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BDS3 R+M - Oral surgery > 1. Principles of exodontia 1 > Flashcards

1. Principles of exodontia 1 Flashcards

1
Q

AIMS

A
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2
Q

indications for extraction? (12)

A
  • Unrestorable teeth
    - most likely due to caries
  • Periodontal disease
    - teeth w/ grade III mobility
    (virtually no bone support for
    tooth)
  • Pericoronitis
    - effects partially erupted teeth (usu
    wisdom), food getting stuck under
    gum surrounding tooth, causes
    localised inflam
  • Associated pathology (e.g. cysts, tumour)
  • Orthodontics
  • Trauma
  • Interfere with construction of a prosthesis
  • Tooth within fracture line
    • typically refer to teeth that are located within the line of a bone fracture
  • Teeth in a fracture line
    • typically means that the teeth are situated within or adjacent to a line of bone fracture
  • Abnormal/ supplemental teeth
  • Impeding eruption of other tooth
    - eg deciduous teeth that aren’t
    falling out
  • Financial / phobia

GOOGLE
Patients with teeth in the fracture line showing no response on pulp vitality testing should be advised extraction to avoid further complications.

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3
Q
A
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4
Q

what factors to consider when deciding if the extraction is safe to perform?

A
  • Aware of medical history?
  • Contra-indications?
  • Know limitations (surgeons capabilities) REFER??
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5
Q

Factors that affect difficulty of extraction

A
  • Tooth
  • Supporting structures
    (PDL, bone)
  • Proximity to adjacent structures
    (nerves, other teeth, maxillary
    antrum)
  • Access
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6
Q

what tooth factors do we look at while deciding to extract tooth?

A
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7
Q

What supporting structures do we look at when deciding to extract?

A
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8
Q

What structures in close proximity to the tooth requiring extraction do we need to look at before extracting?

A
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9
Q

What access factors do we need to look at before extracting teeth?

A
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10
Q

Planning before extraction is very important and ensuring you have all the required equipment!

  • in oral surgery department will have this equipment for extractions
  • what are the required pieces of equipment?r
A
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11
Q
A
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12
Q

What are the 2 main types of extraction?

A
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13
Q

THIS LECTURE LOOKS AT ROUTINE EXTRACTION (using elevation, luxation + forcep extraction)

NEXT LECTURE (EXODONTIA PART 2) LOOKS AT SURGICAL APPROACH

A
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14
Q

Overview mechanisms of routine extraction?

A
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15
Q

PATH OF REMOVAL

1
Path of removal of tooth is determined by?

2
Routine extraction path of removal determined by?

3
Surgical extraction path of removal determined by?

A

)

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16
Q

Main instrument used in routine tooth extraction?

A

Forceps

Look a bit like pliers

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17
Q

What is each part of forceps called and how does it help with tooth extraction?

A

HANDLE
- work by lever principle
- long handle attached to blade

BLADE
- Holds onto tooth during removal
- in long axis of handle (upper teeth) or right angles to handle (lower teeth)
- Wedged shaped blades – dilate socket break PDL

  • ‘Beak to cheek” – upper molar forceps
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18
Q

How does positioning of the blade with the handle effects it’s function?

A
  • Blades in long axis of handle = REMOVE UPPER TEETH
  • Blade in right angles to handle= REMOVE LOWER TEETH
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19
Q

How to hold forceps?

A
  • put index finger between handles so they can open forceps
  • engage tooth at CEJ (effectively coronal portion of root surface of tooth)
  • once engaged tooth removed index finger from between handles so can hold handle tightly (to provide apical pressure needed to remove tooth)
  • hand positioning on upper and lower forceps slightly different

HARD TO SEE IN LECTURE, WILL SEE ON CLINICS BETTER

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20
Q

1
What do the blades need to fit for effective extraction?

2
What do you do if the blade doesn’t fit this?

A
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21
Q

4 main methods of routine tooth extraction?

A
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22
Q

What do forceps do to help with tooth removal?

A

1 Sever PDL
2 dilate bony socket
(Coronally)

EXTRA
- help do this as sat on CEJ of root and blade will sit into PDL space and damage PDL corronally, hence sever
- and with wedge effect will dilate PDL spaced socket coronally
- as engage tooth properly, are able to move tooth laterally to dilate socket as well

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23
Q

Why are teeth delivered buccally durning routine tooth extraction?

A
24
Q

Forcep extraction steps

A
  1. APPLICATION
    Separate coronal PDL from tooth:
  • Probe around the gingival margin of tooth (also tests anaesthesia)
  • open handle of forceps using index finger
  • place blades on CEJ (coronal portion of root) + engage
  • tips of blade should be hidden below gingival cuff (should slide blade down to this area with minimal soft tissue damage)
  • Align forcep beaks along long axis of tooth
  • Push forceps apically along root surface (cowhorns to engage furcation)
  • Engage root surface (grip root) with beaks by closing forceps
  • squeeze hard on forcep handle
  1. APICAL FORCE
    Maintain apical pressure throughout tooth extraction :
  • put a lot of pressure down the long axis of the tooth
  • apical positioning of tooth will dilate the socket

3 LATERAL MOVEMENT
Expansion of socket

  • buccal & palatal/lingual movement
  • Figure of ‘8’/ circular movement
  • Maintaining apical pressure throughout
  1. ROTATIONAL MOVEMENT
    Tear soft tissue attachment (apical granuloma/ gingival mucosa)
  • Removal of circular, single rooted teeth (upper incisors, lower
    premolars)
  1. DELIVERY
    * After tooth is mobilised traction forces remove the tooth from the socket
25
Q

Purpose of:

1
application of blades below gingival margin?

2
lateral movement?

3
rotational movement?

