lecture 3 Flashcards
indications for extraction
have to have an assessment - this is a 50 year old male, we are taking out number 5 for this reason
severe caries pulpal necrosis severe periodontal disease orthodontic reasons mal-opposed teeth cracked teeth pre-prosthetic extactions impacted teeth supernumerary teeth
potential contraindications for extractions
uncontrolled systemic conditions
pregnancy - 1st and 3rd trimesters don’t want to do anything -
2nd trimester if we have to get them out
bleeding?meds
local contraindications for extraction
previous head/neck radiation
previous systemic anti-resorptive therapy
acute pericoronitis - gum on the distal of the 3rd molar - we get in under control before we take it out
potential anatomic considerations for extraction
IAN proximity
Sinus
Adjacent teeth
chair and operator position for standing surgeon :
maxillary
maxillary teeth:
~maxillary arch level with surgeon’s elbow or below
~turn head to quadrant of extraction is visible
~lateral protrusive position of the mandible
patient lays down
chair and operator position standing surgeon
mandibular
upright so when mouth is open,. arch is parallel to floor
bite block
lower chair
turn head so quadrant of extration is visible
some prefer behind the patient approach
what kind of patients do we do pre-radiation
patients with head and neck cancer we do pre-radiation
radiographic eval for extractions:
~proper exposure
~proper date/name - less than _ old
~entire root visible
~relationship to vital structures (sinus, IAN)
~configuration of roots (length and morp, RCT)
~condition of surrounding bone (density, PDL,patholgy)
less than 1 Have to either have a periaplic, a pan or CBCT
Film has to be within a year
Things we want to look at when we get the film
Sinus, root, bone year old
what do we use as a “throat screen”
gauze
optional “behind the patient” position for _ extractions (which arch?)
mandibular extractions - especially when performing solo
basic principles of extraction:
~CONTROLLED FORCE
- all about _, not strength
-do not use excessive force
-recognize when it won’t work easily and processed to surgical extraction
-place finger/thumb around _ to stabilize
NEVER _ the Tooth
all about mechanical advantage. not strength
place finger/thumb around alveolus to stabilize
never “pull” the tooth
push, rock, rotate
simple machines - basis of extraction techniques
_ instrument fulcrum on bone and lifts tooth out(crier the east west or flag)
lever action
simple machines - basis of extraction techniques
wedge to break off the _
break off the periosteum
simple machines - basis of extraction techniques
wheel and axle
look up in book
elevators:
_ technique - safer, more controlled force
- straight
- root tip
wedge
elevators:
_ technique likely to break fragil elevators or teeth and bone
-cryer, cogswell, straight
lever-mechanism
elevators:
_ technique we use a cryer for
wheel and axle
purpose of _
primary purpose - loosen teeth in preparation for extraction with forceps
- create space for forceps
- may be primary mechanism for extraction 3rd molars
elevators
Always use elevators first
Sometimes only need an elevator
Primary - loosen it up
secondary - remove parts of tooth/root
secondary purpose of elevators
remove parts of tooth or root
usually the initial instrument used
primary use- for expansion of alveolus and loosening of tooth/PDL
-Good force, don’t damage adjacent teeth
Loosen of bone and pdl
- often used incorrectly: do not fulcrum off the adjacent tooth
- care must be used to avoid damage to adjacent teeth
- use with working end pointed from _ toward the _ or _
straight elevators
working end pointed from facial toward the lingual or apex
NOT A CROW BAR
straight elevator:
proper use is counter intuitive for _
- wedges the apical edge of the elevator against _ and _ the tooth
- avoids force on adjacent tooth
counter intuitive for mobilization
against crestal bone and pushes the tooth(does not scoop)
If isolated - Turn into the tooth not scoop out
If scoping out - we will elevator the adjacent
Can do this if doing full quad extract
straight elevator:
when used to “scoop” the tooth out, significant force is placed on the adjacent tooth, do not do this routinely, use when _
used when taking out several adjacent teeth
_ elevators:
lever and/or wheel and axle forces
care as can fracture tooth and bone
primary use- removing residual roots from multi-rooted teeth
- sharp tip removes interseptal bone providing access to the retained root
cryer elevators
