Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AAA Companion Animal VMS4005 > Dental Extraction Techniques > Flashcards

Dental Extraction Techniques Flashcards

1
Q

Triadan numbering

A
  • Dogs = 44 teeth, cats = 30 teeth
  • Ordered numerically from mesial to
    distal
  • Canine is -04
  • 1st Molar is -09
  • Maxillary carnassial is PM4 (-08)
  • Mandibular carnassial is M1 (-09)
  • Cats missing PM1 (first cheek tooth = PM2 on upper jaw/maxilla); only have one molar tooth - PM1; only have PM3 + PM4 on mandible)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gingivitis index

A
  • 0 = no inflam
  • 1 = swelling, reddening, no bleeding when probed
  • 2 = inflam, reddening + swelling, will bleed when probed
  • 3 = sig swelling of gingiva, sometimes w/ ulceration, spontaneous bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal periodontal probing depth

A
  • Dog = 1 - 3 mm
  • Cat = 0.5 - 1 mm
  • Measurements w/o gingival enlargement > indicative of apical migration of gingival attachment
  • Measurement of periodontal pocket
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gingival recession

A

Cemento-enamel junction to free gingival margin - measurement made w/ periodontal probe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Periodontal index

A
  • Adding periodontal probing depth to gingival recession then divide by total length of the tooth root (from x-ray)
  • 0 = no attachment loss
  • 1 = up to 25% attachment loss
  • 2 = between 25 - 50% attachment loss
  • 3 = > 50% attachment loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Furcation exposure

A

Where roots divide
- 0 = no furcation exposure
- 1 = furcation felt w/ probe, bone loss < 1/3
- 2 = Probe placed > 1/3 of width of furcation
- 3 = Probe placed through furcation from buccal to lingual/palatal side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tooth mobility

A
  • 0 = no mobility
  • 1 = single root: horizontal mobility < 1 mm
  • 2 = single root: horizontal mobility > 1 mm; multiple roots: horizontal movement < 1 mm
    EXTRACTION:
  • 3 = single root: horizontal + vertical movement; multiple roots: horizontal movement > 1 mm and /or vertical movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Luxator

A
  • Flat blade to cut/sever periodontal ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dental elevators

A
  • Lever
  • Rotational force to tooth or alveolar bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hybrid instrument

A
  • Sharp cutting edges
  • Made of robust steel - used for elevation as well
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Extraction forceps

A
  • After elevation/luxation
  • Grasp loosened tooth + remove from alveolus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Periosteal elevators

A
  • Elevate mucoperiosteal flaps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rotatory instrument

A
  • Sectioning teeth, removing + smoothing alveolar bone, cutting bone + drilling into bone
  • E.g. Sectioning multi-rooted teeth into single-rooted units
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Closed extraction

A
  • Without incising the gingiva (other than within gingival sulcus)
  • Incisors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Closed extraction - indications

A
  • Small, single-rooted teeth e.g. incisors + 1st premolars
  • Maxillary 2nd molars in dog - 2 or 3 partly fused roots
  • Sig bone loss -> inc in mobility associated w/ periodontal disease -> uncomplicated tooth extraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Surgical tooth extraction - indications

A
  • Multi-rooted teeth
  • Canine teeth - non-Sx predisposes to oronasal fistula
  • Periodontally healthy teeth
  • Radio - dilacerations (abnormal bend in tooth)/other abnormalities in root morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adjacent structures to teeth - consider when X

A
  • Infraorbital a., v. + n. exit infraorbital foramen - important for cuts in gingiva, canal sits close - PM3 + PM4
  • Major palatine a.
  • Parotid salivary duct
  • Zygomatic papilla
  • Maxillary recess - lateral diverticulum of nasal cavity - opening lies in transverse plane through mesial roots of maxillary fourth premolar
  • Orbit in Brachies - lies dorsal to maxillary fourth premolar, first molar + second molar
  • Ventral aspect of each mandible = mandibular canal - inferior alveolar a, v, n
  • Middle mental foramen - ventral to second premolar tooth - root apices sit v closely to mandibular canal, tooth root v thin
  • Eye - superficial eyes in brachies, X can slip + skewer eyeball
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Patient + Sx prep

