Lecture 5 4/15/25

Question 1

What must be considered regarding a tooth when planning an extraction?

Answer 1

-mobility
-condition of the crown
-configuration of roots
-proximity to other important structures
-condition of surrounding bone

Question 2

Which arteries are important to consider when doing extractions?

Answer 2

maxillary:
-lateral nasal artery
-branch of the major palatine artery

mandibular:
-middle mental artery
-rostral mental artery

Question 3

Which instruments are used for extractions?

Answer 3

-15 blade
-scalpel handle
-high-speed handpiece
-burs
-dental elevators and luxators
-root tip picks
-extraction forceps
-thumb forceps
-needle holder
-suture

Question 4

What are the characteristics of periosteal elevators?

Answer 4

-used to elevate gingival flaps
-held in a modified pen grip or safety grip
-used to retract flap during bone removal

Question 5

What are the benefits of the modified pen grip?

Answer 5

-good dexterity
-gently handles tissue
-good for thin or friable tissue

Question 6

What are the benefits of the short-stop palm grip/safety grip?

Answer 6

-best strength and control
-helps with lifting well-adhered tissue

Question 7

What are the steps to flap elevation?

Answer 7

-place the edge of the elevator blade into the incision
-shimmy the elevator full thickness under the flap with the edge of the blade directed toward the bone
-peel the flap off the bone with the black of the blade contacting the flap
-use a slow rotating motion to separate the flap

Question 8

What are the uses of each type of bur?

Answer 8

-round carbide bur: remove buccal alveolar bone over roots
-cross-cut fissure bur: section multi-rooted teeth
-diamond bur: alveoloplasty/smoothing alveolar bone after extraction

Question 9

What are the characteristics of round burs?

Answer 9

-sizes 1 through 6 used for buccal bone removal
-sizes 1/4 and 1/2 used to create “moats” around teeth to fit dental elevator into
-want a size that will quickly remove bone without causing collateral damage

Question 10

What are the characteristics of pear burs?

Answer 10

-used for the same things as round burs
-sizes 330, 331, and 332 for buccal bone removal
-size 329 for moating

Question 11

What are the characteristics of tapered fissure burs?

Answer 11

-used for sectioning teeth
-begin at furcation area and work towards the cusp of the crown
-use light paintbrush style strokes to get through tooth
-can be used for buccal bone removal

Question 12

What are the characteristics of diamond burs?

Answer 12

-multiple shapes and sizes
-football and round shapes are most commonly used

Question 13

What are the characteristics of elevators, luxators, and root tip pics?

Answer 13

-used as levers or wedges
-tear the periodontal ligament
-elevates or luxates from the alveolus
-always held with a safety grip

Question 14

What are the characteristics of the 1st order lever use of elevators?

Answer 14

-placed in PDL space and rotated
-longitudinal to the root
-used with rotational forces

Question 15

What are the characteristics of the wheel and axle use of elevators?

Answer 15

-placed perpendicular to the long axis of the root
-used with rotational forces

Question 16

What are the characteristics of luxator use?

Answer 16

-used as a wedge
-sharp, thin instrument
-used with apical force to cut the PDL and expand the space between the alveolus and tooth
-DO NOT rotate

Question 17

What are the characteristics of extraction forcep use?

Answer 17

-used to remove loosened tooth from alveolus
-grasp as apically on the tooth as possible
-pull straight out while rotating slowly in one direction
-do not wiggle tooth

Question 18

What are the characteristics of appropriate suture material for dental extractions?

Answer 18

-absorbable
-monofilament
-synthetic
-4-0 in dogs, 5-0 in cats
-taper needle causes less iatrogenic trauma but dulls faster
-reverse cutting needle stays sharper but causes more trauma and may cut through the tissue

Question 19

What makes an extraction simple/non-surgical?

Answer 19

-small, single rooted teeth
-mobile teeth
-sulcular incision
-no flap creation
-no bone removal

Question 20

What makes an extraction surgical?

Answer 20

-large, multi-rooted teeth
-minimal mobility
-flap created
-bone removal required

Question 21

What are the steps for extraction?

