Introduction To Extractions

Question 0

What are winged elevators?

Answer 0

Working end well adapted to tooth shape, narrow shaft better for visualisation

Question 1

Distinguish luxators and elevators in appearance

Answer 1

Luxators -thinner working ends with a sharper blade

Elevators - more rounded at the end, blade is slightly more spoon shaped.

Question 2

How should you hold an elevator or luxators?

Answer 2

With a palm grasp

Question 3

What should you ensure with extraction forceps?

Answer 3

Ensure beaks meet

Question 4

What can you use to retrieve root fragments? 3

Answer 4

Root tip picks, root tip elevators, root tip extraction forceps

Question 5

What holds the tooth root in the alveolar socket? 2

Answer 5

Gingiva and periodontal ligament

Question 6

What are the broad steps of direct extractions?

Answer 6

1cut gingival attachment
2 insert luxators into periodontal ligament space
3 use elevator for rotation around long axis until wedged and hold under tension
4 repeat step 3 at different locations
5 use extraction forceps on apical crown, rotate and then apply traction then in opposite direction
6 extract

Question 7

What should you check an extracted root for?

Answer 7

Check the apex for roundness and completeness, suspect root fragmentation of sharp edges

Question 8

What should you use to cut gingival attachment?

Answer 8

Scalpel blade no. 11 or 15 or luxator

Question 9

What angle should you hold the luxator to the tooth?

Answer 9

30 degree

Question 10

Why should you avoid holding the luxator parallel to the tooth?

Answer 10

Risk of slipping onto alveolar bone

Question 11

How should you use the elevator?

Answer 11

Insert where luxator was then rotate slowly, avoid tilting or quick digging movements, count to 10 while holding instrument under tension.

Question 12

Define mesial

Answer 12

Anatomical term for direction towards the point between the central incisors

Question 13

Define distal in the context of dentistry

Answer 13

Anatomical term for direction away from the point between the central incisors

Question 14

How do you operate a dental drill?

Answer 14

Always ensure water spray functions, activate foot pedal fully for full speed rotations before touching tooth, alternate 2seconds of pressure and drilling with one second of easing off.

Question 15

Outline the broad steps required for the direct extraction of a multi rooted tooth.

Answer 15

1 cut gingival attachments
2 transect tooth at furcation
3 confirm independent mobility of the segments

Question 16

What should you use to cut the gingival attachment and how should you hold it?

Answer 16

Tapered fissure cutting bar with the modified pen grasp

Question 17

How do you transect the tooth at the furcation?

Answer 17

Point tip of the 702 bur towards the furcation and hold it at a slight angle to the crown. The preferred shape is a slight v shape as is makes it easier to insert the elevator later.

Question 18

How do you confirm independent mobility of the tooth segments?

Answer 18

Insert a small elevator at a 90 degree angle then very gently rotate it around its long axis. Do the two sections move independently of are they still connected?

Question 19

What should you bear in mind with teeth 108 and 208 when sectioning them?

Answer 19

They are three rooted and the furcation is mesial to the centre of the crown. It helps to reduce the crown height first if the tooth is very big e.g. In a very large dog.

Question 20

How should you section 109 or 209?

Answer 20

The first cut should section between the palatial and the two buccal roots. This way the second cut between the two buccal roots will find a natural stop.

Question 21

What should you consider when removing maxillary PM4 distal root?

Answer 21

Use a tapered fissure to cut bur size 701 to remove the distal overhang of the crown to create space for the elevator. Take care not to cut into the crown of molar 1!

Question 22

What are some possible complications of extractions?4

Answer 22

Root fragmentation, jaw bone necrosis (especially if dental drill hasn’t been adequately cooled), iatrogenic jaw fracture and oronasal fistula

Question 23

How many 3 rooted teeth are there in the mandible?

Answer 23

Zero