A
  • Lateral recum - allowing drainage of fluids, good visibility of the buccal surfaces of the uppermost teeth
  • Pharyngeal gauze pack is recommended regardless of patient positioning to protect the airway
  • Removal of calculus prior to extractions will allow more accurate assessment of the tooth structure and provides a cleaner environment for surgery
  • Rinsing the oral cavity with a 0.12% chlorhexidine gluconate solution prior to the procedure will reduce bacteraemia and aerosolised bacteria
  • Instruments should be sharpened and sterilised prior to use
  • To prevent contact with aerosolised bacteria and fluid particles, operator should wear a mask, gloves, and protective eyewear
19
Q

Types of gingival + mucogingival flaps

A
  • Envelope flap
  • Extended envelope flap
  • Triangle flap
  • Pedicle flap
20
Q

Envelope flap

A
  • Gingival flap - not extending apical to mucogingival junction
  • Sulcular incision made + elevate attached gingiva on lingual + buccal aspects + no vertical releasing incisions
  • Common for use in cats - when amputating crown during tooth resorption
21
Q

Extended envelope flap

A
  • Extraction of several adjacent teeth
  • Mucogingival flaps - incisions extend apical to mucogingival junction
  • Flaps used for extraction procedures = full-thickness + include periosteum
22
Q

Triangle flap

A
  • Mucogingival flap
  • Sulcular incision
  • Vertical releasing incision
23
Q

Pedicle flap

A
  • Sulcular incision
  • Two vertical releasing incisions
  • Provides best exposure
24
Q

1). Flap design + management - local flaps

A

Section of ST - gingiva/mucosa + periosteum
- Outlined by surgical incision
- Contains own blood supply
- Allows access to underlying tissues
- Can be replaced in its original position
- Expected to heal after sutured in place
- Big enough to allow adequate exposure of Sx area
- Base of flap must be as wide or broader than free margin to preserve blood supply
- Edges of flap must lie over intact bone
- Consider adjacent vital structures

25
Q

2). Mucogingival flap technique

A
  • 1). Incise through gingival sulcus
  • 2). If need mesial vertical releasing incision - place at distobuccal line angle of adjacent tooth through mucogingival junction + extending into alveolar mucosa
  • 3). Second distal vertical releasing incision made
  • 4). Incisions should extend apical to the mucogingival junction so flap os as long as root
  • 5). Periosteal elevator introduced into sulcus + remove gingiva from underlying bone -> distally reflect mucosa + periosteum from bone
26
Q

3). Bone removal (alveolectomy) technique

A
  • Once exposed bone
  • Round diamond bur (or carbide) -
  • Buccal alveolar bone removed - begin at alveolar margin to how far apically desired
  • Removal of 75% of buccal alveolar bone facilitates X
  • Small round bur - cut periodontal ligament + make space for elevator/luxator
27
Q

Sectioning multi-rooted teeth

A
  • Tapered bur on high-speed
  • Begin at furnication + progress coronally
  • ‘V’ shape removed
28
Q

Luxation technique - tooth extraction

A
  • Long-thin PM roots, cats
  • Used parallel to the root surface of the tooth
  • Blade of the luxator is inserted into the periodontal ligament space and pushed apically, severing the collagen fibres and acting as a wedge
  • Then advanced in the periodontal ligament space until the apex is reached
  • Repositioned on the opposite root surface and advanced in the periodontal ligament space - will push the tooth root into the space created initially, tearing the periodontal ligament fibres and loosening the root
29
Q

Elevation technique - robust roots = canines + carnassials

A

(Once sectioned, from the furnication)
- 1). Elevator = first class lever
- Blade placed into periodontal space, parallel to long axis of tooth
- Rotate + push root away from elevator -> tearing of periodontal ligament + expanding of alveolar bone
- 2). Elevator = wheel + axle lever
- Blade placed at level of alveolar margin, perpendicular to long axis/crown of tooth + rotated w/ concave surface against tooth - move around at 90 degrees to allow periodontal ligament fibres to tear

30
Q

Bone removal (alveoplasty)

A
  • Sharp bone edges after luxation - elevation delays healing of gingival flap -> post-op discomfort
  • Round bur on high-speed/bone rongeurs
  • Smooth down - like sandpaper
31
Q

Management of alveolus post alveoplasty

A
  • Empty alveolus cleared of debris
  • Curettage of alveolus performed to remove pocket of epithelium + remnants of subgingival calculus
32
Q

Suturing

A
  • 5-0/4-0 monocryl for intraoral use (completely absorbed by hydrolysis in 90 d)
  • Reverse cutting needle - oromaxillofacial Sx
33
Q

