indications for extractions Flashcards
what is needed to determine need for extractions
- clinical and radiographic assessment
what are some causes for unrestorable teeth
- gross caries
- advanced periodontal disease
- tooth/root fracture
- severe tooth surface loss
- pulpal necrosis
- apical infection
- dilaceration of root
- traumatic position
- orthodontic indications
what is dilaceration of root
- abnormal bend in the root
what teeth are commonly partially erupted
- wisdom teeth or 2nd premolars that aren’t erupting full need removed
what is an example of a traumatic position causing removal of a tooth
- lingually placed 5 or buccal upper 8 which is traumatising cheek
which teeth are mainly removed for ortho
- premolars
what are straight upper anterior forceps used for
- easy access
- canine to canine
- tip for a single root
what are upper premolar forceps
- same beak and tip as straight so for single root
- slightly curved to reach further back in mouth without stretching cheek
what are upper molar forceps
- forceps for each side of mouth as upper molars have two buccal and one palatal root
- one side has a beak to engage buccal furcation
- beak to cheek
- smooth tip for single root
what is different about lower forceps
- 90 degree angle compared to upper
what are lower universal and lower root forceps
- slightly different with root having a narrower tip but both designed to get single root teeth
what are lower molar forceps
- only mesial and distal roots on lower molars so same forceps can be used on each side
what are cowherd forceps
- unique to lower jaw
- points to engage furcations between mesial and distal root
- only work on younger individuals and will only work if have lower molars with divergent roots
- as you squeeze forceps together, points come together and lift tooth
- can sometimes split tooth in half
- provides no grip
what are bayonet forceps
- z shape
- different tips
- get third molar and root forceps
- for uppers
- root ones are narrower and pointier
- great access for upper 8
where do we stand for extracting lower right side
just gonna do for right handed cause that’s what we all are
- behind patient
where do we stand for extracting lower left side
- in front of patient to the right
where do we stand for extracting uppers
- in front of patient to the right
what are coupland’s
- elevator
- most often used
- used to loosen teeth
- always use before forceps
- widen the socket
- high the rounded surface of a tooth
- numbers 1-3 = bigger number means wider tip
what are Cryer’s
- elevators
- right and left = only need to know for exams as can use both on either side
- goof for elevating roots in a socket
- fit down a socket and twist it and engage the root to rotate and engage root to elevate it
what are Warwick James
- elevators
- set of 3 = straight, right and left
- for upper wisdom teeth mainly
- R and L like a mini Cryer’s but not as sharp
- straight like a mini Coupland’s
what are luxators
- very sharp
- can harm patient or yourself if not used well
- tears ligament around tooth and widens pdl space
- mobilise tooth and cut pdl
- ideally the first instrument to use
what is a periotome
- kind of like a luxator
- very flat
- not used in oral surgery as takes a long time
- like a mini blade
- work it down the pdl and cut the space moving up and tooth gradually moving around tooth
- good for implants as take tooth out atraumatically
- get tips for ultrasonic handpieces
what are the mechanical principles for tooth elevation
- 3 basic modes of action
- wheel and axle = rotation
- lever
- wedge
what is wheel and axle movement
- most common
- use for elevators but not luxator as could break it
- instrument goes in horizontal
- wedge it in so tip is engaging CEJ or as deep as you can go
- rotated on an axle
- twist wrist and rotate
- as it twists upwards it elevates the tooth
what is lever movement
- use more force
- dangerous if not don’t properly
- only occasionally done
what is wedge movement
- with luxators
- tip pushed into pdl and as it works its way in it can push tooth out
- only time a luxator could be used to elevate a tooth
how are the 3 actions used
- all 3 actions can be used in combination with each other
- must avoid excessive force
what are the various points of application for the elevators
- mesial
- distal
- buccal
- superior = not really done
- inferior = not really done
what force of application is used first
- mesial then rotation
- as it rotates, put force up and back to tooth which is good
what other movement is needed for lower molar along with mesial
- need buccal movement as well otherwise mesial would only get it so far
why is buccal movement good in lower molars
- lingual bone is quite thin
what is superior application of force
- would have to remove all the buccal bone to do this
- not really done
what is the most common sequence used for force
- mesial then buccal
why don’t we do mesial and distal force at the same time
- going to fracture mandible
- would have no hand supporting jaw
- not done
how do we change a point of application fro distal to mesial
- use Cryer’s
- put them down socket and rotate it, will fracture bone and engage root so one component of force is vertical which could be enough to elevate the root
- use available space as distal root is done
- vertical force will hopefully dislodge and push root up and possibly back as well
- eventually have more space at mesial side of mesial root and can get instrument in there and rotate again to get it out
- root could get fall backward and be loose enough to elevate it
what is inferior application of force
- drill away buccal bone
- pointless
- not really done
is it safe to leave retained roots?
- if apical radiolucency associated with root, then needs removed as it is a problem
- if ortho can be done without root being removed, then can be left
- if it will interfere with treatment, then needs removed
- if more than 1/3 retained then remove it
- if there is a risk of nerve damage removing it, then better leave it
- whatever you do with it, need to tell patient and ask them what they want as well
