OSM Extraction I and II

Question 1

What is the primary instrument for making incisions?

Answer 1

Scalpel w/ no. 15 blade held in a pen grasp

Question 2

What is required once an incision is made and what is the best instrument?

Answer 2

Reflect tissue from underlying cortical bone in a single layer

Question 3

What are 2 uses of the pointed end of No 9 Molt periosteal elevator?

Answer 3

1. Begin periosteal reflection

2. Reflect dental papilla from between teeth

Question 4

What is the use of the round end of the No 9 Molt periosteal elevator?

Answer 4

To continue elevation of periosteum from bone

Question 5

What is the motion used for the pointed end No 9 Molt Periosteal Elevator?

Answer 5

Twisting prying motion commonly done when elevating dental papilla between teeth or attached gingival around tooth to be extracted

Question 6

What are 2 reasons to use soft tissue retractors?

Answer 6

1. Visibility during surgery

2. Protect soft tissue from sharp instruments

Question 7

What are the 2 most popular cheek retractors?

Answer 7

1. Austin retractor

2. Minnesota retractor

Question 8

What is the most efficient stroke for the No 9 Molt periosteal elevator?

Answer 8

Push stroke with either blunt or pointed end to slide underneath periosteum to separate it from bone

Question 9

Most common instrument used to retract the tongue during routine extractions?

Answer 9

Mouth mirror

Question 10

What is the most common instrument to grasp soft tissue?

Answer 10

Adson forceps (primarily the anterior mouth)

Question 11

What is used to grasp soft tissue in the posterior mouth?

Answer 11

Stillies forceps

Question 12

For most dentoalveolar surgery what is the normal way to control bleeding?

Answer 12

Pressure. If more, use hemostats

Question 13

What instrument is most commonly used for removing bone in dentoalveolar surgery?

Answer 13

Rongeur forceps

-bone cutting

Question 14

How are rongeur forceps used?

Answer 14

Small biting motions to remove small bits of bone

Question 15

What can be used to remove larger sections of bone more aggressively?

Answer 15

Burs in a high speed, high torque handpiece. No 557 fissure bur, No 703 fissure bur, No 8 round bur, or acrylic bur-like bur

Question 16

In what motion do bone files only remove bone?

Answer 16

Pulling motion only

Question 17

What instrument used to remove granulomatous tissue or cysts or any debris from a tooth socket?

Answer 17

Curette

Question 18

How is a needle holder designed?

Answer 18

locking handle, short, stout beak with cross hatchings

Question 19

Why can’t hemostat be used for suturing?

Answer 19

parallel grooves in beak decrease needle control

Question 20

What is the design of a suture needle?

Answer 20

Curved to allow access with either a tapered tip or a triangular cutting tip

Question 21

How is the suture needle held in the needle holder?

Answer 21

held approximately 2/3 distance between tip and needle base

Question 22

How is the needle holder held by the operator?

Answer 22

Thumb and ring finger through rings with index finger along the length of the needle holders

Question 23

How is suture material classified?

Answer 23

Diameter, resorbability, mono or polyfilament

Question 24

What is necessary when extracting mandibular teeth to prevent stress on the TMJ?

Answer 24

Support mandible with Bite Block

Question 25

Is surgical suction the same as general dental suction?

Answer 25

No it has a smaller orifice to more adequately remove fluid from site and avoid tissue injury by sucking tissue into orifice

Question 26

What instrument is used to luxate teeth from the surrounding bone before applying forceps?

Answer 26

Elevators

Question 27

What are 3 components of an elevator?

Answer 27

Handle, shank, blade

Question 28

When is it best to use the straight elevators?

Answer 28

At the beginning of luxation of erupted tooth

Question 29

When are triangular elevators (Cryers) best used?

Answer 29

when broken root remains and adjacent socket is empty

Question 30

What motion is used with the Cryer elevators?

Answer 30

Wheel and axel

Question 31

What instruments are used for removing tooth from alveolar bone?

Answer 31

Extraction forceps

Question 32

What are the 3 basic components of extraction forceps?

Answer 32

Handle, hinge, beak

Question 33

What is the design of extraction forcep beaks?

Answer 33

Designed to adapt to tooth root near junction of crown and root

Question 34

What are the extraction forcep beaks designed to grasp : the root or the crown?

Answer 34

Root

Question 35

Maxillary extraction forcep beaks designed how?

Answer 35

Single rooted teeth, and teeth with 3 roots

Question 36

Why not have a maxillary forcep designed for two rooted teeth due to the maxillary first premolar commonly having two roots

Answer 36

The 2 roots normally occur in the apical 1/3

Question 37

After luxation, Maxillary single rooted teeth are removed with what?

Answer 37

Maxillary universal forceps No 150

Question 38

No 150 Maxillary universals can be used on what teeth?

Answer 38

Maxillary central incisors, maxillary lateral incisors, Maxillary canines, maxillary premolars

Question 39

Modified No 150 used for premolars because its beak has benn modified to be more parallel

Answer 39

150A

Question 40

These maxillary forceps can be used for maxillary incisors and canines. They are straight.

Answer 40

No 1 forceps

Question 41

What is the morphology of the maxillary molar roots?

Answer 41

3 rooted, 1 palatal root and a buccal bifurcation

Question 42

How must a maxillary molar extraction forcep be designed to accommodate this root morphology?

