extractions

Question 1

what do you need for an extraction to be indicated?

Answer 1

clinical +/- radiographic assessment

Question 2

indications for extraction

Answer 2

unrestorable tooth
 - gross caries
 - advanced PDD (bleed on ext)
 - tooth/root fracture
 - severe TSL
 - pulpal necrosis
 - apical infection
symptomatic PE teeth
traumatic position
 - e.g. U8s buccally - biting cheek
ortho indications - usually 4/5s
interference with denture construction

Question 3

upper extraction forceps

Answer 3

6 - beaks in line with handles
root
straight
universal
L molar
R molar
3rd molar/Bayonet

Question 4

straight upper anterior forceps

Answer 4

1, 2, (3)

straight handles

Question 5

upper root forceps

Answer 5

v thin beaks

retained roots

Question 6

upper universal forceps

Answer 6

3, 4, 5

curved handle and beak

Question 7

upper molar forceps

Answer 7

“beak to cheek”
engages furcation
2 buccal roots, 1 palatal

Question 8

lower extraction forceps

Answer 8

4 - beaks perpendicular to handles
root
universal
molar
cowhorns

Question 9

lower root forceps

Answer 9

retained roots

v thin beaks

Question 10

lower universal forceps

Answer 10

1,2,3,4,5

Question 11

lower molar forceps

Answer 11

2 beaks

Question 12

cowhorn forceps

Answer 12

broken down molars you can’t easily grip with molar forceps
v narrow and pointy
squeezing action should elevate tooth. if tooth doesn’t come out then move forceps - no mobilisation with cowhorns
use with care as can cause crown or root fractures
often use in younger pts - bone softer

Question 13

Upper bayonet 3rd molar forceps

Answer 13

Z
straight handle
wider tip to allow you to extract U8s
might not give a good grip as anatomy varies a lot

Question 14

Upper bayonet root forceps

Answer 14

curved handle
Z
narrow tips - grab retained upper molar roots

Question 15

pt positioning lowers

Answer 15

quite upright

Question 16

pt positioning uppers

Answer 16

lie back
less likely to inhale as tongue falls back and joins soft palate (partially closes)
- 45 degree dangerous accidental inhales common

Question 17

operator positioning

Answer 17

behind pt to their right for LL quadrant

in front of pt to their left for LR, UL, UR quadrants

Question 18

Couplands elevators

Answer 18

elevate tooth, widen PDL space
unless mobile tooth always use elevators first before forceps
1 - narrowest
3 - widest
no R+L

Question 19

Warwick James Elevators

Answer 19

straight, R+L
- hold so point towards each other
straight like a narrow Couplands - good for tight spaces e.g. 8s where you can’t fit couplands

Question 20

Cryer’s elevators

Answer 20

good at lifting up roots from sockets
put down a socket and twist - might lift root up
R+L
- hold with concave surface on top - point towards each other

Question 21

luxators

Answer 21

more effective at mobilising teeth
cut PDL
- don’t use for elevating - don’t twist and lift inside socket as will snap or bend tip
only use pushing down action to cut PDL

rounded rather than straight end as in couplands
can harm pt if not used correctly as v sharp

Question 22

Periotome

Answer 22

finest version of a luxator you can get
can also get them fitted to US
use in same way as luxator - go round tooth destroying PDL
use when wanting to minimise trauma to bone e.g. future implant
takes a LOT longer to ext a tooth so only if want implant

Question 23

mechanical principles for tooth elevation

Answer 23

wheel and axle - rotation
lever
wedge

Question 24

wheel and axle

Answer 24

wedge it in - get it as deep as possible

once in twist

Question 25

lever

Answer 25

don’t use often - produces a huge amount of force

may fracture jaw - be very careful if use

Question 26

wedge

Answer 26

push it down, as it goes in the tooth comes up
might accidentally do this with a luxator - only time you would ever do this
lucky when it happens but rate

Question 27

what should you avoid when using elevators?

Answer 27

excessive force

e.g. with bodily movement of elevator rather than rotation

Question 28

points of application for elevators

Answer 28

mesial and buccal - used in sequence
others
- distal - rare as often teeth in way and stretches cheek
- superior - never use as would have to drill all of the buccal bone away
- inferior

never use mesial and distal together (bimanual elevation of teeth) - not supporting jaw enough

changing a point of application of force from distal to mesial

Question 29

what should you always do when using elevators for safety?

Answer 29

support jaw at all times

thumb and finger either side of tooth