extractions Flashcards
what do you need for an extraction to be indicated?
clinical +/- radiographic assessment
indications for extraction
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
upper extraction forceps
6 - beaks in line with handles root straight universal L molar R molar 3rd molar/Bayonet
straight upper anterior forceps
1, 2, (3)
straight handles
upper root forceps
v thin beaks
retained roots
upper universal forceps
3, 4, 5
curved handle and beak
upper molar forceps
“beak to cheek”
engages furcation
2 buccal roots, 1 palatal
lower extraction forceps
4 - beaks perpendicular to handles root universal molar cowhorns
lower root forceps
retained roots
v thin beaks
lower universal forceps
1,2,3,4,5
lower molar forceps
2 beaks
cowhorn forceps
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
Upper bayonet 3rd molar forceps
Z
straight handle
wider tip to allow you to extract U8s
might not give a good grip as anatomy varies a lot
Upper bayonet root forceps
curved handle
Z
narrow tips - grab retained upper molar roots
pt positioning lowers
quite upright
pt positioning uppers
lie back
less likely to inhale as tongue falls back and joins soft palate (partially closes)
- 45 degree dangerous accidental inhales common
operator positioning
behind pt to their right for LR quadrant
in front of pt to their right for LR, UL, UR quadrants
Couplands elevators
elevate tooth, widen PDL space unless mobile tooth always use elevators first before forceps 1 - narrowest 3 - widest no R+L
Warwick James Elevators
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
Cryer’s elevators
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
luxators
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
Periotome
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
mechanical principles for tooth elevation
wheel and axle - rotation
lever
wedge
wheel and axle
wedge it in - get it as deep as possible
once in twist
lever
don’t use often - produces a huge amount of force
may fracture jaw - be very careful if use
wedge
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
what should you avoid when using elevators?
excessive force
e.g. with bodily movement of elevator rather than rotation
points of application for elevators
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
what should you always do when using elevators for safety?
support jaw at all times
thumb and finger either side of tooth
