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Year 3 RMAOH Oral Surgery > Principles of Exodontia 1 > Flashcards

Principles of Exodontia 1 Flashcards

(48 cards)

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1
Q

Give 12 indications for extraction.

A
  1. Tooth is unrestorable
  2. Periodontal disease
  3. Pericorinitis - food caught under gum
  4. Associated pathology (e.g. cysts, tumour)
  5. Orthodontics
  6. Trauma
  7. Interfere with construction of a prosthesis
  8. Tooth within a fracture line
  9. Teeth in a fracture line
  10. Abnormal/supplemental teeth
  11. Impeding eruption of other tooth
  12. Financial/phobia
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2
Q

What is meant by giving the patient a prognosis of an extraction?

A

Giving them the liklehood of success of treatment.

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3
Q

What are the 4 main factors affecting difficulty of extraction?

A
  1. Tooth
  2. Supporting structures
  3. Proximity to adjacent structures
  4. Access
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4
Q

What are the 2 sub-factors for tooth factors when considering the difficulty of an extraction?

A
  1. Crown morphology
  • Grossly carious
    -Restorations- are they large/subgingival, are they crowns, posts or cores?
    -Endodontically treated
  • Bulbous
  1. Root morphology
    Single vs multiple
    Long/short, wide/thin/bulbous
    Curved/conical/divergent/convergent
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5
Q

What are the 3 sub-factors for supporting structures when considering the difficulty of an extraction?

A
  1. Gingival soft tissue
    Gingival overgrowth due to medication, chronic inflammation or subgingival carious activity.
  2. Periodontal ligament
    Periodontal disease
  3. Bone
    Periodontal disease
    Density - age/gender/ethnicity
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6
Q

What are the 2 sub-factors for proximity to adjacent structures when considering the difficulty of an extraction?

A
  1. Teeth

Impacted
Restorations of adjacent teeth (crowns/amalgams)
Mobile adjacent teeth
Distal teeth

  1. Vital structures

Inferior alveolar nerve
Infra-orbital nerve
Maxillary antrum

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7
Q

What are the 2 sub-factors access when considering the difficulty of an extraction?

A
  1. Limited mouth opening due to:

Spread of infection
Disk displacement TMJ
Small mouth
Rare conditions (oral submucous fibrosis)

  1. Tooth position
    Impacted/unerupted
    Crowding
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8
Q

What are the 4 stages of assessment before extraction?

A
  1. Medical history assessment.
  2. Clinical examination
  3. Radiographic assessment to assess the surgical difficulty of the tooth.
  4. Working diagnosis.
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9
Q

Name all the equipment you need for an extraction.

A

look on notes

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10
Q

What are the 2 main methods of tooth extraction?

A
  1. Routine tooth extraction

Forcep extraction
Elevation extraction

  1. Surgical tooth extraction

Sectioning of tooth +/-
Raising a mucoperiosteal flap

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11
Q

What are the 2 steps of rotuinbe tooth extraction and what instruments do you use for each one?

A
  1. Sever periodontal ligament and dilate socket.

Done with elevators and or forceps.
Force applied long axis of tooth.
Beaks positioned apically along roots.

  1. Complete dilation of socket and withdraw tooth.

Forceps.
Support jaw with other hand.
Remove tooth using rotational movements and take out buccally where possible.

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12
Q

What is the path of removal for the extraction of a tooth determined by?

A
  1. Morphology of root (curvature, shape)
  2. Impaction (bone, adjacent tooth)
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13
Q

What is the path of removal for routine extractions?

A

The tooth is removed by path of removal.

Determined by the natural root morphology.

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14
Q

What is the path of removal for surgical extractions?

A

Path of removal altered.

By removing bone and sectioning the teeth.

However- the natural path of removal is not removed altogether.

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15
Q

For upper teeth and lower what forceps are used?

A

look on notes

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16
Q

What are the 4 different instrument combinations used to extract teeth?

A
  1. Forceps
  2. Elevation → Forceps
  3. Elevation → Luxation → Forceps
  4. Luxation → Forceps
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17
Q

What is the role of elevators and luxators?

A

Disrupt the PDL and dilation of bony socket.

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18
Q

What surface of the tooth do the blade tips engage with upon extraction?

A

The ROOT of the tooth.

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19
Q

What side is the tooth take out at and why?

A

Buccal because:

  1. Thinner compared to hard palate.
  2. Thinner compared to lingual bone - exception are lower 8s.
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20
Q

What are the 5 steps in extraction using forceps?

Study These Flashcards
A
  1. Application
  2. Apical pressure
  3. Lateral movement
  4. Rotational movement
  5. Delivery
21
Q

What are the steps in the application stage of forcep extraction?

Study These Flashcards
A

You need to separate the coronal PDL from the tooth:

  1. Probe around the gingival margin of the tooth (also tests anaesthesia)
  2. Place blades under gingivae with minimal soft tissue damage
  3. Align forcep beaks along long axis of tooth
  4. Push forceps apically along root surface (use cowhorns to engage furcation if needed)
  5. Engage root surface (grip root) with beaks by closing forceps
  6. Use apical pressure throughout.
22
Q

What are the steps in the lateral movement stage of forcep extraction?

Study These Flashcards
A
  1. Expansion of socket
  2. Buccal and palatal/lingual movement
  3. Figure of 8 movement
  4. MAINTAIN APICAL PRESSURE
23
Q

When if rotational movement used in forcep extraction and why?

Study These Flashcards
A
  1. This tears any soft tissue attachment like an apical granuloma.
  2. Done to remove circular single rooted teeth.
24
Q

When is delivery executed in extraction?

Study These Flashcards
A

When the tooth is mobilised.

25
Give 4 reasons why apical pressure is vital in extractions.
1. Prevents beaks sliding off root. 2. Expands socket by positioning coronal, wider root apically. 3. Centre of rotation of tooth displaced apically. 4. Alters angle of force on roots.
26
What will happen if you place forceps on the crown with little apical pressure when extracting teeth?
You risk root fracture at the apex:
27
What happens to a molar tooth if you only use buccal pressure?
Root fracture, as you have 2 roots pointing in 2 different directions:
28
What 2 pressures must you use for multi-rooted teeth?
1. Apical pressure 2. Lateral pressure- buccal movement rotation This allows for: 1. Centre rotation closer to buccal root apices 2. Expansion of buccal root socket 3. Palatal root delivered along curvature of the root.
29
What 3 things can occur if you use excessive force for an extraction?
1. Tooth/jaw fracture 2. Discomfort for patient (TMJ pain) 3. Increased patient overall discomfort and anxiety
30
What 2 things can occur if you use limited force for an extraction?
1. Extended extraction time. 2. Inability to extract tooth.
31
What is meant by lateral excursions when extracting teeth?
1. Holding the pressure bucally (sometimes palatal) to allow time for bone to expand. 2. The tooth will move in line of least resistance- pre-determined by root morphology, and you can feel this w/the resistance in your hand.
32
When are lower cowhorns used?
To enagge with the bucco-lingual furcation on lower molars.
33
When are upper cowhorns used?
1. To grip around the palatal root and engage buccal furaction. 2. For heavily broken down/fractured upper molars- no crown to grip onto w other forceps.
34
How is the dental chair positioned when performing a maxillary extraction?
1. Chair reclined. 2. Chair high.
35
How is the dental chair positioned when performing a mandibular extraction?
1. Chair inclined. 2. Chair lower.
36
How is the patients head positioned for a maxillary and mandibular extraction?
1. Maxillary - chin up 2. Mandibular - chin down
37
What 3 things can the other hand do when extracting the tooth?
1. Support the jaw. 2. Retract soft tissue - either thumb and forefinger or minnesota retractor. 3. Feel adjacent tooth to make sure it doesn’t mobilise.
38
What is the role of elevators?
1. Sever the PDL and help dilate the socket. 2. The rotation of the elevator lifts the tooth out of the socket along its line of withdrawl (path of removal)
39
How are elevators positioned?
Horizontally- 90 degrees to the long axis of the tooth.
40
Where are elevators applied when extracting?
1. Between the root surface and alveolar crest. 2. Alveolar crest provides the fulcrum. 3. NOT THE ADJACENT TOOTH
41
What direction to you elevate and why?
Buccally due to access.
42
Give 3 types of elevators.
Couplands 1, 2 and 3. Warwick James’ right left and straight. Cryers right and left.
43
How do you position elevators?
They are pushed firmly between the mesial of the tooth and bone at/below the level of CEJ to engage a point of application. You move the elevator distally and 90 degrees to the long axis of the tooth.
44
What is the difference between couplands and warwick james?
1. Couplands has a larger handle. 2. Warwick james has a 90 degree blade allowing retained roots and interfurcal bone to be levered out.
45
When are warwick james elevators used?
1. Retained roots: The blade first engages the inter-radicular bone and removes it to access the root. The blade then engages the root to lift it out of the socket. 2. Upper 8s elevation. The contra-angled tip can engage mesial upper 8.
46
Whats the difference between luxators and elevators?
Luxators have a flatter and sharper blade:
47
How is a luxator used and what is its role?
Method of use: 1. Inserted in PDL space by application between root and bone. 2. Applied vertically, along the long-axis of the tooth. Role: 1. Sharp blade disrupts PDL. 2. Gentle rotating of handle and advancement of blade towards apex of the tooth to mobilise the tooth.
48
After the tooth is out what 2 things must you check?
1. Apices intact Smooth, round No sharp edges 2. Socket - flush with saline Retained roots Soft tissue Fragments of tooth/debris Hole in antrum

Year 3 RMAOH Oral Surgery (2 decks)

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