Indications for Extractions Flashcards
How do we reach an indication for extractions? (2)
- Clinical
2. Radiographic assessment
List some indications for extractions (5)
- Unrestorable teeth
- Gross caries
- Advanced periodontal disease
- Tooth / root fracture
- Severe tooth surface loss
- Pulpal necrosis
- Apical infection - Symptomatic partially erupted teeth
- Traumatic positioned teeth
- Orthodontic indications
- Interference with construction of dentures
List the types of upper extraction forceps (4)
- Straight upper anterior forceps
- Upper premolar forceps
- Upper molar forceps (R+L)
- Upper bayonet forceps
- Upper bayonet 3rd molar forceps
- Upper bayonet root forceps
List the types of lower extraction forceps (3)
- Lower universal forceps
- Lower molar forceps
- Cowhorn forceps
Where do we use straight upper anteriors?
Describe their appearance
- Upper 3-3
2. Slight curve, normally have single roots so perfect for getting into them
Where do we use upper premolar forceps?
Describe their appearance
- Premolars
- Has a beak but slightly more curved to allow access further back to reach the premolars, without stretching the patients cheek too much
Upper molars have 2 ends, how do they both look?
Pointy end - furcation??
Smooth end - for single palatal root
What angle do lower forceps have?
90 degrees
Narrower at the tip
Compare upper bayonet 3rd molar forceps to the upper bayonet root forceps
3rd molar ones chunkier rounder
Root ones pointy beak like
Standing position for extracting upper/ lower molars
Directly behind patient standing up or in front
For an upper want them sitting quite back
List examples of elevators
- Couplands elevators
- Cryers elevators (R+L)
- Warwicks James Elevators (R+L)
Function of couplands elevators
Elevate a tooth
- Widen the PDL
- Can try to wedge it mesially and lift the tooth up
When should elevators be used?
Before using forceps to break apart the PDL
How do couplands elevators look?
- Rounded shovel like
- Not v sharp but cut ligament with the movements that are generated
- The bigger the no. the wider the tip
How do cryers elevators look?
Pointy like little knives
Point away to the side they should be used on
What are warwicks james elevators used for?
Elevating wisdom teeth
- mesial application
What are the 3 types of warwicks james elevators?
- Straight
- Right
- Left
When would you use a warwicks instead of a couplands?
Getting a couplands between the 7-8 gap is hard
Warwicks can be used as its narrower
How do we figure out what side is which in a warwick james elevator?
Right and left point inwards to each other
Function of luxators
Mobilise teeth
- Can only tear PDL and widen the PDL surface
Order of use for these oral surgery instruments (3)
- Luxator
- Mobilise teeth tear PDL - Elevators
- Couplands (can be used to lift tooth up) - Forceps
What do luxators reduce the risk of
Mobilising a tooth reduces the risk of a failed extraction
What is a periotome?
Luxator but not for the impatient
- Perio like flat bore
- Work it down PDL space and cut the PDL
- Makes the extraction easier and means you can take the tooth with minimum trauma
Why would you want to extract a tooth with minimum trauma caused?
Buccal plate makes it easier to put an implant on
What are the 3 modes of action for tooth elevation?
- Wheel and axle (rotation)
- Lever
- Wedge
What instruments do we use a wheel and axle rotation?
Elevators
- Couplands
- Cryers
- Warwick james
NOT LUXATOR
Will bend the tip and break it
Why is a lever action more dangerous to use?
Generates much more force
You could fracture the mandible if resting on bone and wedge it in
Describe the one case where a luxator can be used to elevate (3)
- Fracture below gum level
- Luxator used to push the tip into the PDL space
- Root can just come up
Most common point of application for elevators (2)
Mesial then buccal
Works v well for wisdom teeth