primary use- removing residual roots from multi-rooted teeth
cryer elevators
sharp tip removes interseptal bone providing access to the retained root
cryer elevators
primary use - removing residual roots from multi-rooted teeth
_ elevators
fragile elevators
appearance seems to indicate they would be for “prying” out root tips
prying forces will bend/break these instruments
sole use is as a _, “wiggle” fine tip apically to _ root tip from socket, sharply pull in a vertical vector to displace root tip
sole use is as a wedge
wedge root tip (do not pry)
when wedging out a root tip with a straight elevator the finger rest is to control _ force
-insert elevator into the PDL space, avoid pressure that will displace the root into the sinus
apical force
Forceps
not for “pulling” teeth
-use the forcep as a _ and _
- primary force is initially and greatest magnitude of force in _ direction to seat the forceps
- secondary force is _ to expand alveolus to release the tooth
- last is minimal _ force
as a handle and lever
primary force is initially in an apical direction
secondary force is buccal, lingual, or rotational to expand alveolus and release the tooth
last is minimal tractional force
First get periostoal elevator - loosen with small elevator and then forceps
forceps movement produces significant _
wedging
expand the bone and rotate the tooth out
loosening of soft tissue attachment:
sharp end of _ first for relief
- dental curette
- confirms anesthesia
- allows forceps to be seated apically or elevator to be placed interproximally
- be kind to soft tissue
sharp end of periosteal elevator
spoon end is for surgical extraction
luxation with elevator
usually a _ elevator _ to the interproximal space or _ to the long axis of the tooth
- luxate tooth
- exapnd bone
- avoid injury to adjacent teeth/crowns
- confirms degree of mobility/establishes need for surgical extraction
straight elevator perpendicular to interprox space or
parallel to long axis of the tooth
adaptation of the Forceps
choose forceps that will adapt well to the _ morphology of the tooth
- confirm long axis of beaks clears adjacent teeth to avoid trauma
- seat with apical force
- avoid pinching soft tissue
- firm apical force - move center of rotation apically to prevent root fracture
- expands alveolus and widens PDL space
subg morp of the tooth
forceps
- firm apical force - move center of rotation _ to prevent root fracture
- expands alveolus and widens PDL space
apically
luxation with forceps:
firm grip
straight wrist with force generating from shoulder and upper arm (not wrist)
firm, steady, sustained force - hold and flex bone to allow expansion of the alveolus
primarily _ first with less _ force, rotate the tooth gently after mobilization
continue to re-seat the forceps apically, do not fracture the crown
primarily buccal at first with less lingual force
removal of tooth from socket:
slight _ usually (buccal or lingual?) is the final step of removal of a tooth
not a pulling motion
slight traction - usually buccal is final step
post-extraction care of the socket:
remove debris is present (PA lesion, calculus, amalgam, tooth fragments)
- realign _ plate - compress socket
- debride granulation tissue from gingival sulcus
- smooth any sharp bone
- pressure from 2x2 placed over the extraction site to promote hemostasis
realign buccal plate - compress socket
Digital palpation to confirm no sharp bone or anything
forcep figure-8 or “ratchet” motion works well, especially for _ teeth
multi-rooted teeth
_ forcep
designed to engage the furcation of lower molar
no crown requirement to engage tooth - may be better than 151 for broken down teeth
must seat into furcation with _ up and down action before any buccal/lingual rotation
seat on _ first taking care not to injure soft tissue
cowhorn #23 mandibular molar forcep
seat into furcation with pumping up and down
seat on lingual first
maxillary incisors: #1 and #150
apical, buccal, lingual, rotation, traction
less rotational forces during the removal of _ teeth
maxillary laterals
maxillary canines: #1 and #150
apical, buccal, lingual, rotation, traction
-these teeth have long roots and are difficult to extract
often require _
_bone is heavier than _ bone
often require mucoperiosteal flap
palatal bone is heavier than buccal bone
Maxillary molars
if a root is going to fracture, then more favorable to fracture a _ root
more favorable to fracture a buccal root
easiest teeth to extract?
mandibular bicuspids - premolars
very conical, straight roots
