Lecture 14: Dental Extractions: equipment and techniques for small animals Flashcards
What wrong and what tx
advanced periodontal disease- abscesses and bone loss
Tx: extraction
plaque is a __ and the __ is the most favorable environment
biofilm, sulcus/pocket
what is stage 0 periodontal disease
clinically normal, no gingivitis, peritonitis, sulcus up to 3mm in dog, 1mm in cats
what is stage 1 periodontal disease
gingivitis: inflammation without attachment loss or bone destruction
Reversible
what is stage 2 periodontal disease
gingivitis and <25% attachment loss, may have stage 1 Furcation involvement
what is stage 3 periodontal disease
gingivitis With 25-50% attachment loss, stage 2 Furcation involvement
what is stage 4 periodontal disease
severe, gingivitis with >50% attachment loss, stage 3 Furcation, often mobile
which stages of periodontal disease often require extraction
3 and 4
what are the alternatives to extraction for fractured teeth with pulp exposure
root canal and crown restoration
what wrong and what would you want to do
crowing of 3rd and 4th PM, extract 3rd PM in hopes of saving 4th PM
What wrong
caries/decay
what are some reasons not to extract a tooth
- Patient in poor health
- Undergoing Radiation or chemo tx
- Bleeding disorders
what these
burs
What these and what used for
periosteal elevators- raise gingival/mucosal flap
what these
dental elevators and luxators
what these
left: dental luxators
Right: dental elevators
what type of suture used for dogs and cats
absorbable for both
Dogs- 4-0 monocryl
Cats- 5-0 monocryl
what are the pros of intra-oral analgesia
- Decrease anesthetic gas requirements
- Duration of up to 24hrs
- Patients more comfortable
- Self mutilation less likely
how do local anesthetics for blocks work
bind Na+ channels and inhibit depolarization- no AP
how does decreased pH affect duration of action of block
decrease
how does increased vascularity affect duration of action of drug and what can you add to block to help
decrease, add epi
what is % mix of bupivicaine commonly used
0.5%- 5mg/mL
how long does bupivicaine last
2-10hrs
what gauge needles do you want to use for block
25g, 1 inch
27g 1/2 inch, 1 1/4 inch
30g
what is dose for 0.5%, 5mg/ml bupivicaine in dogs and cats
dogs: 2mg/kg total dose
Cats: 1-2mg/kg total dose
what is dose of 2% 20mg/ml lidocaine in dogs and cats
dogs: 5mg/kg
Cat: 1mg/kg
what is appropriate dose of 0.5% bupivicaine for 3kg yorkie
- 3kg x 2mg/kg=0.000002 6mg
6mg/ 5mg/ml=1.2/mL 1.2 mL in 4 quadrants= 0.3ml/site max
never use suture under__
tension= failure
what is involved in a closed/simple extraction
- No flap required
- No alveolar bone removed
- No sectioning of teeth
what teeth can have a closed/simple extraction
- Incisors
- First premolars
- Mandibular 3rd molar
what are the steps in a closed extraction
- Pre-extraction rads
- Incise gingiva with scalpel
- Loosen periodontal ligament with dental elevator or luxator
- Remove tooth with small extraction forceps
- Examine tooth- smooth and rads
- Empty alveolus
- Suture
what is the short finger stop
place index finger towards working end of elevator to give more control and prevent trauma from instruments slipping
what is involved in an open/surgical extraction
- Mucoperiosteal flap created
- Alveolar bone removed
- Multi-rooted teeth sectioned
what teeth need an open/surgical extraction
larger, solid single or multi-rooted teeth, fractured roots
what are the steps in an open/surgical extraction
1.pre-op rads
2. Create mucoperiosteal flap
3. Elevate flap with periosteal elevators
4. Buccal bone removal with cutting burr
5. Section multi-rooted teeth with cutting bur
6. Make a moat with round bur for additional alveolar bone removal
7. Elevation- loosen periodontal ligament with elevators or luxators
8. Examine root tips and rads
9. Alveoplasty- smoothing sharp bone with round or diamond bur
10. Suture- make sure tension free
where should you start when sectioning multi-rooted tooth
work from Furcation towards crown
when elevating a multi-rooted teeth each tooth should move __when elevating otherwise not ___
independently, not completely sectioned
t or f: intraoral radiographs required post extraction to confirm no tooth root remnant
true
How do you relieve tension on flap to suture
fenetrate/release periosteum using scalpel or sharp scissors
what can occur on bottom tooth as a result of removing opposing top tooth
increased calculus formation due to lack of lower tooth cleaning
what do you do if you fracture root during extraction
- Create good visualization of retained root- remove enough buccal bone
- Take rads
- Make a moat
- Gently elevate tooth root coronally to avoid pushing into maxillary sinus or mandibular canal
what wrong
retained tooth root
what wrong
retained root
what are the post op instructions following extractions
- Soft food only 10-14 days
- Antibiotics if needed
- Pain control- rimadyl, metacam, tramadol, buprenex- cats
- Recheck 2-4 weeks
what is type 1 resorption
focal or multifocal radiolucency with otherwise normal radiopacity and normal periodontal ligament space
what is type 2 resorption
narrowing or disappearance of periodontal ligament space in at least some areas and decreased radiopacity of part of tooth
what is type 3 resorption
focal or multifocal radiolucency- disappearance of periodontal ligament space, decreased radiopacity in part of tooth
what type of resorption
3
what type of resorption
1
what type of resorption
2
What wrong and what tx
Absence of tooth root
Tx: crown amputation
how do oronasal fistulas occur
- Too much tension on suture
- Didn’t close
what wrong
oronasal fistula
