Indications for Extraction Flashcards
When taking a tooth out what assessments do we need to make?
clinical - is tooth viable/can we restore it?
radiographic - root anatomy, proximity to landmarks such as IAN, antrum
What are some indications for extractions?
• Unrestorable teeth
o Gross caries
o Advanced perio
o Tooth/root fracture
o Severe tooth surface loss – grinding or clenching habit
o Pulpal necrosis – trauma
o Apical infection
• Symptomatic PE teeth
o Could be wisdom tooth or partially erupted premolar (particular second premolar)
o Teeth may not erupt completely due to pericoronitis around them
o Pericoronitis is inflammation around the crown
• Traumatic position
o Lingually placed 5
o Buccally placed 8 traumatising cheek
• Ortho indications
o Premolars
• Interference with construction of dentures
What extraction forceps do we have?
straight upper anterior
upper universal
upper molar
upper bayonet root forceps
upper bayonet third molar forceps
lower universal
lower molar
cowhorn
How do we use cowhorn forceps?
o Used differently to other forceps – points to engage furcation between mesial and distal root and then we SQUEEZE to deliver the tooth
o Best on younger pts or DIVERGENT ROOTS
o If pt has fused roots they cant be used! – need to go into furcation to squeeze tooth out
o The tooth may split in half due to force generated however we can then get half out separately
When do we give up on cowhorn forceps?
If after squeezing the tooth isn’t elevating or the tooth hasn’t split then give up and move to molar forceps as we will be wasting our time
When are cowhorn forceps used?
o Best on younger pts or DIVERGENT ROOTS
When can’t cowhorn forceps be used?
if pt has fused roots - cowhorns are sharp and go into furcation and if fused nowhere to go
What are extraction positions?
Behind and to right for lower right
infront to right for all else
What are elevators used for?
TO elevate a tooth
Mobilise tooth
widen the pdl
When should elevators be used?
Before forceps to widen PDL and mobilise tooth making extraction easier
If tooth breaks what do elevators make easier?
Easier to retrieve roots due to wider socket
What do couplands elevators look like?
half of extraction forceps
they have curved tip
what are couplands used for?
to mobilise and elevate teeth
What does surgical kit always contain?
Elevators
3 couplands
3 warwicks
2 cryers
What are luxators?
They are sharp tipped instruments that are easily broken used to luxate a tooth
What is the problem with luxators?
if used inappropriately tip can bend or fracture and we need to retrieve it from pts mouth
can harm ourselves and pt - rip finger or perf pt
What is difference between elevators and luxators?
Elevators - elevate and mobilise teeth
Luxators - luxate teeth
What are luxators designed to do?
tear pdl and widen pdl space and go far down apically due to how sharp and thin they are so can mobilise teeth very well
What is a peritome?
This is a tool used to cut the PDL space by moving up and down and effectively cuts the PDL so tooth comes out easily (however would take forever to take a tooth out but can be good for implants but we charge for our time)
What are three modes of action for elevators?
Wheel and axle - rotation
lever
wedge
What is the rotation movement?
This is most common way to elevate a tooth
we put the elevator into gap approaching from buccal side and wedge the instrument in so the tip engages the CEJ and then once in rotate out wrist so instrument rotates elevating the tooth upwards
What movement must we never do with luxators?
Rotational movement as will snap the instrument
What is the lever movement?
This is where we insert he instrument by resting it on bone and wedge against surface of tooth and we make a lever movement generating a huge amount of force (can be dangerous and can fracture mandible)
What movement can we do with luxators?
wedge movement
What is the wedge movement?
this is where we insert locator into PDL space and it can help to lift roots out of the socket (only time when luxators act as elevator)
How do we elevate teeth?
Start with mesial application by inserting instrument on medial side going in horizontally
then carry out rotation action
then we may need to switch to buccal application and try engage the furcation to push tooth up
then move back to medial application
then forceps
What force does rotation action put mesially?
Upwards and backwards force
what force does buccal action put on tooth?
uPWARDS AND LINGUAL
describe bone at lower 8 region?
Thin on lingual aspect
more dense buccal due to external oblique ridge
Whats best sequence for elevation?
medial then buccal in sequence
