extractions Flashcards
why is radiographic assessment important before extraction?
important anatomy eg.
- teeth close
- root curvature
- sinus
why might teeth be unrestorable?
gross caries advanced perio tooth/root fracture severe tooth surface loss pulpal necrosis apical infection
what are the indications for extractions?
symptomatic partially erupted teeth
traumatic position
orthodontic indications
interference with constructed dentures
straight upper anterior forceps
perfectly straight for upper anterior
canine-canine
central incisors & canines best
tip is wide for laterals
upper universal forceps
tip same as upper straight
handle curved
most upper teeth
not molars
why is the handle of upper universal curved?
allows further into mouth w/o stretching
upper molar forceps
same handle as universal
tip
one side same as universal for palatal root
buccal side surface to engage root
-point in middle to go in gap between buccal roots called beak
how many roots do upper molars have?
3
2 buccal, 1 palatal
why is there left and right upper molar forceps?
roots of molars are mirror images
cant use same forceps as need to engage furcation on one side
how are lower forceps held?
90 degree angle
describe cowhorn
lower very pointy tips smooth no concave edges not good grip for extracting with squeezing force only used in teeth with good furcation and soft bone- younger px
how many roots do lower molars have?
2
mesial distal
so anatomy same
upper bayonet 3rd molar forceps
upper posterior z-shape - allows good reach into mouth for wisdom teeth tip like upper universal no beak- bad grip
upper bayonet root forceps
pointy tip for grabbing roots of upper molars
fractures, if enough root to grab
narrow tip for fine root
where should you stand for lower right quadrant?
behind px
where should you stand for lower premolars?
behind to the right
direct vision of area
non-dominant hand supports jaw & moves soft tissues
where should you stand for lower left quadrant and all uppers?
in front of px, on the right of px
what should you change for upper anteriors?
lie px back
what are elevators used for?
facilitated extractions
to mobilise before forceps to prevent fracture and easier extraction
always use first
coupland’s elevators
3 sizes
bigger number= wider tip
half tip of universal
in correct place & rotate correctly can elevate tooth
if used incorrectly will damage adjacent teeth
cryer’s elevators
par when holding concave surface facing ceiling, pointing up right hand= right, left hand = left point toward each other to elevate root eg fractured root rotate to lift
warwick james elevators
pair like cryers also straight small couplands -elevating lower wisdom teeth, small hold in hands w/ concave facing ceiling, pointing at each other pointy, but less
what are upper roots used for?
roots
what are upper straights used for?
centrals, laterals, canines
what are upper left & right used for?
molars
what are upper 3rd molar bayonette used for?
8’s
how do you know the difference between upper root and upper universal?
upper root have thinner beak than upper universal
how do you know the difference between upper straights and upper universal?
straights handle in line with beak, forceps straight from handle to tip
universal curved handle and beak at angle to handle
what are lower roots used for?
retained roots
what are lower universals used for?
incisors, canines, premolars
what are lower molars used for?
molars
what are lower cowhorn used for?
broken down molars
how do you tell the dif between lower root vs universal?
hold side by side
root much thinner beak
how do you tell the dif between lower cowhorn vs molar?
hold side by side
cowhorn thin, pincer like beak to get into furcation
molar pointed beak to engage furcation
how should a patient be positioned for upper teeth?
comfortable height
supine position
45-90 degrees
how should a px be positioned for lower teeth?
more upright position
0-45 degrees
how should the operator be positioned for LR?
behind right shoulder
how should the operator be positioned for UR, UL, LL?
stand in front
on px right side
describe extraction technique
ensure soft tissues clear of forceps
apply forceps as far down root as possible w/o traumatising gingivae
place thumb and finger of left hand on alveolar bone for support
apply apical pressure
apply movements for extraction
if lower molar support mandible
what are the movements for extraction for a multirooted tooth eg molar?
figure 8
what are the movements for extraction for a single rooted tooth?
rotation
what are the movements for extraction for multi-rooted premolars?
rotation
what should you do post-extraction?
check tooth apices are intact
check if socket clear
if retained root/bone easy to remove then do so
if not easy call for help
place dampened gauzze in site and as px to bite
leave 5-10 mins then check haemostasis achieved
give post-op instructions
get checked
what are luxators used for?
to sever and tear pdl
create mobility
describe the tip of a luxator
rounded
what are elevators used for?
create space
how are elevators used?
wedge, lever or wheel/axel
describe the tip of an elevator
sharp
describe warwick james elevators
left, straight, right
point inwards
good for wisdom teeth
describe cryers elevators
left, right
point inwards useful in furcation of molars
how should you hold an elevator/luxator
palm of hand
curl thumb and fingers round handle
index finger on shank for support & control
how should you use a luxator
position same as forceps
place left thumb and finger on alveolar bone
-supports bone, prevents fracture, retracts tissues, supports mandible
luxate in buccal sulcus from mesial to distal
