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Oral Surgery > L3- Exodontia > Flashcards

L3- Exodontia Flashcards

1
Q

instead of ‘getting a clearance’ you talk to physcian about

A

is the patient optimized?

*important to determine the severity and stability of the medical condition vs clearance– you make the final call with the information you are given

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2
Q

if implants are done you need

A

socket preservation

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3
Q

patient factors in terms of race

A

race - may affect the density of bone

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4
Q

what makes retraction and visibility more difficult

A

think cheeks and large tongues

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5
Q

teeth with minimal PDL space and need extraction?

A

with minimal PDL space – the roots are close to adjacent teeth

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6
Q

tooth factors that can cause adverse affects

A
  1. endo treated teeth
  2. minimal PDL space - roots of adjacent are closer
  3. long, divergent roots
  4. status of the neighboring teeth
  5. tooth is adjacent to a large crown or restoration
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7
Q

orthodontic reasons for extraction

A

pre-molars

- most common wrong teeth extracted as well

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8
Q

absolute contraindications for exrttactions

A

severe uncontrolled metabolic diseases - diabetes, or end stage renal/ liver failure

uncontrolled leukemias, lymphomas,

due to risk of infection and bleeding

UNSTABLE ANGINA

severe hypertension, hyperthyroidism

severe bleeding disorders

patients on chemotherapy, immunosuppressants, bisphosponates

patients on high dose corticosteroids

if patient is unable to give consent or not sure about the plan

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9
Q

rule of thumb for pregnant pateints

A

postpone ELECTIVE extractions otherwirse 2nd tri-mester is safe

if patient is in pain then extractions can be done in any trimester
x- rays are safe

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10
Q

teeth in region of recent radiotherapy?

A

this is considered a local contraindication

  • at risk of osteonecorsis
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11
Q

acute pericoronitis around a lower third molar? note what

A

this can be considered a local contraindication

  • consider
    extracting the OPPOSING tooth if it is hiting the operculum, antibiotics or irrigation
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12
Q

acute abscess significance if present and need extraction?

A

extracting the cause is preferable but anethesia, access may be a challenge
- draining abscess, antibiotics, then extraction in 2-3 days

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13
Q

principle #1

A

know the patient

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14
Q

principle #2

A

you have to see it to do it

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15
Q

4 main tools to use for examining the oral cavity

A
  1. tongue blades
  2. seldin retractor
  3. minnesota retractor
  4. mirror,explorer, probe
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16
Q

went encompeses the consent

A

discussion of risks, complications, and alternatives

like make them aware that there is a large restoration adjacent and there is a chance that it comes out with the extraction of the adjacent one

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17
Q

concept of Time Out

A

list of the protocol and a checklist that basically goes through everything

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18
Q

principle #3

A

if a patient is not comfortable you will never be

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19
Q

LA suggested with local anesthesia

A

lidocaine 2% with 1:100000 epi is the most commonly used local anesthetic and suggested with NERVE BLOCKS

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20
Q

suggested use for nerve blocks

A

lidocaine 2 with 1:100000 epi

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21
Q

suggest use what for infiltrationns

A

articaine 4% with 1:100000 epi (often used)

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22
Q

use what if epi is not advised

A

use mepivicaine 3%

due to cardiac conditions

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23
Q

long acting LA and its use

A

bupivicaine 0.5% solution is used when long acting anesthesia is required like after third molar surgeries

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24
Q

what does raising a flap allow for

A

allows you to hold the tooth beyond the coronal structure

allows you to access to bone should its removal be necessary

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25
Q

most flaps in OS are?

A

full thickness flaps

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26
Q

envelope flap has no?

A

no vertical releasing incisions

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27
Q

base of flap is kept?

A

the base of a flap is kept broader to ensure adequate blood supply

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28
Q

one of the most common mistakes in beginning of learning extractions

A

not raising an adequate flap

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29
Q

when is a flap may not be completely necessary

A

sometimes when periodontally compromised teth may not need a flap elevation to facilitate extractions

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30
Q

two majaor tools and sequence

A
  1. elevators

2. forcepts

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31
Q

elvators use?

A

help in luxation

used primarily as a lever

a lever is mechanism of trasnmitting a modest force - with mechanical advantages of a long lever arm and a short effector arm into a small movement against great resistance

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32
Q

forceps use

A

helps continue to expand the bony socket and removal of the tooth from the socket

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33
Q

narrow beaks of elevators?

A

forced into the PDL space

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34
Q

luxating aka

A

elevating the tooth

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35
Q

after elevating the tooth?

A

lift out tooth with forceps

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36
Q

use of forceps

A

lift out the tooth

37
Q

role of forcepts and forces they apply

A

FORCE IS APPICAL PRESSURE

center of rotation is displaced apically (root tip fracture can be avoided)

38
Q

how to avoid root tip fracture

A

centre of rotation is displaced apically

39
Q

Principle #4

A

the beaks of forceps should always be parallel to the long axis of the tooth

40
Q

patient on high dose corticosteroids and need extractinos may need?

