Extraction! Flashcards
Systemic contraindications for extraction
Brittle diabetes (a hard to control sub-type of type I diabetes)
End-stage renal disease with severe uremia
Uncontrolled leukaemia or lymphoma - Extraction may be complicated by infection because of non-functioning white cells, and excessive bleeding because of an inadequate number of platelets
Severe myocardial ischemia
Recent myocardial infarction
Malignant hypertension
Pregnancy (first and third trimesters)
Severe bleeding diathesis (e.g. haemophilia)
Medications contraindications for extraction
- Systemic corticosteroids
- Immunosuppressants
- Bisphosphonates
- Chemotherapeutic agents
Local contraindications for extraction
- History of therapeutic radiation for cancer - may result in osteoradionecrosis
- Teeth located within an area of tumour - Extraction may disseminate malignant cells
- Severe pericoronitis - First treat the pericoronitis with irrigation and antibiotics
What patients require AB prophylaxis
- Congenital heart disease with unrepaired cyanotic defects
- History of infective endocarditis
- Prosthetic heart valve repair or replacement
- Rheumatic heart fever in high disease populations
What patients are likely to bleed? and how to proceed with each condition?
- Taking Warfarin? Check INR
Less than 2.2 - Proceed
2.2 – 4.0 - Use tranexamic acid MW
> 4.0 - Consider referral to GP - Aspirin/Clopidogrel - Proceed with haemostatic measures
- Von Willebrand’s Disease - Consider referral to OMFS
- Chronic liver disease - Consult patient’s GP
Anxiety control methods
- Mild anxiety - benzodiazepine
- Moderate anxiety - nitrous oxide
- Severe anxiety - sedation / general anaesthesia
Radiographic considerations
A. Relationship to vital structures
B. Configuration of roots
C. Condition of surrounding bone
What do elevators do?
Disrupt PDL fibers
Expand the tooth’s bony socket
Displace the tooth towards occlusion
What do forceps do?
Disrupt PDL fibers
Expand the tooth’s bony socket
Displace the tooth’s centre of rotation (fulcrum) apically
Deliver tooth from the socket
Justification for leaving root tips
- Patient feels unwell
- There is uncontrolled haemorrhage
- It is small (less than 4 to 5 mm)
- It is deeply embedded in bone
- It is not infected
- It is in proximity to the IAN or maxillary sinus
Why do we raise a flap
To allow for complete access and visualization of the surgical field
To allow for bone removal and tooth sectioning
To prevent unnecessary trauma to soft tissues and bony structures
Principles of flap design
- Sharp, discrete, full thickness incisions that extend completely to underlying bone are imperative
- Base must be broader than the apex to allow for maintenance of vascular supply
- Margin should never be placed over a bony prominence
- Coronal aspects of the releasing incisions should be placed a safe distance 6-8 mm mesial and distal to the extraction site
- Avoid underlying vital structures
- Releasing incisions should be located at a line angle of the tooth
