OSM Extraction I and II Flashcards
What is the primary instrument for making incisions?
Scalpel w/ no. 15 blade held in a pen grasp
What is required once an incision is made and what is the best instrument?
Reflect tissue from underlying cortical bone in a single layer
What are 2 uses of the pointed end of No 9 Molt periosteal elevator?
- Begin periosteal reflection
2. Reflect dental papilla from between teeth
What is the use of the round end of the No 9 Molt periosteal elevator?
To continue elevation of periosteum from bone
What is the motion used for the pointed end No 9 Molt Periosteal Elevator?
Twisting prying motion commonly done when elevating dental papilla between teeth or attached gingival around tooth to be extracted
What are 2 reasons to use soft tissue retractors?
- Visibility during surgery
2. Protect soft tissue from sharp instruments
What are the 2 most popular cheek retractors?
- Austin retractor
2. Minnesota retractor
What is the most efficient stroke for the No 9 Molt periosteal elevator?
Push stroke with either blunt or pointed end to slide underneath periosteum to separate it from bone
Most common instrument used to retract the tongue during routine extractions?
Mouth mirror
What is the most common instrument to grasp soft tissue?
Adson forceps (primarily the anterior mouth)
What is used to grasp soft tissue in the posterior mouth?
Stillies forceps
For most dentoalveolar surgery what is the normal way to control bleeding?
Pressure. If more, use hemostats
What instrument is most commonly used for removing bone in dentoalveolar surgery?
Rongeur forceps
-bone cutting
How are rongeur forceps used?
Small biting motions to remove small bits of bone
What can be used to remove larger sections of bone more aggressively?
Burs in a high speed, high torque handpiece. No 557 fissure bur, No 703 fissure bur, No 8 round bur, or acrylic bur-like bur
In what motion do bone files only remove bone?
Pulling motion only
What instrument used to remove granulomatous tissue or cysts or any debris from a tooth socket?
Curette
How is a needle holder designed?
locking handle, short, stout beak with cross hatchings
Why can’t hemostat be used for suturing?
parallel grooves in beak decrease needle control
What is the design of a suture needle?
Curved to allow access with either a tapered tip or a triangular cutting tip
How is the suture needle held in the needle holder?
held approximately 2/3 distance between tip and needle base
How is the needle holder held by the operator?
Thumb and ring finger through rings with index finger along the length of the needle holders
How is suture material classified?
Diameter, resorbability, mono or polyfilament
What is necessary when extracting mandibular teeth to prevent stress on the TMJ?
Support mandible with Bite Block
Is surgical suction the same as general dental suction?
No it has a smaller orifice to more adequately remove fluid from site and avoid tissue injury by sucking tissue into orifice
What instrument is used to luxate teeth from the surrounding bone before applying forceps?
Elevators
What are 3 components of an elevator?
Handle, shank, blade
When is it best to use the straight elevators?
At the beginning of luxation of erupted tooth
When are triangular elevators (Cryers) best used?
when broken root remains and adjacent socket is empty
What motion is used with the Cryer elevators?
Wheel and axel
What instruments are used for removing tooth from alveolar bone?
Extraction forceps
What are the 3 basic components of extraction forceps?
Handle, hinge, beak
What is the design of extraction forcep beaks?
Designed to adapt to tooth root near junction of crown and root
What are the extraction forcep beaks designed to grasp : the root or the crown?
Root
Maxillary extraction forcep beaks designed how?
Single rooted teeth, and teeth with 3 roots
Why not have a maxillary forcep designed for two rooted teeth due to the maxillary first premolar commonly having two roots
The 2 roots normally occur in the apical 1/3
After luxation, Maxillary single rooted teeth are removed with what?
Maxillary universal forceps No 150
No 150 Maxillary universals can be used on what teeth?
Maxillary central incisors, maxillary lateral incisors, Maxillary canines, maxillary premolars
Modified No 150 used for premolars because its beak has benn modified to be more parallel
150A
These maxillary forceps can be used for maxillary incisors and canines. They are straight.
No 1 forceps
What is the morphology of the maxillary molar roots?
3 rooted, 1 palatal root and a buccal bifurcation
How must a maxillary molar extraction forcep be designed to accommodate this root morphology?
have smooth concave beak for palatal root and pointed beak to engage buccal bifurcation
Due to their design, how are Maxillary molar extraction forceps presented?
in pairs (right and left)
What are the most common maxillary molar forceps?
