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Oral surgery > Extraction of teeth > Flashcards

Extraction of teeth Flashcards

1
Q

Some indications for extraction of teeth

A
  • Periodontal disease
  • Pulpal disease
  • Pathological lesions surrounding the teeth
  • Crown and root fracture
  • Before radiation therapy
  • Orthodontic indications
  • Supernumerary teeth
  • Impacted teeth
  • Malposition of teeth
  • Teeth in bone fracture lines
  • Caries
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2
Q

Systemic contraindications for extractions

A
  • Severe anxiety
  • Haemophilia/other coagulopathies
  • Uncontrolled diabetes
  • Uncontrolled hypertension and cardiac diseases
  • Ongoing radio-chemotherapy
  • Medications that affect immune system/delay healing
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3
Q

Particular attention should be paid to following medications

A
  • Anticoagulants
  • Cancer medication
  • Glucocorticoids
  • Immunosuppressants
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4
Q

Local contraindications of extractions

A
  • Acute inflammation or infection(if from pulpal diseases can be resolved by extractions)
  • Lower third molar with pericoronitis
  • Radiation therapy
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5
Q

Reasons why operation contraindicated after radiation therapy

A
  • Necrosis of bone(some cancer meds also cause necrosis of bone after extraction)
  • Delayed healing
  • Dehiscence
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6
Q

Clinical features evaluated before extraction

A
  • Condition of crown
  • Tooth and root mobility
  • Access to perform extraction
  • Pathology of pulp and surrounding tissues
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7
Q

Importance of radiographic assessment pre extraction

A

Evaluates difficulty of extraction by assessing:

  • Root anatomy
  • Pathology in surrounding bone
  • Ankylosis or hyper-cementosis of root
  • Proximity of molars to sinus in maxilla
  • Position of mandibular canal(relation to third molars)
  • Position of mental foramen(where flap is raised to remove premolars)
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8
Q

Most common radiograph for extractions

A

Periapical

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9
Q

Radiographs for assessing impacted teeth

A
  • Panoramic
  • Scanogram
  • Cone beam
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10
Q

Sinus rupture results in

A

Oroantral communication

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11
Q

Preoperative mouth rinse can be done with

A

Chlorhexidine

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12
Q

Patient position for extraction of Maxillary teeth

A
  • Patient mouth at same height as dentist shoulder
  • 120 ° angle between dental chair and floor
  • Occlusal surface of maxillary teeth at 40 ° when open compared to horizontal
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13
Q

Patient Chair position for extraction of mandibular teeth

A
  • 110 ° angle between chair and floor
  • Occlusal surface of mandibular teeth parallel to floor when mouth open
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14
Q

Surgeon position for extraction with forceps for maxillary teeth

A

-Infront or to the side of the patient

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15
Q

Surgeon position for extraction with forceps for mandibular teeth

A
  • Right posterior and anterior teeth→ behind patient
  • Left mandibular teeth→ in front of patient
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16
Q

Two stages of extraction

A
  • Tooth separated from surrounding soft tissues→ Desmotome or elevator
  • Tooth extracted from socket→ forceps or elevator
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17
Q

Desmotome use

A
  • Pen grip with dominant hand
  • Positioned at bottom of gingival sulcus to sever PDL
  • Continuous motion from mesial to distal→ buccally then lingually/palatal
  • Non dominant hand→ index finger and thumb positioned on buccal and palatal
18
Q

Elevator Function

A

Push or reflect gingiva→ allows extraction forceps to grasp tooth beneath cervical line

19
Q

Extraction technique with forceps

A
  • Beaks of forceps at cervical line of tooth→ parallel to long axis of tooth
  • Gentle initial buccal then lingual/ palatal movements
  • Gradual increase in pressure first at buccal(bone thinner and more elastic)
  • Rotational force if roots single and conical
  • Slight traction to facilitate extraction but not used at final stage
  • Final movement → Maxilla=buccal and curved outwards and upwards

→ Mandible=Buccal direction and curved outwards and downwards

20
Q

Extraction technique of maxillary central incisor

A
  • Initial gentle labial and palatal movements
  • Increase in force first at labial
  • Rotational forces permitted due to conical root
  • Slight traction
21
Q

Extraction technique of maxillary lateral incisor

A
  • Labial and palatal movements with forceps
  • Rotational forces not permitted(thin root curved distally)→only very slight rotation at final stage with traction
22
Q

