Extraction Instruments and Positions Flashcards
What do we base our decision to extract a tooth? (2)
clinical judgement radiographic assessment
<p>What are some indications for XLa?</p>
Gross caries
unrestorable teeth
advanced perio disease
tooth/root fracture
pulpal necrosis
apical infection
upper wisdom tooth damaging cheek when biting
symptomatic PE teeth
traumatically positioned teeth
ortho indications
interference with denture constructions
What are the types of forces? (8) (10)
Straight upper anterior forces
Upper universal forceps
Upper molar forceps
Lower universal forceps
Lower molar forceps
Cowhorn forceps
Bayonet forceps - upper bayonet third molar forceps and upper bayonet root forceps
What do straight upper anterior forceps look like?
Straight instrument - when put on table will lie flat
What do we use straight upper anterior forceps for?
3-3 (upper canine to canine)
can’t use in posterior teeth as its straight and we need curve for back teeth
What do all the lower forceps have in common?
90 degree angle between handle and head
What do upper universal forceps look like?
they have a slight curve meaning they can reach further back in mouth
won’t lie flat on desk but tip is identical to upper straight forceps
What does the curve in upper universal forceps allow for?
Reach further back in mouth
Describe difference between upper universal forceps and straight upper anterior forceps
Same tip of instrument but different handles (upper universal curved and won’t lie flat)
What do we use upper universal forceps for?
Premoalrs forward (not good for molars as not good enough grip)
What teeth are upper universal forceps good for?
SINGLE ROOTED TEETH - canines
What do upper molar forceps look like?
Tips have concave surface and triangular beak shape
What is the tip of an upper molar forceps like?
has a concave area which is used for the single root (palatally)
triangle beak shape which is used for two roots ducally
Where does the point of upper molar forceps beak go?
in between root furcation
What are lower universal forceps like?
They are concave on both sides and right angle of tip to handle
what are lower universal forceps used for?
5-5 - single rooted teeth
What are lower molar forceps like?
They have pointed beaks on each side (triangle) which engage the buccal and lingual furcation
What are cowhorn forceps?
Pointy and sharp instrument that are very narrow
How are cowhorn forceps used?
they are used differently to normal forceps - only used In two rooted molars - we need radiograph to show to straight separate roots
Where are cowhorn forceps sput?
Down into furcation and we squeeze handle which goes into furcation and lifts tooth out (normal technique is mobilising teethe then extract with forceps)
what are the types of bayonets forceps?
upper bayonet third molar forceps
upper bayonet root forceps
What is the difference between upper bayonet third molar forceps and bayonet root forceps?
Upper their dmolars are more rounded and wider whereas upper root forceps are used to remove roots if there is fracture and are narrower, finer and sharper
What do lower forceps have between handle and blade?
90 degree curvature
When extracting teeth when do we stand in front of pt to the right?
If extracting upper 1-5
upper molars
lower molars - left
lower pre molars - left
lower anteriors
wHEN EXTRACTING TEETH WHEN do we stand behind pt?
lower molars - right
lower pre molars - right
What position are we in to extract upper 1-5?
Infront of pt to the right
What forceps can we use to extract upper 1-5?
Straight upper anterior forceps
Upper universal forceps
What position are we in to extract upper molars?
To the front and to the right but have pt a little bit more backwards
What forceps can we use to extract upper molars?
Upper molar forceps (r or left)
Upper bayonet third molar forceps
upper bayonet root forceps if the root fractures
What position are we in to extract lower molars on left hand side?
in front of pt to the right hand side - chair slightly reclined
What forceps do we use to extract lower left molars?
Lower molar forceps
Cowhorn forceps - if two root s
What position are we in to extract lower right molars?
behind pt to the right
What forceps do we use to extract lower right molars?
Lower molar forceps - R
Cowhorn forceps
What position are we in to extract lower left pre molars?
Infrotn and to right
What forceps do we use for lower left pre molars?
