Extractions Flashcards
Define extraction
Painless removal or whole tooth or root, with minimal trauma to investing tissues, so wound heals uneventfully and no post-op problem created
List the indications for extractions
- Orthodontic
- Impaction
- Perio: periapical pathology, poor prognosis
- Patho: sharp and causing pain
- Prostho: non restorable
- Prophylactic: dental clearance (e.g. tooth loose)
- Fracture
List the contraindications to extractions
1) Heart attack
- within past 6 months
2) Undergoing radiotherapy
3) Blood thinners/bleeding disorders
- change/ stop if not will have excessive bleeding
What is the expected ideal extraction?
- Dilatation of bony socket to allow removal of tooth
- Disjunction of PDL around tooth
- Removal of tooth with minimal damage to adjacent structures
*elderly bone is tougher and does not dilate as easily
What are the factors that could complicate an extraction?
1) Medical conditions
2) Restricted mouth opening
- infection, tumour, muscle spasm
- GA if cannot open
3) Gag reflex
4) Lips and cheek
5) Anatomical Factors
- nerves, sinuses, blood vessels, root configuration
6) Condition of tooth, bone
7) Adjacent crowns/ FONs
Name the different types of extractions
1) Simple (forceps and elevators)
2) Surgical
- Trans Alveolar extraction (flaps, bone removal, tooth sectioning)
Briefly describe the procedure for simple extraction and surgery
Extraction:
1. Anesthesia
2. Removal of tooth
3. Hemostasis
4. Post-op management
Surgery:
1. Anesthesia
2. Raise flap
3. Removal of bone
4. Sectioning of tooth (if necessary(
5. Removal of tooth
6. Hemostasis
7. Post-op management
What are the post-expo instructions for patients?
1) Bite on gauze for 30 mins (change if require)
- initial clot retraction time
2) No rinsing/spitting for 24 hours (dont brush teeth)
- may dislodge clot
3) No strenuous activities for 48 hours
4) OHI (keep area clean)
5) Take medication as prescribed
6) Sinus precautions
- May cause perforation to reopen
- Cannot increase air pressure
- Travelling, sneezing with nose closed, blow balloons
7) Report to clinic/AnE if needed
Describe the positioning of the maxilla/mandible during extraction
Maxilla
- occlusal plane 45-60 degrees
- 3 inches below shoulder
- turn patients head to improve access and visuali
Mandible
- occlusal plane parallel to floor
- 6 inches below elbow of operator
*extract teeth along the long axis of the tooth
Name the parts of a forcep
- Beak (some have claw)
- Neck
- Handle
Which tooth uses right and left forceps?
Maxillary molars -> 3 rooted
Describe upper anterior forceps
- straight handle and straight beak without claw
Describe upper anterior root forcep
Straight handle with straight beak without claw (thinner at the beak)
Describe the upper molar forcep
Curved handle with straight beak with claw
Describe the lower anterior forcep
L shape beak with no claw
Describe the lower molars forcep
L shape beak with claw
Describe lower roots forcep
L shape beak but thinner
What is the purpose of forceps?
- Expansion of the bony socket
- pocket dilation
- break PDL fibres - Removal of tooth
What are the 5 motions of a forcep
1) Apical pressure to expand bony socket (v impt)
2) Buccal force to expand buccal crestal bone
3) Lingual force to expand lingual crestal bone
4) Rotational force to cause internal expansion of tooth socket
5) Tractional force (at the last and is gentle to deliver tooth from socket)
What are the common elevators used?
Coupland, Warwick-James, cryer, others
When do you use elevators?
- Luxate and remove teeth that cannot be engaged by thre beaks of forceps (impacted, extensively decayed, drifted teeth)
- Remove fractured roots
- Loosen teeth prior to application of forceps
- Split teeth which have grooves cut in them
- Remove intra-radicular bone
What are couplands used for? How do you use a coupland?
- Used to elevate and loosen PDL
- Used to split tooth if not fractured fully
- Has 3 sizes (smaller to larger)
- Push and rotate while having finger on the next tooth
- Palm grip and finger guard
- DO NOT use next tooth/buccal/lingual plate as fulcrum
What is war-wick James used for? How does it look like?
- Used for upper wisdom teeth (remove most distal tooth)
- Used to raise flap after incision
- Looks like golf/hockey sticks
- There’s left and right (curving upwards face up)
What is a cryer used for? How does it look like?
- Similar to Warwick James but sharper and longer
- Used to elevate in a 3D movement with narrow engagement
- Go in between the roots to dig bone
- Used to break interradicular bone
What’s the difference between root pick, luxator and apexo?
Root pick is finer than apexo
Root pick used for very small root stumps
Apexo used for very deep root stumps
Small luxator used for very deep lower anteriors
Describe the direction of movements from incisors to molars
Incisors: rotary only (careful not to break buccal plate)
Canines: rotate + buccal lingual movement
Maxillary Premolars: rotate + buccal lingual movement (more BL movement because 2 rooted)
Mandibular Premolars: rotate (single rooted)
Molars: Buccal lingual movement + figure of 8
What is important to take note about the technique of using forceps?
1) Grab the root not crown for greater support
2) Direction of extraction should be parallel to long axis
3) Maintain deep, firm grip
4) Avoid hitting opposing tooth
- Lower teeth should come out buccally if not hit upper tooth
What are the common mistakes causing fracture of tooth?
1) Improper technique
2) Dense bone
3) Fragile roots
4) Damaged tooth (pre warn patient!!!)
- pupless, RCT, grossly carious, pre-existing fracture
What instruments do you use to remove single roots at the gingival margin?
Root forcep + luxator (to create space around root to enable adaptation of root forcep)
What’s the difference between luxator and elevator
- Both designed to elevate teeth but luxator is thinner and sharper
What’s purpose of winged/non winged elevators
- Wings hug the root so its less likely to slip
- Works in periodontal space rather than crush surrounding bone
How do you use a luxator/elevator?
- Place the luxator perpendicularly into the interdental area
- Move the blade upwards
- Use in a circular cutting motion to separate tooth from surrounding bone and PDL
- Elevators tear PDL but luxators cut
Which principle do you use to remove a root from the socket?
Wheel and axle principle
How to remove multirooted teeth?
1) Coupland/luxator to loosen
2) Apply forceps if possible
3) Subgingival (separate roots/deliver roots individually)
