L3- Exodontia Flashcards
instead of ‘getting a clearance’ you talk to physcian about
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
if implants are done you need
socket preservation
patient factors in terms of race
race - may affect the density of bone
what makes retraction and visibility more difficult
think cheeks and large tongues
teeth with minimal PDL space and need extraction?
with minimal PDL space – the roots are close to adjacent teeth
tooth factors that can cause adverse affects
- endo treated teeth
- minimal PDL space - roots of adjacent are closer
- long, divergent roots
- status of the neighboring teeth
- tooth is adjacent to a large crown or restoration
orthodontic reasons for extraction
pre-molars
- most common wrong teeth extracted as well
absolute contraindications for exrttactions
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
rule of thumb for pregnant pateints
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
teeth in region of recent radiotherapy?
this is considered a local contraindication
- at risk of osteonecorsis
acute pericoronitis around a lower third molar? note what
this can be considered a local contraindication
- consider
extracting the OPPOSING tooth if it is hiting the operculum, antibiotics or irrigation
acute abscess significance if present and need extraction?
extracting the cause is preferable but anethesia, access may be a challenge
- draining abscess, antibiotics, then extraction in 2-3 days
principle #1
know the patient
principle #2
you have to see it to do it
4 main tools to use for examining the oral cavity
- tongue blades
- seldin retractor
- minnesota retractor
- mirror,explorer, probe
went encompeses the consent
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
concept of Time Out
list of the protocol and a checklist that basically goes through everything
principle #3
if a patient is not comfortable you will never be
LA suggested with local anesthesia
lidocaine 2% with 1:100000 epi is the most commonly used local anesthetic and suggested with NERVE BLOCKS
suggested use for nerve blocks
lidocaine 2 with 1:100000 epi
suggest use what for infiltrationns
articaine 4% with 1:100000 epi (often used)
use what if epi is not advised
use mepivicaine 3%
due to cardiac conditions
long acting LA and its use
bupivicaine 0.5% solution is used when long acting anesthesia is required like after third molar surgeries
what does raising a flap allow for
allows you to hold the tooth beyond the coronal structure
allows you to access to bone should its removal be necessary
most flaps in OS are?
full thickness flaps
envelope flap has no?
no vertical releasing incisions
base of flap is kept?
the base of a flap is kept broader to ensure adequate blood supply
one of the most common mistakes in beginning of learning extractions
not raising an adequate flap
when is a flap may not be completely necessary
sometimes when periodontally compromised teth may not need a flap elevation to facilitate extractions
two majaor tools and sequence
- elevators
2. forcepts
elvators use?
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
forceps use
helps continue to expand the bony socket and removal of the tooth from the socket
narrow beaks of elevators?
forced into the PDL space
luxating aka
elevating the tooth
after elevating the tooth?
lift out tooth with forceps
use of forceps
lift out the tooth
role of forcepts and forces they apply
FORCE IS APPICAL PRESSURE
center of rotation is displaced apically (root tip fracture can be avoided)
how to avoid root tip fracture
centre of rotation is displaced apically
Principle #4
the beaks of forceps should always be parallel to the long axis of the tooth
patient on high dose corticosteroids and need extractinos may need?
supplemental dose of steroids
risk associated with recent radiotherapy
risk of osteoneccrosis
help retract soft tissue FLAP from site
seldin retractor
minneosta retractor does the soft tissue and see site of injection of LA as well
what to ensure when extracting a maxillary tooth
anesthetize the adjacent teeth as well since the extraction process will cause pressure on adjacent teeth
tooth w/ infection and cannot get adequate anesthesia, try?
PDL injection
if mandibular tooth – sometimes buccal infiltration with articaine helps
support TMJ with?
bite block and also use a gauze piece to prevent debris or tooth from falling back into the throat
significance of extracting mandibular central incisors
hard to numb – cross innervation
so block and infiltration
most commonly used to raise a flap
number 15 blade and use in a pen grasp
full thickness flap
mostly used and lifts the periosteum with it as well
envelope flap
no vertical releasing incisions
two important instruments for tooth removal
- elevators (first)
- loosen tooth and make room for - forceps
- continue expansion
lever arm and effector arm? which class?
want a long lever and a short effector
FIRST CLASS LEVER
elevators used as?
levers
shape of forceps and implication
beaks of forceps are narrow at tip and they broaden as they go up
narrow beaks forced into where and why?
into the PDL space to expand the bone and fore the tooth out of the socket
implication if elevator forced into pdl?
can displace the root/ tooth out of the socket
technique used mostly when one root comes out and still one left?
wheel and axle
cryers elevators
can be used in the wheel and axle technique
crane pick elevators
just a type?
first 4 steps in extraction
- exam, consent, time out (check-list)
- local anesthetic
- reflecting periosteal flap
- luxating / elevating the tooth (with elevators)
first force applied with the forceps is?
significance?
APICALLY
center of rotation is displaced apically and root tip fracture can be avoided
after you luxate / use elevators?
FORCEPS
Beaks of forceps always?
parallel to long axis of the tooth
most commonly used forceps
- universal mandibular 151
151 extraction forceps
universal mandibular
universal maxillary extraction #
150
rotational forces aim to?
loosen the tooth within the socket
buccal force? when?
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
lingual pressure?
expands lingual bone
rotational forces for?
internal expansion of socket
teeth with SINGLE CORTICAL ROOTS– MAX INCISORS AND MANDIBULAR PRE-MOLARS
Rotation forces not for
multi-rooted teeth or curved roots
force that is ‘gentle’ only
tractional force
tractional force
used to deliver the tooth from the socket
if feel more force is required – spend more time locating the tooth
distal curvature on roots?
maxillary lateral incisors
maxillary canines note?
long roots, part of labial alveolar bone may fracture and be removed with the tooth
high liklihood of roots to fracture
maxillary 1st pre-molars – because two roots
maxillary first molars; note what?
look for divergence of roots, long palatal root, proximity to sinus
hard to anesthetize?
mandibular incisors
easiest to remove
mandibular pre-molars
isolated molars seen in?
elderly patients and difficult to extract
mandibular molars; note what?
thick alveolar bone, strong long divergent roots
maxilla bone type and significance
maxilla bone is THINNER than the palatal so teeth are removed by buccal forces
buccal forces help in removal of which teeth
maxillary because buccal bone thinner than palatal
mandible bone description and impliucation
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
post extraction what helps with getting pieces
rongeours
bone file used?
post extraction – smooth out the site
fifth principle
IRRIGATION
crane pick? triangular elevator/ aka ?
crane pick –good to use in purchase points and force apppically
triangular - role in wheel-and-axle motion – cryers elevators
occlusal side of elevator?
turned towards tooth and handle also moved apically to gelp elevate the tooth
