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Alimentary - Dentistry > Surgery > Flashcards

Flashcards in Surgery Deck (45):

What is the difference between a luxator and an elevator

Luxators have thiner working ends with a sharp blade

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


Describe winged elevators

Working end that is well adapted to tooth shape

Narrow shaft better for visualisation

Metal is quite thin so can chip or blunt easily


How should an elevator or luxator be held?

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


What should be ensured when choosing extraction forceps?

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


What holds the tooth root into the alveolar socket?


Periodontal ligament


What is the first step of tooth root extraction?

Cut the gingival attachment

Use a scalpel blade and move slowly


What are the six steps of single root tooth extraction?

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


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

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


Describe use of an elevator in tooth extraction

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


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

Four corners


Describe use of the extraction forceps in tooth removal

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


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

Dental drill with tapered fissure cutting bur


How should the dental drill be held?

Modified pen grasp


Describe operation of the dental drill

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


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

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

Hold it at a slight angle


What shape should you transect with multirooted teeth and why?

Slight 'V' shape

Makes the elevator easier to insert


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

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


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

Reduce crown height first


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

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

Take care not to cut into crown of molar 1


What are four possible complications of extractions?

Root fragmentation

Jaw bone necrosis

Iatrogenic jaw fracture

Oro-nasal fistula


What are the four indications for surgical extraction?

Big rooted teeth

Persistent deciduous canine teeth

Limitation of the risk of iatrogenic jaw bone fracture

Dealing with or preventing extraction complications


What are the two basic flap designs?

Envelope flap - no vertical release incisions

Flap with one or two release incisions


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



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

Two divergent and longer incisions

  • Provides a broader base
  • Provides better exposure


Why should dental tissue be handled gently?

Oral mucosa is easily crushed by rough handling


Describe how to handle dental tissue during surgical extractions

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


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

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


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

Parotid duct and its orifice

Parotid papilla

  • Must section the crown between the roots


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

Tooth resorption

  • 1/3 of adult cats have one or more lesions


Describe the pathogenesis of tooth resorption in cats

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


Describe two anatomic landmarks of a healthy tooth on a radiograph

Lamina dura

  • White line around root

Periodontal ligament space

  • Thin black line around root


What does type 1 resorption look like on a radiograph?

Focal lesion with periodontal ligament around root still intact


What sort of extraction does a type 1 resorption need?

Standard extraction technique


How do type 2 tooth resorptions appear on a radiograph?

Root replacement or at least partial loss of periodontal ligament


How can type 2 resorption often be treated?

Crown amputation with intentional root retention


What is type 3 tooth resoprtion?

A combination of type 1 and 2


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



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

Presence of infection or inflammation at root level

Stomatitis patients

Patients with systemic condition comprimising immune response


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

Extract if supragingival or there is communication with the oral cavity

Leave in if subgingival and no sign of pain or inflammation


What are the 12 stages of surgical extractions?

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


Describe how release incisions should be made

Bold incisions through all layers right onto the bone

Cut depth towards dentinal ridge with control when nearing ridge


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

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


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

Start where alveolar bone meets the crown

Remove buccal bone plate until about 80% is exposed

Don't cut into root excessively


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

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


Describe flap closure in a surgical extraction

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