Answer 42

have smooth concave beak for palatal root and pointed beak to engage buccal bifurcation

Question 43

Due to their design, how are Maxillary molar extraction forceps presented?

Answer 43

in pairs (right and left)

Question 44

What are the most common maxillary molar forceps?

Answer 44

No 53 right and left

Question 45

These are a variation for Maxillary molar extraction with longer more accentuated beaks. Still presented as pairs.

Answer 45

No 88 right/left upper cowhorn forceps

Question 46

What is a problem associated with No 88 Upper cowhorn forceps?

Answer 46

Crush crestal alveolar bone and can remove large portion of buccal plate

Question 47

What are English forceps?

Answer 47

Vertical hinge and vertically positioned forceps

Question 48

What is required in the design for mandibular extraction forceps?

Answer 48

Beaks that can be used for single rooted teeth (incisors, canines, premolars) and 2 rooted teeth (molars)

Question 49

Forceps most commonly used for mandibular single rooted tooth extraction

Answer 49

No 151 Lower universal forceps

Question 50

Modified No 151 for mandibular premolar teeth with more parallel beaks. Only to be used on mandibular premolars

Answer 50

No 151A

Question 51

What is the risk with using the English forceps on mandibular anterior single rooted teeth?

Answer 51

Can generate great force and increase risk of root fracture

Question 52

What is the root morphology of the mandibular molars?

Answer 52

Two rooted with bucco-lingual bifurcation

Question 53

What does the single bucco-lingual bifurcation on mandibular molars mean for the presentation of the mandibular molar forceps?

Answer 53

Only need one, don’t need a right and left like maxillary because mandibulars lack a palatal root

Question 54

What is the design of mandibular molar forceps?

Answer 54

Straight handles with beaks set obliquely downward with pointed tips to engage buccal and lingual bifurcations

Question 55

What is the commonly used mandibular molar forceps?

Answer 55

No 17

Question 56

What is an alternate to the no 17 molar forceps?

Answer 56

No 87 cowhorn forceps

Question 57

How are No 87 Cowhorns used?

Answer 57

Once seated, the handles are pumped up and down while handles are squeezed together to squeeze the tooth out of the socket

Question 58

What are the 5 general steps for exodontias?

Answer 58

1. Loosen soft tissue around tooth (#9 Molt) 2. Luxate tooth with elevator 3. Adapt forceps to root 4. Luxate tooth with forceps 5. Remove tooth from socket w/ gentle traction

Question 59

Are the 5 steps considered together or separately and can some be skipped?

Answer 59

Consider as separate steps. Some may be modified/omitted as situation dictates

Question 60

What instrument and how is it used to luxate the tooth?

Answer 60

small straight elevator (#301) using bone as fulcrum, not adjacent teeth

Question 61

Which beak is normally seated against the tooth root first: buccal or lingual?

Answer 61

Lingual

Question 62

When luxating the tooth with forceps, what direction is the pressure applied, and which way is lateral movement made first: buccal or lingual?

Answer 62

Srong apical pressure, luxate to buccal first, then lingual, then alternate

Question 63

Is initial luxation aggressive or gentle?

Answer 63

Gentle

Question 64

What is the pressure and direction a tooth is removed from the socket with the forceps?

Answer 64

Gentle traction, normally toward the buccal

Question 65

What are 2 things luxation does for extraction?

Answer 65

Expand socket Disrupt PDL

Question 66

Are teeth ever removed by "pulling" them?

Answer 66

No

Question 67

What is done finally with the extraction site after the tooth is removed?

Answer 67

debride any granulation tissue, check and smooth any bony margins, suture if necessary

Question 68

What are three reasons a suture is required after surgery?

Answer 68

1. control bleeding 2. Hold something in the socket (e.g. Gelfoam) 3. Position tissue

Question 69

What are 4 considerations for the order of extraction?

Answer 69

Maxillary first Posterior first Most difficult first/ or last Symptomatic tooth first, especially if doubt entire procedure can be completed in one appointment

Question 70

What are the three forces applied to teeth?

Answer 70

1. Luxation 2. Rotation 3. Traction

Question 71

When removing a tooth, what should the operator be doing to the alveolus with his non-extracting hand?

Answer 71

Stabilizing alveolus w/ thumb and forefinger on either side of ridge

Question 72

What is the general guideline for patient positioning for the extraction of Maxillary teeth?

Answer 72

Pt semireclined w/ maxillary occlusal plane 60 deg to floor at elbow height of operator. Chairback approximately 120 deg from horizontal(180 deg, with upright being 90 deg)

Question 73

What is the general guideline for patient positioning for the extraction of Mandibular teeth?

Answer 73

Pt more upright so mandibular occlusal plane near parallel w/ floor, height at elbow level or lower for operator comfort. Chairback approximately 110 from horizontal(180 deg, with upright being 90 deg)

Question 74

What is the ultimate guide for positioning of operator /how one plans to remove the tooth?

Answer 74

Always consider the root and crown anatomy of the tooth to be removed

Question 75

What is the movement normally used with single rooted teeth, especially if conically shaped root?

Answer 75

Rotation/traction

Question 76

which forceps are especially useful for grasping teeth that are loose in the mouth?

Answer 76

Russian tissue forceps (they are round-ended)

Question 77

a heavy instrument used to elevate whole roots or even teeth after purchase point has been prepared

Answer 77

crane pick

Question 78

forceps: universal upper

Answer 78

150

Question 79

forceps: universal lower

Answer 79

151