Exo Flashcards
Possible complications of removing impacted upper molar
Tuberosity fracture
OAC
Perforated maxillary sinus
Damage adjacent teeth
Name some indications for exo
Grossly carious and cannot be restored
Acute/chronic pulpitis, cannot be restored by RCT
> 1/2 alveolar bone loss
Tooth fracture (root, longitudinal, lie in fracture line)
Bony lesion lies over tooth
Impacted
Ortho
Supernumerary
Pre bisphosphonate therapy
Retained deciduous
Tooth hurting soft tissue
Contraindications fro exo
Cardiac disease eg valvular heart disease
Blood disorders eg severe anemia
Liver disease, vit k deficiency
Pregnancy 1st and 3rd trimester
Malignancy (if extraction is around tumour site)
Patient on steroids
What must you do before exo
Time out
Why is it compulsory to take pre exo radiograph
Root morphology, proximity to vital structures, impacted teeth, periapical pathology, accompanying conditions eg sinusitis
How long does 2% lidocaine with 1:100000 epinephrine provide anaesthesia for
1 hour of dental pulp analgesia
3-5 hours of soft tissue analgesia
Possible complications of IDN block
Infection
Patients have tendency to bite tongue and lips
Nerve injury
How much to inject for IDN block
1.5-2ml
If lingual block required, withdraw needle 0.5cm and inject 0.5ml
Mental nerve block target
Apex of second premolar
How to use luxator
Wedge. Thin and sharp tip insert into narrow apical space between bone and tooth to slide in further
Rotating motion
How to use dental elevator
Prying motion, leverage
To loosen tooth prior to forcep use
How to use periotome
Sharp tip, tapering blade, insert between tooth and surrounding bone to cut PDL
Rotating, twisting motion
Motion when using forceps to extract mandibular molars
Buccolingual motion, more lingual motion because lingual plate thinner
What are the principles in expanding the bony socket
Socket dilatation
Small fractures of buccal plate and interradicular septa
Loose bone must be removed
How should patient be positioned for extraction of q4 tooth
Mandibular occlusal plane parallel to floor
Working height elbow level
Operator stand behind patient
How should patient be positioned for q2 extraction
Occlusal plane about 60º to the floor
Elbow level
Operator stand in front of patient
Extraction movement for upper incisors
Rotation only
Extraction movement for lower incisors
Labolingual movement
Extraction movement for upper canines
Rotation followed by labiolingual if required
Extraction movement for upper premolars
Buccopalatal movement
Extraction movement for lower premolars
Rotary
Extraction movement for lower molars
Buccolingual movement
Indications for trans alveolar removal
Very dense bone
Severe root curvature
Prominent external oblique ridge
Gross caries/caries below bone crest
High risk of oap
hypercementosis
Post op instructions for exo
Bite on gauze for 30min No rinsing out for 24h No high intensity activities for 2-3 days Soft diet, eat on other side Sleep with head slightly inclined Judicious pain control
Possible complication sduring extraction
Failure to obtain adequate anaesthesia
Fracture of crown, root, tuberosity, opposing tooth
TMJ dislocation
Displacement of root into maxillary sinus, aspiration
Excessive hemorrhage
Wrong tooth extracted
Damage to soft tissue, nerves, adjacent teeth, maxillary sinus (oac)
Possible complications post exo
Post op pain
- damage t hard and soft tissue
- dry socket
- acute osteomyelitis
- traumatic TMJ arthritis
Post op swelling
- Edema
- Hematoma
- Infection
- Trismus
- Oroantral communication
Post op trismus ie myositis ossificans
Post op numbness due to nerve injury
Clinical signs of OAC
Visualisation of sinus in socket
Part of sinus floor attached to root
Water enter nose from mouth
Misting of mirror on occluding nasal passage
Acute sinusitis — pus discharge, pain and erythema over sinus
What is considered a small oac
<2mm
How to trea moderate OAC
2-6mm, can heal on its own with local measures (surgical and suture)
nasal precautions for 10-14 days. ab, decongestants/antihistamines (syst or nasal spray) to maintain ostium patency and reduce thickness of mucous membrane, chlorhexidine m/w, dont sneeze with your mouth closed, no straw/smoking
Post op instructions after surgery to fix large oac >6mm
No nose blowing, sneezing, straw drinking for 10 days
Nasal decongestant
Augmentin for 2 weeks
STO ≥10 days
How long does it take for sinus membrane to reform
2 weeks
Incidence of alveolar osteitis
5-20%
Symptom of dry socket
Increasingly severe pain 3-7 days after exo
Patient had tooth extracted. Begins to feel pain 4 days after extraction that becomes increasingly severe. Patient notices a bad smell. Possible cause?
Alveolar osteitis. Dissolution of blood clot, exposing lamina dura to the oral environment. Fibrinolysis due to increased fibrinolytics activity
How to treat dry socket
Heals by itself within 2 weeks,
but symptomatic relief – irrigate and pack alveogyl, review after 1 week
How to retrieve small root in antrum
2-3mm
Retrieve through irrigation
Risk when leaving behind root in antrum
Risk of sinusitis
Available local hemostatic agents
Gel foam, surgicel, collagen ring, transexamic acid
What is secondary bleeding
Bleeding 7-10 days after exo possible due to infection
3 possible sources
- Bony socket
- Soft tissue
- Neurovascular bundle
Healing process of extraction wound
Formation of blood clot filling the socket
Organisation of clot
Epithelialisation
Formation of woven bone filling the socket (1-2 months)
Woven bone is replaced by trabecular bone, alveolus remodelling
