Surgery

Question 1

What is the difference between a luxator and an elevator

Answer 1

Luxators have thiner working ends with a sharp blade

Elevators are more rounded at the end, the blade is slightly more spoon shaped

Question 2

Describe winged elevators

Answer 2

Working end that is well adapted to tooth shape

Narrow shaft better for visualisation

Metal is quite thin so can chip or blunt easily

Question 3

How should an elevator or luxator be held?

Answer 3

Palm grasp - Tip of index finger placed on shaft no more than 1cm away from working tip

Question 4

What should be ensured when choosing extraction forceps?

Answer 4

That the beaks of the forceps meet otherwise they are unable to grasp tiny teeth

Question 5

What holds the tooth root into the alveolar socket?

Answer 5

Gingiva

Periodontal ligament

Question 6

What is the first step of tooth root extraction?

Answer 6

Cut the gingival attachment

Use a scalpel blade and move slowly

Question 7

What are the six steps of single root tooth extraction?

Answer 7

1. Cut gingival ligament
2. Insert luxator into periodontal ligament space
3. Use an elevator to rotate tooth to break periodontal ligament
4. Repeat step 3 around different points of the tooth
5. Use extraction forceps to remove tooth
6. Extract and inspect tooth

Question 8

Describe how a luxator should be inserted into the periodontal ligament space

Answer 8

Hold instrument at 30º angle towards tooth and wedge luxator into gap

Attempt to walk luxator around the tooth, cutting periodontal ligament and widening gap

Avoid holding instrument parallel to the tooth and slipping onto alveolar bone

Question 9

Describe use of an elevator in tooth extraction

Answer 9

Wedge in and rotate slowly around its own long axis

Avoid tilting or quick digging movements

Be patient

Repeat same rotation around long axis with tip slightly deeper

Question 10

What technique should be used with the elevator on incisor teeth?

Answer 10

Four corners

Question 11

Describe use of the extraction forceps in tooth removal

Answer 11

Apply beaks of forceps as far apically on the crown as possible

Rotate around tooth’s long axis

Apply traction once maximum point is reached

Question 12

What should be used during a direct extraction of a multi-rooted tooth to cut the gingival attachment?

Answer 12

Dental drill with tapered fissure cutting bur

Question 13

How should the dental drill be held?

Answer 13

Modified pen grasp

Question 14

Describe operation of the dental drill

Answer 14

Always ensure water spray functions

Activate foot pedal fully for full-speed rotations before touching tooth

Alternate 2 seconds of pressure and drilling with one second of easing off

Question 15

What should be done after cutting the gingival attachment with multi-rooted teeth?

Answer 15

Transsection of the tooth at the furcation by pointing the tip of the bur towards the furcation

Hold it at a slight angle

Question 16

What shape should you transect with multirooted teeth and why?

Answer 16

Slight ‘V’ shape

Makes the elevator easier to insert

Question 17

What needs to be confirmed before trying to remove multirooted tooth fragments?

Answer 17

Independent mobility of the segments by inserting an elevator and gently moving it

Question 18

What is it helpful to do when sectioning 3-rooted teeth?

Answer 18

Reduce crown height first

Question 19

What should be done with the maxillary 4th premolar tooth prior to extraction?

Answer 19

Remove distal overhang of the crown creating a space for the elevator

Take care not to cut into crown of molar 1

Question 20

What are four possible complications of extractions?

Answer 20

Root fragmentation

Jaw bone necrosis

Iatrogenic jaw fracture

Oro-nasal fistula

Question 21

What are the four indications for surgical extraction?

Answer 21

Big rooted teeth

Persistent deciduous canine teeth

Limitation of the risk of iatrogenic jaw bone fracture

Dealing with or preventing extraction complications

Question 22

What are the two basic flap designs?

Answer 22

Envelope flap - no vertical release incisions

Flap with one or two release incisions

Question 23

How many release incisions can be made for a small tooth?

Answer 23

One

Question 24

How many incisions should be made for larger tooth surgical incisions?

Answer 24

Two divergent and longer incisions

• Provides a broader base
• Provides better exposure

Question 25

Why should dental tissue be handled gently?

Answer 25

Oral mucosa is easily crushed by rough handling

Question 26

Describe how to handle dental tissue during surgical extractions

Answer 26

Elevate slowly and gently with sharp periosteal elevators Use fine-tipped atraumatic tissue forceps cautiously Use retraction at the base of the flap more than holding onto and pulling the flap

Question 27

What two structures should you take care not to cut into?

Answer 27

**Neurovascular bundle that exits from infraorbital foramen** * Push it out of the way before making caudal oblique release incision for canine tooth extraction **Neurovascular bundle exiting from mental foramen**

Question 28

What should be taken care of when surgically extracting the maxillary 4th premolar?

Answer 28

**Parotid duct and its orifice** **Parotid papilla** * Must section the crown between the roots

Question 29

What is one of the most common dental diseases in cats and what fraction of adult cats have it?

Answer 29

**Tooth resorption** * 1/3 of adult cats have one or more lesions

Question 30

Describe the pathogenesis of tooth resorption in cats

Answer 30

Teeth attacked by odontoclasts Adhere to root surface and form resorptive lacunae Vascular granulation tissue fills lesion and may be replaced by bone and cementum like tissue

Question 31

Describe two anatomic landmarks of a healthy tooth on a radiograph

Answer 31

**Lamina dura** * White line around root **Periodontal ligament space** * Thin black line around root

Question 32

What does type 1 resorption look like on a radiograph?

Answer 32

Focal lesion with periodontal ligament around root still intact

Question 33

What sort of extraction does a type 1 resorption need?

Answer 33

Standard extraction technique

Question 34

How do type 2 tooth resorptions appear on a radiograph?

Answer 34

Root replacement or at least partial loss of periodontal ligament

Question 35

How can type 2 resorption often be treated?

Answer 35

Crown amputation with intentional root retention

Question 36

What is type 3 tooth resoprtion?

Answer 36

A combination of type 1 and 2

Question 37

What is currently the only accepted option for tooth resorption treatment?

Answer 37

Extraction

Question 38

In what three cases should crown amputation for treatment of type 2 resorptions not be used?

Answer 38

Presence of infection or inflammation at root level Stomatitis patients Patients with systemic condition comprimising immune response

Question 39

What are the two options for treatment of tooth resorption in dogs?

Answer 39

Extract if supragingival or there is communication with the oral cavity Leave in if subgingival and no sign of pain or inflammation

Question 40

What are the 12 stages of surgical extractions?

Answer 40

1. Plan flap design 2. Cut gingival attachment using scalpel 3. Perform release incisions 4. Elevate the flap 5. Reflect the flap to expose buccal jaw bone 6. Remove exposed bone plate over root 7. Cut deeper grooves along the root outlines 8. Rotate tooth using elevator or luxator 9. Inspect root apex 10. Smooth down bony spikes - alveoloplasty 11. Test and prepare flap for closure 12. Close flap

Question 41

Describe how release incisions should be made

Answer 41

Bold incisions through all layers right onto the bone Cut depth towards dentinal ridge with control when nearing ridge

Question 42

What action is required to elevate the flap during surgical extractions?

Answer 42

Firm action of pushing down onto the bone in a controlled push and twist action

Question 43

Describe how to remove the exposed bone plate in a surgical extraction

Answer 43

Start where alveolar bone meets the crown Remove buccal bone plate until about 80% is exposed Don't cut into root excessively

Question 44

Describe how to make deeper grooves along the root outlines in a surgical extraction

Answer 44

Use a small size 1 or 1/2 round bur medially to cut a groove deeper than 50% of the tooth width Don't drill too deep as nasal cavity is nearby Connect mesial and distal exposed root area by drilling a shallow line close to the root apex

Question 45

Describe flap closure in a surgical extraction

Answer 45

No tension 5/0 or 4/0 monocryl or vicryl suture material Reverse cutting, curved, 13-16mm needle Take fairly big 'bites' about 3-5mm away from flap margin Keep sutures 3-4mm apart