indications for extractions and techniques Flashcards
indications for extractions
Clinical ± Radiographic assessment
Viable? Restorable?
Look for unusual anatomy, related important structure
unrestorable tooth - need extracted
Gross caries
Advanced periodontal disease
Tooth/root fracture
Severe tooth surface loss
Pulpal necrosis
Apical infection
reasons for extractions
unrestorable teeth
symptomatic partially erupted teeth
traumatic position - mesial 5; buccal 8
orthodontic indications
interference with construction of dentures (unusual)
pericornitis
inflammation around partially erupted crown
straight upper anterior forceps
only straight ones
easy access
3-3
single rooted
upper premolar forceps
same single rooted tip as upper anterior forceps
curved slightly to allow access further back
upper molar forceps
2 roots abd 1 palatal
- engage furcation on buccal side
- beak to chhek
separate ones for each side
smooth single root
point engage furcations
feature of lower forceps
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
cowhorn forceps
engage furcation in mesial and distal roots
Only really on younger individual – lifts tooth
Need divergent roots
No grip, just squeeze
bayonet forceps
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
extraction technique for lower molars - right handed
Behind pt for lower right
Then all other in front of pt to right
elevators role
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
coupland’s elevators
most frequently used
Hug rounded surface of tooth trying to elevate
single
Bigger number = wider the tip (1, 2, 3)
cryer’s elevators
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
warwick james elevators
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
luxators role
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)
periotome
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
mechanical principles for tooth elevation - 3
Wheel and Axle (Rotation)
Lever
Wedge
wheel and axle elevator action
Most common
Elevators (not luxators – bend tip)
Buccal elevation
Twisting on axle
- Elevate tooth upwards
lever elevator action
more force
can be dangerous - larger force on bone - can fracture
wedge elevator action
can be used for elevators (and luxators if careful for fractured roots fragments)
push down ligaments to displace fractured root out
mechanical principles for positioning and movement of elevators
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
