Periotomes, luxators and elevators Flashcards
What do we want to preserve when extracting?
As much bone as possible, buccal plate of bone
Why are implants better when younger?
Less bone has resorbed and maintains bone and good OH
What makes up an atraumatic tooth extraction?
Preservation of hard and soft tissue
What are the principles of exodontia?
Expansion of bony socket
Separation of the attachment of the PDL
Separation of the attachment of the gingival soft tissues
What happens post extraction?
- complicated cascade of biochemical and histological events
Alveolar ridge undergoes on average 3.8mm horizontal loss
Vertical reduction
Buccal plate exhibits more resorption compared to lingual plate
When would you expect the socket to be fully healed?
8 weeks
How does a socket heal?
Clot formation and fibrin meshwork
Epithelial migration over socket
Clot becomes granulation tissue
Granulation tissue becomes collagen and early bone
Bone marrow occupies the socket replacing woven bone
What happens immediately post extraction?
Bleeding, bleeding into socket, platelet aggregation and clot formation
Do we take post op radiographs to check for healing?
No - only if a problem
What are bone preserving extraction techniques?
1) sever connective tissue fibres
2) minimise soft tissue reflection
3) section multi rooted teeth
As the buccal plate of bone is thin what is there a risk of when extracting?
Fracture of buccal plate
What are periotomes?
Look like flat plastic but are sharp and pointy
Used anteriorly, long axis of the blade inserted into inter-proximal region along long axis preserving buccal plate.
Push deeper into PDL space along mesial and distal to sever PDL below alveolar crest.
Don’t use on facial plate as bone is thin
Keep it in situ for 10-20 seconds, expands bone as the tooth is pushed against the alveolus
Gently push further down and tap and tooth should start to become mobile.
Periotome can then be used as a lever and rotated to touch root and bone, rotation of the handle increases tooth mobility and force against cortical plate to further expand.
What are luxators?
Chunky handles but sharp and thin blades
Able to fit in tight spaces
Efficient at severing the PDL
Separate tooth and bone
Technique sensitive
Bone preserving
How are luxators used?
Size - choose a size similar to root diameter (usually 3mm or 5mm)
Angle - straight for anterior teeth/angled for posterior
Insert towards root surface to the apex
Apply axial pressure as you work down
Gently rock to sever PDL
Space is created - air spells into socket breaking the vacuum allowing easier removal of tooth
Deliver with forceps
What are elevators?
Instruments used either horizontally - rotating around fulcrum or along the long axis of tooth - widening socket.
3 technique: Lever, wedge - like luxator, wheel and axle
Classic - Coupland’s
