Oral surgery - extraction techniques

Question 1

Why take xrays before extracting teeth?

Answer 1

• find extra roots
• find thick roots
• resorptive lesions
• neoplasia
• deciduous/permanent teeth

Question 2

What analgesia is used for extractions?

Answer 2

• Systemic analegesia - opiate or paracetamol in dogs
  
  • NSAIDS
• Local anaesthesia

Question 3

When should we use antibiotics with dental work?

Answer 3

• Single dose (amoxicillin) as prophylactic but used rarely unless expect to cause bactaraemia in an animal that is highly susceptible
• There is an infection
  
  • osteomyelitis

Question 4

What are the steps to dental extraction?

Answer 4

• scalpel to release gingival attachment around tooth (No. 15 blade in sulcus)
• elevators (modified bone gouge) and luxators (modified scalpel blade) - pick some that fit aroung the root of the tooth perfectly to enter peridontal ligament space and gradually work it down

Question 5

What are the aims of luxation and elevation? How does each tool work?

Answer 5

AIM
* Break-down PDL fibres
* Slightly expand alveolus

Techniques
* Luxation - cut PDL fibres
* Elevation - fatigue PDL fibres and expand alveolus

Question 6

What do you need to do before extracting a double rooted tooth?

Answer 6

divide roots into singular portions

Question 7

How do you use an elevator?

Answer 7

• Wedging
• Rotation
  
  • vertical
  • horizontal
• apply twist and hold for 20 seconds

Question 8

What are the 2 types of extraction techniques? What is the difference?

Answer 8

Simple /Closed
* No flap
* No bone removal
* Single rooted teeth
* Multi-rooted teeth
* Mobile dentition
* Tissue preservation
* Faster healing
* Reduced discomfort

Surgical /Open
* Flap
* Bone removal
* Multi-rooted teeth
* Immobile teeth
* Root remnants
* Persistent deciduous
* Avoid complication
* Tissue preservation
* Faster healing
* Reduced discomfort

Question 9

WHat do we need to think about when designing our flap for tooth extraction?

Answer 9

• flap design needs to be generous so as to have good blood supply
• base of the flap needs to be the same length as the top or wider
• design with scalpel blade
• elevate with periosteal elevators (ensure no tearing, work horizontally)

Question 10

How can you use a bur to cut teeth?

Answer 10

Cut towards crown
Furcation: section
Crown: enamel bulge

Question 11

What is meant by making a gutter when extracting teeth? What would you use when making a gutter on an upper canine?

Answer 11

opening up periodontal ligament space and using a small bur

Elevator on upper canine

Question 12

What should you do following a surgical exctraction?

Answer 12

• smooth bone
• debride sulcus
• aim = clean blood clot
• flap closure
  
  • Ensure a secure bite through gingiva.
  • Appositional & everting patterns.
  • Interrupted – simple, cruciate, mattress.
  • Continuous.
• zero tension
• supported sutures

Question 13

What postoperative monitoring do you undertake following extractions?

Answer 13

• Analgesia
  
  • Pre, peri & post operative
  • Opiate
  • NSAIDS
  • Local anaesthetic
• Feeding (soft food for 5 days)
• Antibiotics? (only if relevant, metronidazole, amoxicillin-clavunate)
• Rechecks
• Homecare
  
  • tooth brushing from 3-5 days post op