No 53 right and left
These are a variation for Maxillary molar extraction with longer more accentuated beaks. Still presented as pairs.
No 88 right/left upper cowhorn forceps
What is a problem associated with No 88 Upper cowhorn forceps?
Crush crestal alveolar bone and can remove large portion of buccal plate
What are English forceps?
Vertical hinge and vertically positioned forceps
What is required in the design for mandibular extraction forceps?
Beaks that can be used for single rooted teeth (incisors, canines, premolars) and 2 rooted teeth (molars)
Forceps most commonly used for mandibular single rooted tooth extraction
No 151 Lower universal forceps
Modified No 151 for mandibular premolar teeth with more parallel beaks. Only to be used on mandibular premolars
No 151A
What is the risk with using the English forceps on mandibular anterior single rooted teeth?
Can generate great force and increase risk of root fracture
What is the root morphology of the mandibular molars?
Two rooted with bucco-lingual bifurcation
What does the single bucco-lingual bifurcation on mandibular molars mean for the presentation of the mandibular molar forceps?
Only need one, don’t need a right and left like maxillary because mandibulars lack a palatal root
What is the design of mandibular molar forceps?
Straight handles with beaks set obliquely downward with pointed tips to engage buccal and lingual bifurcations
What is the commonly used mandibular molar forceps?
No 17
What is an alternate to the no 17 molar forceps?
No 87 cowhorn forceps
How are No 87 Cowhorns used?
Once seated, the handles are pumped up and down while handles are squeezed together to squeeze the tooth out of the socket
What are the 5 general steps for exodontias?
- Loosen soft tissue around tooth (#9 Molt)
- Luxate tooth with elevator
- Adapt forceps to root
- Luxate tooth with forceps
- Remove tooth from socket w/ gentle traction
Are the 5 steps considered together or separately and can some be skipped?
Consider as separate steps. Some may be modified/omitted as situation dictates
What instrument and how is it used to luxate the tooth?
small straight elevator (#301) using bone as fulcrum, not adjacent teeth
Which beak is normally seated against the tooth root first: buccal or lingual?
Lingual
When luxating the tooth with forceps, what direction is the pressure applied, and which way is lateral movement made first: buccal or lingual?
Srong apical pressure, luxate to buccal first, then lingual, then alternate
Is initial luxation aggressive or gentle?
Gentle
What is the pressure and direction a tooth is removed from the socket with the forceps?
Gentle traction, normally toward the buccal
What are 2 things luxation does for extraction?
Expand socket Disrupt PDL
Are teeth ever removed by “pulling” them?
No
What is done finally with the extraction site after the tooth is removed?
debride any granulation tissue, check and smooth any bony margins, suture if necessary
What are three reasons a suture is required after surgery?
- control bleeding
- Hold something in the socket (e.g. Gelfoam)
- Position tissue
What are 4 considerations for the order of extraction?
Maxillary first
Posterior first
Most difficult first/ or last
Symptomatic tooth first, especially if doubt entire procedure can be completed in one appointment
What are the three forces applied to teeth?
- Luxation
- Rotation
- Traction
When removing a tooth, what should the operator be doing to the alveolus with his non-extracting hand?
Stabilizing alveolus w/ thumb and forefinger on either side of ridge
What is the general guideline for patient positioning for the extraction of Maxillary teeth?
Pt semireclined w/ maxillary occlusal plane 60 deg to floor at elbow height of operator. Chairback approximately 120 deg from horizontal(180 deg, with upright being 90 deg)
What is the general guideline for patient positioning for the extraction of Mandibular teeth?
Pt more upright so mandibular occlusal plane near parallel w/ floor, height at elbow level or lower for operator comfort. Chairback approximately 110 from horizontal(180 deg, with upright being 90 deg)
What is the ultimate guide for positioning of operator /how one plans to remove the tooth?
Always consider the root and crown anatomy of the tooth to be removed
What is the movement normally used with single rooted teeth, especially if conically shaped root?
Rotation/traction
which forceps are especially useful for grasping teeth that are loose in the mouth?
Russian tissue forceps (they are round-ended)
a heavy instrument used to elevate whole roots or even teeth after purchase point has been prepared
crane pick
forceps: universal upper
150
forceps: universal lower
151