Answer 21

-rads
-sulcular incision (between gums and tooth)
-possible creation of mucoperiosteal flap
-possible removal of buccal bone
-breakdown of PDL
-extraction of tooth
-curettage of extraction site
-alveoloplasty of alveolar bone
-radiograph to ensure successful extraction
-closure of flap if created

Question 22

What are the characteristics of an envelope flap?

Answer 22

-horizontal excision
-easy to close
-minimal exposure

Question 23

What are the characteristics of a 3-corner flap?

Answer 23

-vertical incision with a horizontal incision
-increased exposure

Question 24

What are the characteristics of a 4-corner flap?

Answer 24

-2 vertical release incisions with a horizontal incision
-maximum exposure and flap mobility
-takes the longest to close

Question 25

What are the characteristics of mucoperiosteal flap creation?

Answer 25

-divergent incisions -incisions should be supported by bone when flap is closed -do not cut through sulcus of a neighboring tooth -extend vertical incisions into the mucosa -be aware of surrounding vessels and nerves

Question 26

How is appropriate elevator size chosen?

Answer 26

want the elevator surface to be about as wide as the tooth

Question 27

What are the characteristics of periosteum release?

Answer 27

-periosteum is full of collagen and does not stretch -can use scissors to bluntly dissect periosteum off rest of flap and cut it -periosteum releases allows the flap to stretch and cover the defect as needed

Question 28

What are the characteristics of flap closure?

Answer 28

-start at corners of flaps -continue with horizontal incision first, then vertical incision(s) -simple interrupted sutures with 5 to 6 throws -cut the suture tails short -space sutures 2 to 3 mm apart -place pressure on flap to check for gaps/blood flow

Question 29

What is the approach to multi-rooted teeth?

Answer 29

-after removal of buccal bone, split tooth into individual root components -start at furcation and use fissure bur to cut through the crown -continue as if each section was a single rooted tooth

Question 30

What are the characteristics of the maxillary 4th premolar and molars?

Answer 30

-three rooted teeth -palatal root needs separated from the more buccal roots -blind sectioning done with a fissure bur -tooth sectioned into 3 components -buccal roots are removed first -bone can be removed on buccal aspect of palatal root as needed once first two roots are removed

Question 31

How is a fractured tooth complication handled during extraction?

Answer 31

-visualize the fragment -increase exposure and enlarge the flap -remove buccal alveolar bone -create moat around fragment with small bur -use small elevators to mobilize the fragment -use small extraction forceps to secure the fragment -take and refer to radiographs at any point

Question 32

When is it better to leave a fractured-off root tip?

Answer 32

-risk outweighs benefit of removal -small fragment less than 3mm in length -deeply embedded in bone -no evidence of periodontal or endodontic infection

Question 33

What must be done if a root tip is left behind?

Answer 33

-owner notified of complication -radiographic record of root tip taken -patient monitored for signs of infection

Question 34

What are the characteristics of jaw fracture complications?

Answer 34

-most common when removing mandibular canines in cats and small dogs -can occur easily with advanced bone loss -must prepare owners if there is a risk -better to manage an iatrogenic fracture than allow continued bone loss to lead to pathologic fracture -can try to prevent complication during extraction by removing adequate buccal bone and stabilizing both mandibles with non-dominant hand

Question 35

What are the characteristics of local tissue damage complications?

Answer 35

-can damage/perforate the eyes, nasal cavity, sinuses, and mandibular canal -short stop grip and minimally applied apical forces can help to prevent damage

Question 36

What are the characteristics of infection complications?

Answer 36

-occurs with poor technique -want to use clean or near-sterile technique -systemic antibiotics not usually needed in healthy patients -antibiotics are used in cases of osteomyelitis and immunocompromised patients -can do local or oral rinses with chlorhexidine if concerned about contamination/infection

Question 37

What are the characteristics of dehiscence and oronasal fistula formation?

Answer 37

prevention: -tension-free closures -flaps supported by bone -appropriate tissue handling treatment: -allow second intention healing if dehiscence occurs but underlying bone is present -allow 4 to 6 weeks of healing before corrective surgery to allow for angiogenesis and reduction of inflammation