Principles of Tooth Extraction Flashcards
What are the seven principles of tooth extraction
pre-surgical assessment informed consent surgeon and patient preparation proper pain and anxiety control chair position extraction of tooth post-op care of patient
What three things make up the pre-surgical assessment
clinical evaluation
radiographic evaluation
proper diagnosis and indication for extraction
What are the 14 indications for extraction
severe caries pulpal necrosis severe periodontal disease orthodontic reasons mal-opposed teeth cracked teeth pre-prosthetic extractions impacted teeth supernumerary teeth teeth associated with pathological lesions pre-irrradiation therapy teeth in the line of jaw fractures esthetics economics
What are 7 systemic conditions that are contraindications for extractions
uncontrolled metabolic diseases malignancy recent MI (6 weeks) pregnancy (1st and 3rd trimester) immunocompromised bleeding disorders medications tha alter hemostasis or healing
What are three local conditions that are contraindications for extraction
previous head and neck irradiation
previous systemic anti-resorptive therapy
acute pericoronitis
What are three anatomic considerations that are contraindications for extraction
IAN proximity
sinus
adjacent teeth
What are five clinical evaluations for extractions
access
mobility
condition of the crown, previous RCT treatment
condition of the adjacent teeth/restorations
bone adjacent to the teeth
What six things are important to evaluate for the radiographic evaluation
proper exposure proper date/name (<1year) entire root is visible (PA) relationship to vital structures such as sinus and IAN configuration of roots condition of surrounding bone
What is the position of the chair in the standing technique if the patient is having maxillary teeth extracted
maxillary plane is 60° to the floor or greater
maxillary arch is level with the surgeons elbow or below
turn head to quadrant so extraction is visible
lateral protrusive position of the mandible
What is the position of the chair in the standing technique if the patient is having mandibular teeth extracted
upright, so when the mouth is open the arch is parallel to the floor
bite block
lower chair
turn head so quadrant of extraction is visible
some prefer the “behind the patient” approach
What is the concept of controlled force
It is all about the mechanical advtange, not strength
place fingertips around the alveolus to stabilize
recognize when it won’t work and proceed to surgical extraction
What is the motion of extraction the tooth
never “pull” the tooth
push, rock, and rotate
What are the three “simple machine” basis of extraction
lever
wedge
wheel and axle
Using this type of elevation is the safer more controlled force used with the straight or root tip elevators
wedge
This type of elevation is likely to break fragile instruments or teeth and bone used with the cryer, cogswell, and straight elevators
lever
This type of elevation is used with the cryer elevator
wheel and axle
What is the primary purpose of elevators
to loosen teeth in preparation for extraction with forceps
create space for forceps
may be the primary mechanism for extraction
What is the secondary purpose of elevators
remove parts of the tooth or root
This is usually the initial instrument used primarily for expanding the alveolus and loosening of the tooth/PDL
straight elevator
How should you NOT use a straight elevator
do NOT fulcrum off the adjacent tooth
Where should the working end of the straight elevator face
point from the facial toward the lingual or apex; don’t elevator from the lingual
Elevators are not this
a crow bar
What is the technique for using the straight elevator
wedges the apical edge of the elevator against crestal bone and “pushes” (does not “scoop”) the tooth
These are used for lever and/or wheel and axel forces but care is used
cryer elevators
What is the primary use of a cryer elevator
removing residual roots of multi-rooted teeth
This portion of the cryer elevator removes interseptal bone providing access to the retained root
the sharp tip
These are fragile elevators that are used as a wedge, not a “prying” force
root tip elevators
What is the technique for using root tip elevators
“wiggle” the fine tip apically to wedge the root tip from the socket
sharply pull in a pure vertical vector to displace the root tip
These are used as a handle and a lever and the movement produces significant wedging
forceps
What is the primary force of a forcep
initially in an apical direction to seat the forceps
What is the secondary force of a forcep
buccal, lingual, or rotational to expand the alveolus to release the tooth
What is the last force of a forcep
minimal tractional force
What are the eight steps for a simple extraction
- confirm profound anesthesia of pulp, soft and hard tissue
- release soft tissue around tooth
- elevate tooth with the elevator
- adapt forceps to tooth
- luxate with forceps
- remove the tooth from the socket
- examine socket for soft tissue/granulation tissue: curette
- place a 2x2 directly over the socket and compress with occlusal forces
What should be used for loosening the soft tissue attachment
use the sharp end of the periosteal elevator or dental curette
What are three characteristics of loosening the soft tissue attachment
confirms the anesthesia
allows the forceps to be seated apically or elevator to be placed inter proximally
be kind to the soft tissues
How should you hold the elevator (usually straight) to luxate the tooth
perpendicular to the inter proximal space or parallel to the long axis of the tooth
Choose forceps that will adapt well to which tooth morphology
the sub-gingival morphology
Confirm the long axis of the beak of the forcep does what
clears the adjacent teeth to avoid trauma
What are two characteristics of the firm apical force used by the forceps
moves center of rotation apically to prevent root fracture
expands alveolus and widens PDL space
Where should the force of luxating the tooth with forceps come from
straight wrist with force generating from shoulder and upper arm, not the wrist
Using the forceps, you are primarily buccal at first with less lingual, then you do what
rotate the tooth gently after mobilization
What is the force that removes the tooth from the socket
slight traction, usually buccal is the final step
What are the five steps of post-extraction socket care
remove debris
realign the buccal place “compress socket”
debride granulation tissue from gingival sulcus
smooth any sharp bone
pressure from the 2x2 gaze placed over the extraction site to promote homeostasis
Seat the beak of the 150/151 forceps with a firm and deliberate apical pressure which does what three things
lowers the center of rotation to decrease root fracture
secures purchase on non-carious/sound tooth
further wedging for augments that already accomplished by elevator
This type of motion (150/151) works well, especially for multi-rooted teeth
figure-8 or ratchet
This forcep is designed to engage the furcation of the lower molar; no corn is needed to engage
mandibular #23 cowhorn
How should you seat the #23 forcep
seat into furcation with a “pumping” up and down action before buccal/lingual rotation; this will help close the beaks together
Which side, buccal or lingual, should you seat the #23 forcep first?
lingual
Once te #23 forcep is seated, what motion is used to remove the tooth
buccal-lingual action or figure-8 motion
There is a less of a rotational movement to remove these teeth
maxillary laterals
These teeth have long roots and are difficult to extract, they often require a mucoperiosteal flap
maxillary canines
This bone is heavier than buccal bone
palatal bone
These teeth often have two roots which don’t separate until the apical 1/3 which is difficult for rotation and often fracture
maxillary 1st premolars
These teeth usually have just one root so rotational moment is more useful
maxillary 2nd premolars
Which forceps are used for the maxillary 1st and 2nd molars
150
53 R and L
88 R and L
Apply moderate pressure in which direction to maxillary 1st and 2nds
lingual
Which root is more favorable to fracture on maxillary molars
buccal
Second maxillary molars typically have roots that do this, which make the extraction simpler
root fusion
These teeth have somewhat conical roots and flatten with thin buccal bone
mandibular incisors/canines
Which forceps are used for mandibular incisors and premolars
151
Ash
These teeth are the easiest to extract, very conical straight roots; important to use rotational forces
mandibular premolars
