elevators fragile elevators appearance seems to indicate they would be for "prying" out root tips prying forces will bend/break these instruments sole use is as a _, "wiggle" fine tip apically to _ root tip from socket, sharply pull in a vertical vector to displace root tip

sole use is as a wedge wedge root tip (do not pry)

when wedging out a root tip with a straight elevator the finger rest is to control _ force -insert elevator into the PDL space, avoid pressure that will displace the root into the sinus

apical force

Forceps not for "pulling" teeth -use the forcep as a _ and _ - primary force is initially and greatest magnitude of force in _ direction to seat the forceps - secondary force is _ to expand alveolus to release the tooth - last is minimal _ force

as a handle and lever primary force is initially in an apical direction secondary force is buccal, lingual, or rotational to expand alveolus and release the tooth last is minimal tractional force First get periostoal elevator - loosen with small elevator and then forceps

forceps movement produces significant _

wedging expand the bone and rotate the tooth out

loosening of soft tissue attachment: sharp end of _ first for relief - dental curette - confirms anesthesia - allows forceps to be seated apically or elevator to be placed interproximally - be kind to soft tissue

sharp end of periosteal elevator spoon end is for surgical extraction

luxation with elevator usually a _ elevator _ to the interproximal space or _ to the long axis of the tooth - luxate tooth - exapnd bone - avoid injury to adjacent teeth/crowns - confirms degree of mobility/establishes need for surgical extraction

straight elevator perpendicular to interprox space or parallel to long axis of the tooth

adaptation of the Forceps choose forceps that will adapt well to the _ morphology of the tooth - confirm long axis of beaks clears adjacent teeth to avoid trauma - seat with apical force - avoid pinching soft tissue - firm apical force - move center of rotation apically to prevent root fracture - expands alveolus and widens PDL space

subg morp of the tooth

forceps - firm apical force - move center of rotation _ to prevent root fracture - expands alveolus and widens PDL space

apically

luxation with forceps: firm grip straight wrist with force generating from shoulder and upper arm (not wrist) firm, steady, sustained force - hold and flex bone to allow expansion of the alveolus primarily _ first with less _ force, rotate the tooth gently after mobilization continue to re-seat the forceps apically, do not fracture the crown

primarily buccal at first with less lingual force

removal of tooth from socket: slight _ usually (buccal or lingual?) is the final step of removal of a tooth not a pulling motion

slight traction - usually buccal is final step

post-extraction care of the socket: remove debris is present (PA lesion, calculus, amalgam, tooth fragments) - realign _ plate - compress socket - debride granulation tissue from gingival sulcus - smooth any sharp bone - pressure from 2x2 placed over the extraction site to promote hemostasis

realign buccal plate - compress socket Digital palpation to confirm no sharp bone or anything

forcep figure-8 or "ratchet" motion works well, especially for _ teeth

multi-rooted teeth

_ forcep designed to engage the furcation of lower molar no crown requirement to engage tooth - may be better than 151 for broken down teeth must seat into furcation with _ up and down action before any buccal/lingual rotation seat on _ first taking care not to injure soft tissue

cowhorn #23 mandibular molar forcep seat into furcation with pumping up and down seat on lingual first

maxillary incisors: #1 and #150 apical, buccal, lingual, rotation, traction less rotational forces during the removal of _ teeth

maxillary laterals

maxillary canines: #1 and #150 apical, buccal, lingual, rotation, traction -these teeth have long roots and are difficult to extract often require _ _bone is heavier than _ bone

often require mucoperiosteal flap palatal bone is heavier than buccal bone

Maxillary molars if a root is going to fracture, then more favorable to fracture a _ root

more favorable to fracture a buccal root

easiest teeth to extract?

mandibular bicuspids - premolars very conical, straight roots

lecture 3 Flashcards

(42 cards)