Intro to Extractions

Question 1

How can luxators and elevators be distinguished?

Answer 1

• luxators thinner working end with sharp blade (softer metal)
• elevators have rounded end, blade spoon shaped

Question 2

Why may different sized luxators and elevators be required?

Answer 2

• different sized teeth

- crown and root apex requires different sizes

Question 3

Why are winged elevators more useful? What are the disadvantages?

Answer 3

• Thinner shaft for visualisation
• well adapted to tooth shape
• metal thin at wings so can chip/blunt easily

Question 4

What tool is used to remove the tooth following luxation and elevation?

Answer 4

Extraction forceps

Question 5

What kind of analgesia should be used for extractions?

Answer 5

• regional nerve blocks preoperatively

- multimodal opioid and NSAID if no contraindicatin perioperatively

Question 6

Give 2 tools for the retrieval of root fragments

Answer 6

• root tip picks/elevators

- root tip extraction forcepts

Question 7

What 2 periodontal attachments must be severed before the tooh can be extracted? What tools should be used?

Answer 7

• gingiva (scalpel or luxator, stab don’t sweep, ensure reaches alveolar bone crest)
• periodontal ligament (luxator) most difficult step

Question 8

Outline the method of entering the periodontal ligament space

Answer 8

• hold luxator at 30* angle towards tooth
• tip should feel slightly wedged in when periodontal ligament space has been entered
• walk luxator around tooth, cutting ligament and widening gap
• ensure within alveolar bone crest not just between bone and gingiva

Question 9

How should an elevator be used?

Answer 9

• Insert into gap until it feels “wedged”
• Rotate around long axis
• Avoid digging and tilting action
• Count to 10 while holding under tension in rotated position

Question 10

Which are the most useful aspects of the tooth to use an elevator on?

Answer 10

Mesial and distal

Question 11

How should incisors be elevated?

Answer 11

4 “corners”/surfaces

Question 12

How should exraction forceps be used?

Answer 12

• reach as far apically as possible
• apply MODERATE pressure (may fracture tooth)
• slowly rotate and apply traction
• hold for a few seconds

Question 13

Which aspect of the maxilary tooth should not be elevated? Why?

Answer 13

Buccal - maxillary bone very thin, may fracture

Question 14

What should always be carried out following an extraction?

Answer 14

Check apex of root for completeness and roundnesss

- suspect root fragmentation is sharp edges present

Question 15

In what situations may ^ amounts of bone be left attached to extracted tooth?

Answer 15

• surgical extraction

- Post-mortem extraction

Question 16

Is bone being left attached to extracted tooth an issue?

Answer 16

Not really, alveolar bone not required if no tooth present

Question 17

How should multi-rooted teeth be removed?

Answer 17

1. cut gingival attachement
2. tapered fissure cutting burr help with modified pen grasp
3. transsect tooth at furcation making slight V shape so that elevator easier to insert later
4. check sections move independently (insert elevator at 90* into cut surface)

Question 18

How should dental drills be used?

Answer 18

• fully activate foot pedal before touching tooth

- alternate 2 seconds of pressure, 1 second easing off

Question 19

How does sectioning of 3-rooted teeth differ to 2 rooted?

Answer 19

• Furcation mesial/rostral to centre of crown (start at furcation rather than occlusal surface)
• in 109/209 cut between palatal and 2 buccal roots first, then second cut between 2 buccal roots will find natural stoping point

Question 20

Which tooth requires special consideration?

Answer 20

maxillary 4th PM

• very closely adhered to 1st molar
• use tapered fissure burr to remove distal overhang of crown to make space for elevator
• be careful not to cut molar 1

Question 21

Give 4 possible complications of extraction

Answer 21

• root fragmentation
• jaw bone necrosis (usually power tool overheating realted)
• iatrogenic jaw Fx
• oro-nasal fistula

Question 22

Which arcade has no 3 rooted teeth in it in the dog?

Answer 22

Mandible