Extraction technique of maxillary canines

A
  • Labial/palatal movements with increasing pressure
  • Rotational movements not permitted due to distally curved root→ if used very slight w/ alternating buccopalatal pressure
  • Final extraction movement labial
23
Q

Extraction technique for maxillary first premolar

A
  • Initial buccal and palatal movements
  • Rotational movements not permitted→ 2 roots w/ slight curve
  • Final movement buccal
24
Q

Extraction technique for maxillary second premolar

A
  • Same technique as first premolar
  • Easier due to one root
  • Final movement buccal
25
Q

Anatomy to consider during extraction of maxillary molars

A
  • Three diverging roots(longest root palatal and two buccal roots w/distal curve)
  • Tooth firmly anchored to alveolar bone and buccal surface reinforced by extension of zygomatic process
  • Strong force required for extraction
  • Risk of oroantral communication→ root tips close to sinus
26
Q

Extraction technique for maxillary first and second molars

A
  • Initial buccal and palatal pressure w/ emphasis on buccal
  • increasing pressure w/ final movement buccal w/ upwards curved movement
27
Q

Extraction technique for maxillary third molar

A
  • If roots conical (fused)- simple w/ buccal pressure mostly to avoid thin palatal alveolar process fracture
  • If 3 or more roots→ buccal pressure w/ slight palatal pressure
  • Final extraction movement buccal

-

28
Q

Extraction technique of mandibular incisor teeth

A
  • Extraction easy→ thin alveolar bone and roots not firmly attached to alveolar bone
  • Labial and lingual movements w/ increasing pressure
  • Roots slightly curved esp. lateral→ slight rotational movement only
29
Q

Extraction technique of mandibular canines

A
  • Same movements as incisors
  • Harder to extract than incisors→ longer root and curvature of root tip
  • Final movement labial curved outwards and downwards
30
Q

Extraction technique of mandibular premolars

A
  • Buccal/lingual movements
  • Final extraction movement outwards and downwards
  • Easy extraction as roots straight and conical
31
Q

Anatomy to consider for mandibular first molar

A

-Two roots(mesial and distal)

Mesial root larger, more flattened and curved distally

-Distal root straighter, narrower and more rounded

32
Q

Anatomy to consider for mandibular second molar

A

-More easily removed despite denser bone→ roots smaller and less divergent(often fused together)

33
Q

Extraction of mandibular first and second molars

A
  • Forceps as apical as possible beneath cervical line→ beaks parallel to long axis
  • Initial gentle buccal and lingual pressure
  • Gradual increase in force and final movement buccal
34
Q

Anatomy to consider for Extraction of mandibular third molar

A
  • Two roots w/ similar morphology to other molars→ smaller and fused in conical shape w/ wide distal divergence
  • If one or two roots converge and curve in same direction→ straight elevator can be used
  • Lingual bone very thin compared to alveolar bone(unyielding in third molar area)
35
Q

Extraction technique for mandibular third molar

A
  • Buccal/lingual pressure
  • Main force in lingual area to mobilise tooth
  • Careful pressure to avoid fracture in area of lingual plate
36
Q

Risk involved in extraction of deciduous teeth

A

May extract bud of permanent tooth(especially under deciduous molar as crown short0

37
Q

How to avoid extraction of underlying tooth bud

A

Beaks of forceps placed on mesial or distal area of tooth and not central(furcation area)

38
Q

Extraction technique of elevator

A
  • Held in dominant hand w/ index finger along blade
  • Used buccally(not lingual/palatal)
  • Concave surface contacts mesial or distal
  • Alveolar bone used as fulcrum
  • In maxillary posterior teeth- perpendicular to long axis and in rest→ perpendicular, parallel or at angle
39
Q

Protective measure during elevator use

A

Cotton wool or gauze between finger and palatal to avoid injury if elevator slips

40
Q

Post extraction care of socket

A
  • Periapical curette used at bottom of socket(removes granulation tissue preventing cyst)
  • If sharp and bony edges-ronguers forceps or bone file to smooth alveolar margin
  • Haemostasis aided by pressure on socket w/ gauze for 30-45 min
41
Q

Post operative instructions

A
  • Rest
  • Analgesia
  • Edema
  • Bleeding
  • Antibiotics
  • Diet
  • Oral hygiene

Oral surgery (105 decks)

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