Advanced Extraction Proceures Flashcards
Root fragment vs Root tip
1/3 or more = fragment
1/3 or less = Tip
Removal technique for Root FRAGment
three techniques/instruments can be used
- Forceps
- Elevator
- Surgical (in conjunction with others)
Removal technique for Root FRAGment
Forcep technique indication
with adequate root structure to grasp
or
Thin buccal bone that can be pinched off with the root fragment in the forcep
Removal technique for Root FRAGment
Elevator numbers/types (5)
1) 301
2) 34
3) 46
4) Cryers 30
5) Cryers 31
Why would we opt for surgical for removal of root frag?
Ankylosis, hypercementosis
inadequate root structure to instrument (flat top)
Removal technique for Root FRAGment
two surgical procedures aspects
LARGE flap
Remove bone
What is the adequate amount of bone that needs to be removed in a surgical extraction of a root fragment?
Removing buccal bone to the width of the root involved.
AND
Half of the height (to begin with and more as needed)
Removal technique for Root TIP
TWO! techniques
Closed
Open
Removal technique for Root TIP
Four examples of closed techniques
Irrigation
APEX Pick
Endo file
Small bur (#4) “stuck in root”
Removal technique for Root TIP
Two options for open technique
Soft tissue flap THEN Remove bone OR Modified open tech
Removal technique for Root TIP
What is modified open technique?
Drill hole at apex of root through buccal bone and use pick to pry out root tip.
Conditions needed for leaving root tips (3)
- Less than 5mm
- Deeply embedded (much bone)
- Not infected
Reasons for leaving root tips
-Vital structures
Protocol if leaving root tips (3)
INFORM YO PATIENTS
TAKE RAD
RECALL IN 1 YR
Sectioning techniques Maxillary
Reasons for using sectioning
- Large ROOTS (trifurcated)
- Diverging roots
- Sinus proximity
Sectioning techniques Maxillary (Sound structure of tooth)
Steps (6)
- Flap
- Remove bone to trifurcation
- Divide off the buccal roots just above trifurcation
- Remove the crown (attached to only palatal root)
- Separate the two buccal roots from selves
- Remove buccal roots
Sectioning techniques Maxillary (Decayed tooth structure)
Steps (4-6)
- Flap
- Remove buccal bone
- Section ALL 3 roots
- REMOVE Buccal roots (MB, then DB)
- Remove palatal roots
Sectioning techniques Mand
Reasons (3)
- Gross decay
- Large roots
- Divergent
Sectioning techniques Mand (Sound structure of tooth)
Steps (5)
- Flap
- Reduce buccal bone
- Bur a groove from bifurcation to buccal groove
- Place elevator and Fracture in HALF
- Remove each half
Sectioning techniques Mand (Decayed tooth structure)
Steps (4)
- Flap
- Reduce buccal bone
- Remove crown
- Use cryers on each root
(may need to remove interradicular bone)
Multiple extractions (order of operations)
Maxillary teeth
posteriors (not 1st molars)
Canines and 1st molars [LAST]
Three reasons Maxillary teeth pulled first
- Anestesia wear off faster in max
- Debris does not fall into mand sockets
- More space to instrument and remove mand molars.
Reason for posterior teeth first
More room for elevators
they are more difficult in general
Why do we remove granulation tissue?
Because it will prolong post op bleeding
Why do you not PULL tissues to approximate them?
It will reduce the depth of the VESTIBULE!
