Oral Surgery Zoom - elevators Flashcards
3 types of elevators
coupland’s elevators
cryers
warwick james
how do elevator types differ
in shape of blade and handle
3 basic components of elevators
handle
shank
blade
types of coupland’s elevators
3 sizes
1 - narrowest
2
3- widest
how to hold a couplands elevator
rounded handle in palm of hand and index finger on shank
Apply sufficient force while maintaining adequate support to prevent slippage
movement of coupland elevator
rotational
shape of cryers elevator
triangular shape blade with pointed tip
types of cryer’s elevator
right
left
right sitting on right, left sitting on left (blade tip in)
use of cryer’s elevator
molar root extraction
Apply buccally to engage with furcation
Or placed within a socket to elevate a fractured root
types of warwick james elevators
straight
right
left
blade directed to oppostie side talking about
use of right and left warwick james elevator
used to elevate maxillary 3rd molars
shape of straight warwick james elevators
flat and convex surface
used similarly to Couplands
how to use couplands elevators
lower right 4 root
When using elevators, ensure adequate support with the thumb and index of supporting hand
Place Coupland in mesial or distal contact points with concave surface facing the tooth root
Place perpendicular to the long axis of the root
Rotational movement applied to elevate the root
how to use cryers
lower first molar
Support
Hold like couplands
Tip of cryers used to engage the furcation and rotational movement to elevate the root
- Useful in extraction of molar roots
luxators
Different shape of blade
- Rounded, sharp cutting blade whereas couplands more angled
Designed to fit periodontal space and separate periodontal ligamnent
- Allows widening of socket prior to extraction
use of luxators
positioned parallel to long axis of the root
only to separate PDL not elevate the tooth
pt history in oral surgery
Presenting complaint- ask what they are hear for
HPC
- Pain, swelling - address their primary concerns first
- SOCRATES
- Severity
- Scale – can compare with past appointments
MH - Use completed medical history form as a guide - Continue to assess - Language barrier - Understanding barrier - Thinking not relevant - Systemic enquiry - All systems in body - Remember how you do so don’t miss - Give examples to jog them Duodenal ULCERS and ASTHMA - Cannot have ibuprofen Blood thinning/ bleeding issues - Medications - Reactions/allergies to medications/food/materials
DH - Focus on extraction experience Ask if they have had before - When - How was it - Just LA or need GA, IDB - Broken tooth - Problems afterwards – bleed/infections Establish their level of anxiety
SH - Smoking - Alcohol – units - Occupation - Caring responsibilities Will these be jeopardised for time if GA/surgery Prepare them for this
extra oral exam
Asymmetry
- Swelling
- Redness
- Drop - palsy
Lymph nodes - Stand above and look down on pt Submandibular Submental Cervical - Compare both sides Enlarged Tender
TMJs - Two fingers over condyle - Pop out when open - Move freely - Clicks - Crunching Ask pt
Muscles of mastication - Master Sides of cheeks, clench teeth Part of bulging Hypertrophy with grinding - Temporalis Fingers at temples Bulging
Trismus
- Limited opening
Ask pt before look – have they noticed reduction
- What is their normal, any Problems
Get measurement
- Callipers
Upper incisal edge to lower incisal edge
2 finger – not too bad, can eat and talk, and airway
intra oral examination
Soft tissues NAD – no abnormality detected - Buccal mucosa - Hard palate - Surfaces of tongue x4
Unharmful ones – but note
- White striae – lichenoid
- Linea alba
- Polyp
- Haemangioma – tend to be older
Teeth General comment - Gross caries all teeth - Excellent OH, teeth well alligned Focus on problem area - Is the tooth carious - Surfaces left - Restorations present - Mobility - TTP – tender to percussion (infections under roots)
presenting the pt
Get clinician to review your work
- Summarise all the information you have gathered and present it to your clinician
- Start with patients’ name and where they have been referred from
Identify the problem area and be prepared with a diagnosis or two
- Suggest special investigations that might aid your diagnosis
- X-ray comments
Mark the tooth to be extracted, as well as surrounding gingivae
Complete the whiteboard on the wall- make sure you include patients name, CHI number, medical history, tooth to be extracted
Use terminology for pt – pt friendly
Complete consent form along with clinician
communicating with pt in oral surgery
Use patient friendly language
Establish a rapport with patient during history taking
You will be nervous, but so will your patient
Identify beforehand with your clinician what you will be expected to do eg local anaesthetic +/- extraction
Avoid waving LA needle or forceps in front of patient
Clincian must be in the room when you are giving LA/ extracting tooth
Never discharge a patient without confirming with a clinician
Ask for help
how many upper forceps are there
6
how many lower forceps are there
4
upper straight forcep
flat handle, thick beak
use on upper anterior 1, 3, 3
upper universal forceps
curved handle
used on upper 4, 5, or 3
upper root forceps
curved handle
narrower beak to get into periodontal space
upper molar forceps
right and left
- beak to cheek
- interact with birfucation
curved handle
bayonet types
normal and roots (narrower beak)
upper teeth
bend in handle
feature in all lower forceps
90 degree bend in handle between handle and beak
lower universal forceps
used on lower anteriors and premolars (4-4)
lower root forceps
narrower beaks, thinner
used on any lower roots
lower molar forceps
beaks on both sides to engage bifurcation on buccal and lingual side
cowhorn forceps
used on lower molars
squeeze tooth out
most widely used elevators
couplands
why use elevators
Elevated, extracting teeth when cannot get grip with forceps (retained roots)
Loosened before applying pressure with forceps
luxators features
rounded, like spoon
Insert parallel to long axis of tooth
Shear of PDL to aid forceps removal
process for tools when extracting tooth
Use luxator
Elevator – loosen, widen socket
Forceps to extract
where does right handed operator stand for pt upper right and upper and lower left
stand in front to right
patient reclined to enable good visualisation of the tooth being extracted
raises pt mouth to your elbow level
non dominant hand retracts soft tissue and supports alveolar bone
where does right handed operator stand for pt lower right quadrant
Behind pt right shoulder
Patient is in an upright position
Raise the patients’ mouth to just below elbow level
Support mandible as well as alveolar bone and retract tissues
- Counteract force of extraction
how to extract tooth with forceps
Get forceps as far down route as can
Try not to traumatise gingiva
Use non-dominant hand to guide forceps into place if necessary and retract tissue
Beaks of forceps are designed to fit snugly around the crowns
Engage with bifurcation
Once you are confident the forceps are positioned correctly apply the relevant forces to loosen the tooth
first force used when extracting any teeth
apical pressure
force for extracting single rooted teeth and premolats
apical
then rotations
then should have some tooth movement and buccal movement to extract
forces for extracting molar teeth
apical
then figure of 8
- roots diverge and splayed in different directions
- expand sockets so all roots involved
buccal movement out
tiring
