indications for extractions and techniques

Question 1

indications for extractions

Answer 1

Clinical ± Radiographic assessment

Viable? Restorable?

Look for unusual anatomy, related important structure

Question 2

unrestorable tooth - need extracted

Answer 2

Gross caries

Advanced periodontal disease

Tooth/root fracture

Severe tooth surface loss

Pulpal necrosis

Apical infection

Question 3

reasons for extractions

Answer 3

unrestorable teeth

symptomatic partially erupted teeth

traumatic position - mesial 5; buccal 8

orthodontic indications

interference with construction of dentures (unusual)

Question 4

pericornitis

Answer 4

inflammation around partially erupted crown

Question 5

straight upper anterior forceps

Answer 5

only straight ones

easy access

3-3

single rooted

Question 6

upper premolar forceps

Answer 6

same single rooted tip as upper anterior forceps

curved slightly to allow access further back

Question 7

upper molar forceps

Answer 7

2 roots abd 1 palatal

• engage furcation on buccal side
• beak to chhek

separate ones for each side

smooth single root
point engage furcations

Question 8

feature of lower forceps

Answer 8

90 degree angle to allow reach lower arch

Root narrower at tip

Universal and root - single roots

molar - pointy beaks on both sides as both engage furcation

Question 9

cowhorn forceps

Answer 9

engage furcation in mesial and distal roots

Only really on younger individual – lifts tooth

Need divergent roots

No grip, just squeeze

Question 10

bayonet forceps

Answer 10

Z shaped

Uppers

Narrow pointy one – root forceps

Upper 8s have variable morphology – common to have multiple roots fused – assume single root no furcation to grip

Question 11

extraction technique for lower molars - right handed

Answer 11

Behind pt for lower right

Then all other in front of pt to right

Question 12

elevators role

Answer 12

Mobilise the tooth

Widen PDL

Before delivering tooth with forceps – more control, less chance of inhalation of loose tooth

Grab tooth higher up as forceps can go into the socket that has been widened

Question 13

coupland’s elevators

Answer 13

most frequently used

Hug rounded surface of tooth trying to elevate
single

Bigger number = wider the tip (1, 2, 3)

Question 14

cryer’s elevators

Answer 14

Sets of 2 – pairs

Tips facing, concave surface is facing up – right hand holds right (same for Warwick James) (smile to sky)

Elevate roots down a socket
- E.g. fractured part remains in sockets

Question 15

warwick james elevators

Answer 15

wisdom

Sets of 3

• Right
• Left
• Straight

Concave surface of right and left, but less sharp than cryers
- Uppers 8s

Straights – useful for lower 8s elevation as can fit more effectively into narrower space

Question 16

luxators role

Answer 16

Very sharp

Like Coupland’s ended – but sharper

Narrow – easily broken, bend

Very effective but risky as can cause harm

Designed for luxating the tooth
- Tear ligament around tooth
(not elevators)

Question 17

periotome

Answer 17

Mini blade
Work down PDL
Cut space
Effectively cut most ligament around tooth to ease extraction

Atraumatic to adjacent bone – good for implant
- Save as much bone as possible

Timely – long procedure but more preservative for bone

Can get tips of US

Question 18

mechanical principles for tooth elevation - 3

Answer 18

Wheel and Axle (Rotation)
Lever
Wedge

Question 19

wheel and axle elevator action

Answer 19

Most common

Elevators (not luxators – bend tip)

Buccal elevation

Twisting on axle
- Elevate tooth upwards

Question 20

lever elevator action

Answer 20

more force

can be dangerous - larger force on bone - can fracture

Question 21

wedge elevator action

Answer 21

can be used for elevators (and luxators if careful for fractured roots fragments)

push down ligaments to displace fractured root out

Question 22

mechanical principles for positioning and movement of elevators

Answer 22

All three actions can be used in combination with each other - wedge, lever, wheel and axle

Must avoid excessive force (e.g. with bodily movement of elevator rather than rotation)

There are various points of application for the elevators

start mesial
- concave surface mesial to surface to elevate
twist rist
- upwards and backwards force on tooth to displace tooth out

lower 8 go lingual (only one) as buccal bone denser

combination of sequence of mesial then buccal – best
- don’t do in unison - need to have a hand supporting pts jaw