Extraction techniques Flashcards
What is the best analgesia for tooth extractions?
- local
When are prophylactic AB indicated for oral surgery?
- infection not being dealt with straight away (e.g. tooth root abscess that you’re not taking out immediately)
– short time high dose, then remove - animal with suppressed immune system can get bacteraemia (esp when extract teeth)
– give dose 2h pre-op
– CV issues, diabetes esp
Oral surgery prep
- scale
- flush
- disinfect with 0.12% chlorhexidine
Tooth extraction - Step 1
- number 15 scalpel blade in sulcus to release gingival attachment around the tooth
– cut to the bone with stabbing action
Tooth extraction - Step 2
- choose a luxator or elevator and drive down into the periodontal ligament space
What is a luxator?
- modified scalpel blade that cuts fibres when drive down into periodontal ligament space
What is an elevator?
- modified bone gouger that is for stretching/fatiguing of fibres and to expand the size of the socket (alveolus) through rotation
How far down a root do you need to drive an elevator before twisting?
- 25%
Aim of luxation & elevation
- breakdown PDL fibres
- slightly expand alveolus
luxator down 1st, then elevator
What do you need to do to multi-rooted teeth before luxation + elevation?
- section them
- bur from the furcation and cut out in diamond shape to leave wedge between 2 roots down to furcation
What must you never do when attempting to loosen a tooth with an elevator?
- lean on adjacent healthy tooth -> causes significant damage
What is vertical elevation?
- blade down into periodontal space, twist + feel tension
– hold and count to 20
Horizontal elevation
- aim concave side of elevator towards root want to loosen first + slowly rotate so lower edge of blade contacts root -> pushes up and away
- elevator now sits in sideways -> both roots pushed away from socket wall
Indications for simple/closed extraction
When teeth easy to remove:
- no flap
- no bone removal
- mobile dentition
What do periostea elevators do?
- raise flaps
Indications for surgical/open extractions
- carnassial, canine, broken tooth, fragile teeth, avoid complication, persistent deciduous
- flap
- bone removal
- immobile teeth
What do you do once the tooth is mobile?
- use extraction forceps to remove
– must only ever apply these to root and never crown
How must you remove bone windows over multi-rooted teeth?
- remove bone per root
- not over two roots at want to preserve as much bone as possible
Characteristics of a good flap
- big
- wider than is long
- greater base size than top edge
- one horizontal releasing incision
- two vertical releasing incisions in between teeth
What to do once you have made a flap
- place periosteal elevator blade onto bone + lift periosteum off bone to create clean, soft tissue-free area
How many roots does a maxillary carnassial have?
2 mesial at front, 1 distal at back
Surgical gutter
- Tiny bur used to cut out periodontal ligament space so elevator can be slotted in
What teeth can you use a surgical gutter to cut out the periodontal ligament space?
- carnassials
- canines
What should you do once the tooth is removed?
- ensure nothing pokes out
- smooth bone using rongeurs + flush and debride sulcus if required
What is the most important thing that should form following extraction of tooth?
- clean blood clot
Gingival flap closure - suture material & pattern
- monocryl 4-0
- ensure good secure, big bite through gingiva
- use an appositional + everting pattern eg continuous, interrupted
Analgesia
- must be multi-modal
– opioids & NSAIDs
– local during
Post-dental food
- soft food
Peri-dental indications for post-op AB
- open for ages
- struggling
- crushed bone
- damaged tissue
What force should you apply to extraction forceps?
- Apical pressure -> push inwards
What burr should you use to remove buccal bone + expose roots?
- Large burr
Once roots are exposed, what burr should you use to divide the two root portions for a multi-rooted tooth?
- Smaller burr to cut wedge of tooth from crown to bifurcation
What is a furcation?
- Where the roots and crown meet in a multi-rooted tooth
How many roots does the lower carnassial have?
- 2
Should you burr from the furcation outwards towards the crown or from the crown inwards towards furcation?
- Furcation outwards
- Use pen strokes
Dental chart: 3ry meaning
- reparative dentine
Dental chart: tract meaning
- draining abscess
Dental chart: GR meaning
- gingival recession
Dental chart: PD meaning
- pocket depth
Dental chart: F meaning
- furcational bone loss