A

1
- Separate coronal PDL from tooth
- grip tooth

2
expand socket

3
tear soft tissue attachment

26
Q

why does apical pressure need to be maintained throughout whole extraction of tooth?

A

Apical force:
* Prevents beaks sliding off root
* Expands socket by positioning coronal, wider root apically
* Centre of rotation of tooth displaced apically to prevent tooth fracture
* Alters angle of force on roots

27
Q

how does centre of rotation effect extraction?

a
- optimum centre of rotation on root and how to ensure this?

b
what may affect the centre of rotation negatively and why might the root break?

A
  • centre of rotation effects the risk of the root breaking during extraction
28
Q

why is it important to dilate socket buccally and lingually + palatally

A
  • likely to get root fracture in multi rooted teeth
29
Q

1
what is apical and lateral pressure in multi rooted teeth?

2
why is apical + lateral pressure important while remove multirooted teeth?

A
30
Q

BONE EXPANSION THROUGH LATERAL MOVEMENT

what bone expands?

A
31
Q

1
what is the right amount of pressure during extraction?

2
what happens if you apply excessive force

3
what happens if you apply too little force

4
tips for lateral excursion pressure application

5

A
32
Q

LOWER COWHORNS

1
what are they?

2
what do they engage?

3
where to position?

4
type of movement used to extract tooth

A
33
Q

UPPER COWHORNS

1
Where do they grip tooth

2
what type of teeth are these useful for?

A

1
Where do they grip tooth

2
what type of teeth are these useful for?

34
Q

are these teeth held correctly by the forceps? are they upper or lower teeth removal?

A
35
Q

are these teeth held correctly by the forceps? are they upper or lower teeth removal?

A
36
Q

what is this forcep called and how is it grabbing the tooth

A
37
Q

are these teeth held correctly by the forceps? are they upper or lower teeth removal?

A
38
Q

why is chair positioning important?

A
  • can help tooth come out easier
  • if incorrectly positioned can hinder extraction
39
Q

EXTRACTION POSITIONING

1
MANDIBULAR Vs MAXILLARY EXTRACTION
- chair position
- chair height

2
ANTERIOR Vs POSTERIOR
- chair height

3
MANDIBULAR Vs MAXILLARY EXTRACTION
- head position

A

1
MANDIBULAR Vs MAXILLARY EXTRACTION
- want patient more upright than maxillary
- maxillary more reclined
- maxillary want chair higher compared to mandibular

2
ANTERIOR Vs POSTERIOR
- anterior want patient generally upright as access isn’t that difficult
- posterior lie patient more flat for better access

3
MANDIBULAR Vs MAXILLARY EXTRACTION
* Mandibular extraction - chin down
* Maxillary extraction – chin up
(WANT TO SEE OCCLUSAL SURFACES OF TOOTH

40
Q

what to do with other hand during tooth extraction?

A

1 SUPPORTING HAND

*Support the jaw - counteract force from forceps/ elevators to stabilize jaw
- support alveolar bone
*Finger rest

2 RETRACTION OF SOFT TISSUE

*Thumb and forefinger either side of arch adjacent to tooth
*Holds retractor - to see surgical sight

3 FEEL ADJACENT TOOTH

*Check adjacent tooth not mobilising during extraction/ elevation
- if mobilising hen need to change method of extraction otherwise adjacent mobile tooth may also come out

41
Q

what do elevators do?

A

sever PDL + can help dilate socket

42
Q

ELEVATORS

1
position

2

3
movement while extracting?

A
  • usu Positioned horizontally (90° to long axis tooth)
  • usu Applied to root surface (mesial, buccal or distal) (positioned within PDL space
  • Applied between root surface and alveolar crest (i.e. in PDL space).
  • Alveolar crest (not adjacent tooth) provides fulcrum

2
* Accidental elevation against adjacent tooth can mobilise adjacent tooth and even extract it (especially if adjacent tooth is last standing)

3
* Rotation movement
* Elevate buccally not lingually due to access (due to access)

43
Q

1
types of elevator?

2
structure / names of parts of equipment

3
what partengages tooth and what does it try to do?

A

3
blade engages tooth to try and mobilise

44
Q

how to hold elevator?

A
  • firm grasp of elevator

-forefinger up shaft to prevent slipping

45
Q

how to position elevators?

A
46
Q

black line = elevator positioned

are these positioned correctly?
why?

A
47
Q

Elevator positioning and what does it do?

A
48
Q

COUPLANDS

1
sizes?
what size should you use?

2
why is the long/ larger handle useful?

3
how to insert and where? (HINT MESIAL OR DISTAL)

4
how does it’s use help extraction?

A
49
Q

How to know if you’re using the correct size elevator, how do you know if it’s too small or big?

A
50
Q

WARWICK JAMES & CRYERS ELEVATORS

A
51
Q

WARWICK JAMES & CRYERS ELEVATORS

particularly useful to remove?

A

EXTRA - retained roots
- diagram = fractured L 2nd molar during removal
- has retained distal root
- cryers has been placed within mesial root socket to engage mesial surface of distal
- in order to do this sometimes interfercal bone needs to be nibbled away using cryers or warwick james (usu easy to do as quite soft)
- do this until instrument engages root surface
- then with rotation lifts root out of socket

52
Q

can you remove wisdom teeth just using elevators

A
  • should use elevators to mobilise molars

BUT not to remove tooth in its entirety

BECAUSE there’s no control and risk of tooth falling into patients throat

53
Q

LUXATORS

1
Instrument structural difference to elevator

2
Where is it inserted and how

3
Function?

4

A
54
Q
A
55
Q

once tooth is out how do we check it’s been taken out in it’s entirety

A
56
Q

TIPS

A

BDS3 R+M - Oral surgery (10 decks)

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