Module 2_Extraction of Molar tooth

Question 1

What are the two types of chisel?

Answer 1

• Regular (have bevel and edge, tip to one side)–>when used chisel will be displaced towards tip
• Osteotome: tip in the centre, two bevels

Question 2

What are the steps to extracting a molar tooth?

Answer 2

Initial bone removal
1. Cut flap and ensure jaw is supported

2. Using mallet and chisel, create one vertical line (perpendicular to grain) in the bone in line with mesial surface, a second in line with the distal surface and join them up with a horizontal line parallel to grain
   (For vertical cuts ensure bevel is facing inwards, for horizontal cut make sure bevel is facing downwards)
3. Use the chisel to remove the rectangular section of bone

Crown removal
1. Use round bur to drill horizontally (bucco-lingually) straight through the tooth above the furcation and below the enamel

2. Use a flat fissure bur to extend the cut mesio-distally until entire crown is separated from tooth
3. Lift the crown off with a straight elevator

Root removal
1. Clean the area by scraping soft tissue away with instrument so can distinguish between tooth and bone

2. Drill a vertical hole into the middle of the tooth using a round bur until you reach the interseptal area. (If you hit the interseptal bone it’ll heal up)
3. Section the tooth into 4 quarters corresponding with the canals using a flat fissure bur
4. Use an elevator to remove each section separately. Ensure each one can move independantly as this indicates that they are not connected

Question 3

What is the metal that fills in the mallet head and adds weight to it?

Answer 3

Lead

Question 4

How should a mallet be handled?

Answer 4

With thumb and finger

Don’t use a full swing

Question 5

What happens if you try to chisel and jaw is unsupported?

Answer 5

• Lose lot of force at the tip of the chisel
• Also putting a lot of force that would normally be focussed on the tip into the patient’s jaw, in particular the jaw joint–>sore jaw

Question 6

What do you have to bear in mind when getting your assistant to support the jaw?

Answer 6

-Ensure their hands are away from the chisel and also away from the line of force you are applying to the chisel (in case the chisel slips upwards and goes towards the opposite side)

Question 7

Is there any need for bone grafts after extraction?

Answer 7

No, it will heal up on it’s own

Question 8

Will the buccal plate that you have taken off return to it’s former shape?

Answer 8

No

-It will heal/fill up but the ridge height will not increase substantially

Question 9

What force do we use to elevate each root section out and how can this result in dentine breakage?

Answer 9

• We use a diagonal force to bring the tooth up with the elevator (as it is impossible to use a straight vertical force when flicking/levering something up)
• Vertical component lifts tooth
• Horizontal component introduces risk of dentine fracture