A

supplemental dose of steroids

41
Q

risk associated with recent radiotherapy

A

risk of osteoneccrosis

42
Q

help retract soft tissue FLAP from site

A

seldin retractor

minneosta retractor does the soft tissue and see site of injection of LA as well

43
Q

what to ensure when extracting a maxillary tooth

A

anesthetize the adjacent teeth as well since the extraction process will cause pressure on adjacent teeth

44
Q

tooth w/ infection and cannot get adequate anesthesia, try?

A

PDL injection

if mandibular tooth – sometimes buccal infiltration with articaine helps

45
Q

support TMJ with?

A

bite block and also use a gauze piece to prevent debris or tooth from falling back into the throat

46
Q

significance of extracting mandibular central incisors

A

hard to numb – cross innervation

so block and infiltration

47
Q

most commonly used to raise a flap

A

number 15 blade and use in a pen grasp

48
Q

full thickness flap

A

mostly used and lifts the periosteum with it as well

49
Q

envelope flap

A

no vertical releasing incisions

50
Q

two important instruments for tooth removal

A
  1. elevators (first)
    - loosen tooth and make room for
  2. forceps
    - continue expansion
51
Q

lever arm and effector arm? which class?

A

want a long lever and a short effector

FIRST CLASS LEVER

52
Q

elevators used as?

A

levers

53
Q

shape of forceps and implication

A

beaks of forceps are narrow at tip and they broaden as they go up

54
Q

narrow beaks forced into where and why?

A

into the PDL space to expand the bone and fore the tooth out of the socket

55
Q

implication if elevator forced into pdl?

A

can displace the root/ tooth out of the socket

56
Q

technique used mostly when one root comes out and still one left?

A

wheel and axle

57
Q

cryers elevators

A

can be used in the wheel and axle technique

58
Q

crane pick elevators

A

just a type?

59
Q

first 4 steps in extraction

A
  1. exam, consent, time out (check-list)
  2. local anesthetic
  3. reflecting periosteal flap
  4. luxating / elevating the tooth (with elevators)
60
Q

first force applied with the forceps is?

significance?

A

APICALLY

center of rotation is displaced apically and root tip fracture can be avoided

61
Q

after you luxate / use elevators?

A

FORCEPS

62
Q

Beaks of forceps always?

A

parallel to long axis of the tooth

63
Q

most commonly used forceps

A
  1. universal mandibular 151
64
Q

151 extraction forceps

A

universal mandibular

65
Q

universal maxillary extraction #

A

150

66
Q

rotational forces aim to?

A

loosen the tooth within the socket

67
Q

buccal force? when?

A

following the apical pressure

causes expansion of buccal plate at crest of ridge and also causes lingual apical pressure

expands buccocortical plate toward crestal bone with lingual expansion at apical end

68
Q

lingual pressure?

A

expands lingual bone

69
Q

rotational forces for?

A

internal expansion of socket

teeth with SINGLE CORTICAL ROOTS– MAX INCISORS AND MANDIBULAR PRE-MOLARS

70
Q

Rotation forces not for

A

multi-rooted teeth or curved roots

71
Q

force that is ‘gentle’ only

A

tractional force

72
Q

tractional force

A

used to deliver the tooth from the socket

if feel more force is required – spend more time locating the tooth

73
Q

distal curvature on roots?

A

maxillary lateral incisors

74
Q

maxillary canines note?

A

long roots, part of labial alveolar bone may fracture and be removed with the tooth

75
Q

high liklihood of roots to fracture

A

maxillary 1st pre-molars – because two roots

76
Q

maxillary first molars; note what?

A

look for divergence of roots, long palatal root, proximity to sinus

77
Q

hard to anesthetize?

A

mandibular incisors

78
Q

easiest to remove

A

mandibular pre-molars

79
Q

isolated molars seen in?

A

elderly patients and difficult to extract

80
Q

mandibular molars; note what?

A

thick alveolar bone, strong long divergent roots

81
Q

maxilla bone type and significance

A

maxilla bone is THINNER than the palatal so teeth are removed by buccal forces

82
Q

buccal forces help in removal of which teeth

A

maxillary because buccal bone thinner than palatal

83
Q

mandible bone description and impliucation

A

buccal is thinner from incisors to molars,
so incisors canines and pre-molars –> extract with strong buccal forces

mandibular molars benefit from stronger lingual forces

84
Q

post extraction what helps with getting pieces

A

rongeours

85
Q

bone file used?

A

post extraction – smooth out the site

86
Q

fifth principle

A

IRRIGATION

87
Q

crane pick? triangular elevator/ aka ?

A

crane pick –good to use in purchase points and force apppically

triangular - role in wheel-and-axle motion – cryers elevators

88
Q

occlusal side of elevator?

A

turned towards tooth and handle also moved apically to gelp elevate the tooth

Oral Surgery (26 decks)

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