Indications for Extraction

Question 1

When taking a tooth out what assessments do we need to make?

Answer 1

clinical - is tooth viable/can we restore it?

radiographic - root anatomy, proximity to landmarks such as IAN, antrum

Question 2

What are some indications for extractions?

Answer 2

• 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

Question 3

What extraction forceps do we have?

Answer 3

straight upper anterior

upper universal

upper molar

upper bayonet root forceps

upper bayonet third molar forceps

lower universal

lower molar

cowhorn

Question 4

How do we use cowhorn forceps?

Answer 4

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

Question 5

When do we give up on cowhorn forceps?

Answer 5

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

Question 6

When are cowhorn forceps used?

Answer 6

o Best on younger pts or DIVERGENT ROOTS

Question 7

When can’t cowhorn forceps be used?

Answer 7

if pt has fused roots - cowhorns are sharp and go into furcation and if fused nowhere to go

Question 8

What are extraction positions?

Answer 8

Behind and to right for lower right

infront to right for all else

Question 9

What are elevators used for?

Answer 9

TO elevate a tooth

Mobilise tooth

widen the pdl

Question 10

When should elevators be used?

Answer 10

Before forceps to widen PDL and mobilise tooth making extraction easier

Question 11

If tooth breaks what do elevators make easier?

Answer 11

Easier to retrieve roots due to wider socket

Question 12

What do couplands elevators look like?

Answer 12

half of extraction forceps

they have curved tip

Question 13

what are couplands used for?

Answer 13

to mobilise and elevate teeth

Question 14

What does surgical kit always contain?

Answer 14

Elevators

3 couplands

3 warwicks

2 cryers

Question 15

What are luxators?

Answer 15

They are sharp tipped instruments that are easily broken used to luxate a tooth

Question 16

What is the problem with luxators?

Answer 16

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

Question 17

What is difference between elevators and luxators?

Answer 17

Elevators - elevate and mobilise teeth

Luxators - luxate teeth

Question 18

What are luxators designed to do?

Answer 18

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

Question 19

What is a peritome?

Answer 19

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)

Question 20

What are three modes of action for elevators?

Answer 20

Wheel and axle - rotation

lever

wedge

Question 21

What is the rotation movement?

Answer 21

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

Question 22

What movement must we never do with luxators?

Answer 22

Rotational movement as will snap the instrument

Question 23

What is the lever movement?

Answer 23

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)

Question 24

What movement can we do with luxators?

Answer 24

wedge movement

Question 25

What is the wedge movement?

Answer 25

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)

Question 26

How do we elevate teeth?

Answer 26

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

Question 27

What force does rotation action put mesially?

Answer 27

Upwards and backwards force

Question 28

what force does buccal action put on tooth?

Answer 28

uPWARDS AND LINGUAL

Question 29

describe bone at lower 8 region?

Answer 29

Thin on lingual aspect

more dense buccal due to external oblique ridge

Question 30

Whats best sequence for elevation?

Answer 30

medial then buccal in sequence