Lower universal forceps
What position are we in to extract lower right pre molars?
behind and to right
What forceps do we use to extract lower right pre molars?
lower universal forceps
What forceps do we use to extract lower anterior teeth?
Lower universal forceps
what position are we in to extract lower anterior teeth?
infront to right
or behind pt to right
What position should pt be in for upper extractions?
Pt up high with pts head level to our shoulders
we stand to the front and right of the pt
How should our elbows and arms be when extracting tooth?
straight as possible
When extracting tooth what do we use non dominant hand for?
To support alveolus with thumb and index finger
In teeth 1-5 what movement do we use?
primary rotational movement `(cork bottle) then secondary buccal to palatal movement to dilate the socket and deliver the tooth
Why do we use buccal to palatal movement?
to dilate the socket and deliver the tooth
What movement do we use in molar teeth?
Additional figure of eight movement
Describe how to extract an upper right canine
position ourselves infant and to right of patient
take the straight upper anterior forceps or upper universal forceps
use non dominant left hand to retract the soft tissues and support the alveolus
then begin with apical pressure to ensure blades of forceps are on root surface
primary rotational movement (cork screw movement)
buccal to palatal movement
Describe how to extract upper left 2nd premolar
position ourselves infrotn and to right of pt
select upper universal forceps
use non Dom hand to supportr soft tissue and alveolus
primary rotation movement
secondary buccal to palatal movement
deliver tooth
How do we extract an upper 1st molar?
Infront and to right of pt
select upper molar forceps
use non Dom hand to support soft tissues and alveolar (thumb and index finger)
ensure upper molar forceps were BEAK TO CHEEK!!!!
apply firm apical pressure
primary rotational movement
secondary buccal to palatal
additional figure of 9 socket movement to deliver tooth
What is different with chair position for lower extractions?
it is more reclined and low so pts head is level with our elbows
For lower right quadrant where do we stand when xla?
behind and to right of pt
For lower left quadrant where do we stand when xla?
infront and to rigtht of pt
What do we use non Dom hand for?
thumb and index fingers for alveolus and remaining fingers for mandible
Describe how to extract a lower right canine
Stand behind pt to the right t
select lower universal forceps
position non Dom hand
primary rotational
secondary buccal to lingual movement
Describe how to extract lower right 2nd molar
stand behind pt to right
select lower molar forceps (r) or cowhorn forceps
non dom hand
apply forceps with firm apical pressure
initial primary rotational movements
secondary buccal to lingual
additional figure of 8 movements to widen and dilate socket
How do we extract lower left canine?
infrotn and right of pt
select lower universal forceps
non dom hand
apical pressure
primary rotational movement
secondary buccal to lingual
What are elevators?
these are used to loosen the tooth
elevator instruments are used to luxate teeth, and this technique imparts forces to tooth particles that sever the periodontal ligament around tooth roots inside the socket and expand alveolar bone around tooth particles.
LUXATE THE TOOTH and minimise how much we break teeth
What are the three types of elevators?
couplands
cryers
Warwicks
What are couplands elevators?
These are 3 different sized elevators that are used to split multi rooted teeth and are inserted between the bone and tooth roots and rotated to elevate them out of the socket
What are the sizes of couplings?
1 2 3
narrow to wide
What are cryers elevators?
Set of two pointed instrument - concave surface points to ceiling upwards (pointy bits will paint at each other)
What are cryers used for?
to get out fractured retained roots
What are the two cryers?
left and right
What are Warwick James elevators?
set of 3 elevators - left right and straight
What is straight warwkicj used for ?
lower wisdom teeth
How is couplings elevator held?
iN PALM OF HAND AND INDEX FINGER SUPPROTS THE SHANK
what movement for couplands elevator?
rotational movement
What shaped blade does cryers have?
triangle
What are cryers good for extracting?
molar roots
Where can cryers be applied?
Buccal to engage furcation or placed in socket to elevate fractured root
wHAT CAN R and l Warwickjames be good for?
Elevatign maxillary 3rd molars