Suturing the flap

A
  • No tension on the suture line
  • If necessary, bluntly dissect the flap submucosally (sub-cutaneously) towards the lip margin in order to gain more tissue
  • Free the edge of the palatal/lingual mucosa by gently inserting the periosteal elevator between the bone and soft tissue
  • Lowering the margin of remaining alveolar bone using a round diamond bur will also help reduce tension
  • Periosteum, may be incised if necessary, to ensure closure without tension
34
Q

Perioperative management

A

Analgesia
- Opioids - pre-op + post-op
- NSAIDs
- Local anaesthesia - regional nerve blocks
Homestasis support
- IVFT
- Warmth
- Post-op nutrition
Wound management
- Post-op chlorhexidine oral rinse

35
Q

Trigeminal nerve CN V branches

A
  • 1). Ophthalmic
  • 2). Maxillary -> pterygopalatine nerve (major + minor); infraorbital nerve
  • 3). Mandibular -> lingual nerve; inferior alveolar nerve
36
Q

Regional local anaesthesia - maxilla

A
  • 1). Infraorbital - doesn’t really anaesthetise tissues of interest, too far rostrally
  • Insert needle into infraorbital canal + inject LA - de-sensitises tissue into foramen/canal
    OR
  • Deposit local anaesthetic at opening of canal (infraorbital foramen)
  • 2). Caudal maxillary - anaethetises whole side of maxilla
  • Insert needle into soft tissues caudal to dental arcade + inject LA
  • Completely anaesthetises ipsilateral half of maxilla
  • > palatine n. -> infraorbital n -> infraorbital foramen, needle goes straight up
37
Q

Regional local anaesthesia - mandible

A
  • 1). Mental
  • Needle into mental foramen + inject LA
    OR
  • Deposit anaesthesia at opening of mental foramen
  • 2). Inferior alveolar (caudal mandibular) - needle on lingual aspect of mandible, caudal to dental arcade + deposit LA half way between 3rd molar + angular process
  • Halfway between tooth + angular process - anaesthetises whole side of mandible
  • Corner of the jaw
38
Q

Types of LA drugs

A
  • Lidocaine - rapid onset, duration 1 - 2 h, total dose < 4 mg/kg, may contain adrenaline, least cardiotoxic
  • Bupivicaine - onset 20 - 30 min, duration 6 - 8/12 h, < 2 mg/kg
  • Mepivicaine
  • Articaine
39
Q

Complications of local anaesthesia - systemic

A
  • Local anaesthetic drugs are cardiotoxic if injected intravenously
  • Cause unresponsive cardiac arrest
  • Cats are especially sensitive to local anaesthetic drugs
  • Lidocaine least cardiotoxic
  • All regional local anaesthetic techniques require perineural injection of LA, but all are neurovascular bundles therefore
  • Must withdraw syringe plunger before injecting to ensure not within
    blood vessel.
40
Q

Perioperative management

A
  • Analgesia - NSAIDs
  • Homeostasis support - IVFT, patient warmth post-op nutrition
  • Wound management - pos chlorhexidine oral rinse
  • AB not used - unless really need to
41
Q

Complications of X

A
  • H+ - control w/ digital pressure
  • Trauma to adjacent teeth - adjacent teeth should not be used as fulcrum for elevation
  • Trauma - during primary extraction of teeth, before eruption of their counterparts, damage to enamel will permanent
  • Trauma from opposing teeth
  • Sublingual oedema + salivary mucocele
  • Orbital trauma
  • Surgical site dehisces
  • Fracture of alveolus/jaw
  • Fx of roots
42
Q

Fx of alveolus/jaw

A
  • Usually as a result of pre-operative bone loss from disease
  • Pre-op radiography is essential to demonstrate pathology before surgery is
    attempted
  • Treated by removal of diseased tissue and good repair of soft tissues
  • Stabilisation of fracture fragments and/or partial mandibulectomy may be
    required
43
Q

Oronasal communication

A
  • As a result of disease or iatrogenic trauma
  • Good tension free closure with single layer buccal mucosal/mucoperiosteal lap
  • Two layer closure if required
44
Q

Fx of roots

A
  • May be part of disease process (trauma/periodontal disease/TR) or may be as a result of ineffective extraction technique
  • If inflamed or infected tissue remains then inflammation and pain in the surrounding tissues is likely to persist
  • Care must be taken with their extraction
  • Pre and post extraction radiography is essential
  • Atomisation is never an acceptable way of treating these, will just leave hole in tooth

AAA Companion Animal VMS4005 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions