Advanced Extraction Proceures

Question 1

Root fragment vs Root tip

Answer 1

1/3 or more = fragment

1/3 or less = Tip

Question 2

Removal technique for Root FRAGment

three techniques/instruments can be used

Answer 2

• Forceps
• Elevator
• Surgical (in conjunction with others)

Question 3

Removal technique for Root FRAGment

Forcep technique indication

Answer 3

with adequate root structure to grasp
or
Thin buccal bone that can be pinched off with the root fragment in the forcep

Question 4

Removal technique for Root FRAGment

Elevator numbers/types (5)

Answer 4

1) 301
2) 34
3) 46
4) Cryers 30
5) Cryers 31

Question 5

Why would we opt for surgical for removal of root frag?

Answer 5

Ankylosis, hypercementosis

inadequate root structure to instrument (flat top)

Question 6

Removal technique for Root FRAGment

two surgical procedures aspects

Answer 6

LARGE flap

Remove bone

Question 7

What is the adequate amount of bone that needs to be removed in a surgical extraction of a root fragment?

Answer 7

Removing buccal bone to the width of the root involved.
AND
Half of the height (to begin with and more as needed)

Question 8

Removal technique for Root TIP

TWO! techniques

Answer 8

Closed

Open

Question 9

Removal technique for Root TIP

Four examples of closed techniques

Answer 9

Irrigation
APEX Pick
Endo file
Small bur (#4) “stuck in root”

Question 10

Removal technique for Root TIP

Two options for open technique

Answer 10

Soft tissue flap
THEN
Remove bone
OR
Modified open tech

Question 11

Removal technique for Root TIP

What is modified open technique?

Answer 11

Drill hole at apex of root through buccal bone and use pick to pry out root tip.

Question 12

Conditions needed for leaving root tips (3)

Answer 12

1. Less than 5mm
2. Deeply embedded (much bone)
3. Not infected

Question 13

Reasons for leaving root tips

Answer 13

-Vital structures

Question 14

Protocol if leaving root tips (3)

Answer 14

INFORM YO PATIENTS
TAKE RAD
RECALL IN 1 YR

Question 15

Sectioning techniques Maxillary

Reasons for using sectioning

Answer 15

1. Large ROOTS (trifurcated)
2. Diverging roots
3. Sinus proximity

Question 16

Sectioning techniques Maxillary (Sound structure of tooth)

Steps (6)

Answer 16

1. Flap
2. Remove bone to trifurcation
3. Divide off the buccal roots just above trifurcation
4. Remove the crown (attached to only palatal root)
5. Separate the two buccal roots from selves
6. Remove buccal roots

Question 17

Sectioning techniques Maxillary (Decayed tooth structure)

Steps (4-6)

Answer 17

1. Flap
2. Remove buccal bone
3. Section ALL 3 roots
4. REMOVE Buccal roots (MB, then DB)
5. Remove palatal roots

Question 18

Sectioning techniques Mand

Reasons (3)

Answer 18

1. Gross decay
2. Large roots
3. Divergent

Question 19

Sectioning techniques Mand (Sound structure of tooth)

Steps (5)

Answer 19

1. Flap
2. Reduce buccal bone
3. Bur a groove from bifurcation to buccal groove
4. Place elevator and Fracture in HALF
5. Remove each half

Question 20

Sectioning techniques Mand (Decayed tooth structure)

Steps (4)

Answer 20

1. Flap
2. Reduce buccal bone
3. Remove crown
4. Use cryers on each root
   (may need to remove interradicular bone)

Question 21

Multiple extractions (order of operations)

Answer 21

Maxillary teeth
posteriors (not 1st molars)
Canines and 1st molars [LAST]

Question 22

Three reasons Maxillary teeth pulled first

Answer 22

1. Anestesia wear off faster in max
2. Debris does not fall into mand sockets
3. More space to instrument and remove mand molars.

Question 23

Reason for posterior teeth first

Answer 23

More room for elevators

they are more difficult in general

Question 24

Why do we remove granulation tissue?

Answer 24

Because it will prolong post op bleeding

Question 25

Why do you not PULL tissues to approximate them?

Answer 25

It will reduce the depth of the VESTIBULE!