Extractions

Question 1

What are the two main techniques that cam be used for extraction?

Answer 1

• Simple - removed w/ no bone removal - quicker to perform surgical on multi-rooted or firmly embedded
• Surgical - includes removal of alveolar bone

Question 2

What should be done pre-extraction of teeth?

Answer 2

• GA, intubated, pharynx packed, head of animal declined
• Chart + clean teeth
• +/- pre-procedural AB’s
• Local anaesthesia - decrease GA plane, reduce pain windup, recovery w/less pain

Question 3

What are the 7 steps involved in a simple extraction?

Answer 3

1. Pre extraction radiograph
2. Gingival incision
3. Luxation/elevation
4. Removal of root
5. Management of alveolus
6. Suture
7. Post extraction radiograph

Question 4

Name the type of root shown in the radiograph below:

Answer 4

Dilacerated (abnormal shape) - curved root

Question 5

Describe how you would perform a gingival sulcal incision:

Answer 5

• Size 15 blade - run around the tooth - 15 degree incising into gingiva

Question 6

Describe how you elevate/luxate a tooth?

Answer 6

• Periodontal ligament space - wiggle between the tooth root and alveolar bone (if it doesn’t use a small bur - ¼ to ½ round) → create a channel (3mm)
• Push the elevator in an apical direction - once in rotate around root for 15-30s → fatiguing PL

Question 7

Describe how tooth root should be removed

Answer 7

Gentle twisting (corking) of the tooth - grasp over enamel bulge as far apically as possible

Question 8

Describe the proper management of an alveolus (socket):

Answer 8

• Ensure no debris present through gentle lavage + curette
• No need for aggressive cleaning - we want a blood clot present

Question 9

What type of suture material, pattern, needle and suturing style would you want for extractions?

Answer 9

• Monosyn or monocryl best
• Absorbable, reverse cutting - 4/0 or 5/0
• Simple interrupted 2-4mm

Question 10

How do multi-rooted teeth differ from single rooted teeth?

Answer 10

• Cut tooth into sections → make each root section a single entity
• Crosscut taper fissure bur (e.g. size 701L) or round bur to remove alveolar bone (e.g. size 2 or 4)
• Start at furcation → bur away from gum

Question 11

What are the 10 steps that are involved in surgical extraction?

Answer 11

1. Pre extraction radiograph
2. Gingival incision
3. Elevation of flap
4. Buccal bone removal (alveolotomy or partial alveolectomy)
5. Section tooth if multi-rooted
6. Luxation/elevation
7. Removal of root
8. Management of alveolus
9. Suture
10. Post extraction radiograph

Question 12

When designing a flap is it better to have a mesial or a distal incision? Why?

Answer 12

• Blood supply runs from distal to mesial - preferable to have mesial incision over distal if possible

Question 13

Name the flap technique that is shown below:

Answer 13

Triangle flap - has one vertical releasing incision → create a triangular flap

Question 14

Name the technique that is shown below:

Answer 14

• Pedicle flap - gingival incision then caudal and rostral vertical incision
• Divergent vertical incisions to preserve blood supply