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SP15 Oral Surgery > Principles of Tooth Extraction > Flashcards

Principles of Tooth Extraction Flashcards

1
Q

What are the seven principles of tooth extraction

A 
pre-surgical assessment
informed consent
surgeon and patient preparation
proper pain and anxiety control
chair position
extraction of tooth
post-op care of patient
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2
Q

What three things make up the pre-surgical assessment

A

clinical evaluation
radiographic evaluation
proper diagnosis and indication for extraction

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3
Q

What are the 14 indications for extraction

A 
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
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4
Q

What are 7 systemic conditions that are contraindications for extractions

A 
uncontrolled metabolic diseases
malignancy
recent MI (6 weeks)
pregnancy (1st and 3rd trimester)
immunocompromised
bleeding disorders
medications tha alter hemostasis or healing
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5
Q

What are three local conditions that are contraindications for extraction

A

previous head and neck irradiation
previous systemic anti-resorptive therapy
acute pericoronitis

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6
Q

What are three anatomic considerations that are contraindications for extraction

A

IAN proximity
sinus
adjacent teeth

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7
Q

What are five clinical evaluations for extractions

A

access
mobility
condition of the crown, previous RCT treatment
condition of the adjacent teeth/restorations
bone adjacent to the teeth

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8
Q

What six things are important to evaluate for the radiographic evaluation

A 
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
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9
Q

What is the position of the chair in the standing technique if the patient is having maxillary teeth extracted

A

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

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10
Q

What is the position of the chair in the standing technique if the patient is having mandibular teeth extracted

A

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

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11
Q

What is the concept of controlled force

A

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

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12
Q

What is the motion of extraction the tooth

A

never “pull” the tooth

push, rock, and rotate

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13
Q

What are the three “simple machine” basis of extraction

A

lever
wedge
wheel and axle

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14
Q

Using this type of elevation is the safer more controlled force used with the straight or root tip elevators

A

wedge

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15
Q

This type of elevation is likely to break fragile instruments or teeth and bone used with the cryer, cogswell, and straight elevators

A

lever

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16
Q

This type of elevation is used with the cryer elevator

A

wheel and axle

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17
Q

What is the primary purpose of elevators

A

to loosen teeth in preparation for extraction with forceps
create space for forceps
may be the primary mechanism for extraction

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18
Q

What is the secondary purpose of elevators

A

remove parts of the tooth or root

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19
Q

This is usually the initial instrument used primarily for expanding the alveolus and loosening of the tooth/PDL

A

straight elevator

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20
Q

How should you NOT use a straight elevator

A

do NOT fulcrum off the adjacent tooth

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21
Q

Where should the working end of the straight elevator face

A

point from the facial toward the lingual or apex; don’t elevator from the lingual

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22
Q

Elevators are not this

A

a crow bar

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23
Q

What is the technique for using the straight elevator

A

wedges the apical edge of the elevator against crestal bone and “pushes” (does not “scoop”) the tooth

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24
Q

These are used for lever and/or wheel and axel forces but care is used

A

cryer elevators

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25
Q

What is the primary use of a cryer elevator

A

removing residual roots of multi-rooted teeth

26
Q

This portion of the cryer elevator removes interseptal bone providing access to the retained root

A

the sharp tip

27
Q

These are fragile elevators that are used as a wedge, not a “prying” force

A

root tip elevators

28
Q

What is the technique for using root tip elevators

A

“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

29
Q

These are used as a handle and a lever and the movement produces significant wedging

A

forceps

30
Q

What is the primary force of a forcep

A

initially in an apical direction to seat the forceps

31
Q

What is the secondary force of a forcep

A

buccal, lingual, or rotational to expand the alveolus to release the tooth

32
Q

What is the last force of a forcep

A

minimal tractional force

33
Q

What are the eight steps for a simple extraction

A
  1. confirm profound anesthesia of pulp, soft and hard tissue
  2. release soft tissue around tooth
  3. elevate tooth with the elevator
  4. adapt forceps to tooth
  5. luxate with forceps
  6. remove the tooth from the socket
  7. examine socket for soft tissue/granulation tissue: curette
  8. place a 2x2 directly over the socket and compress with occlusal forces
34
Q

What should be used for loosening the soft tissue attachment

A

use the sharp end of the periosteal elevator or dental curette

35
Q

What are three characteristics of loosening the soft tissue attachment

A

confirms the anesthesia
allows the forceps to be seated apically or elevator to be placed inter proximally
be kind to the soft tissues

36
Q

How should you hold the elevator (usually straight) to luxate the tooth

A

perpendicular to the inter proximal space or parallel to the long axis of the tooth

37
Q

Choose forceps that will adapt well to which tooth morphology

A

the sub-gingival morphology

38
Q

Confirm the long axis of the beak of the forcep does what

A

clears the adjacent teeth to avoid trauma

39
Q

What are two characteristics of the firm apical force used by the forceps

A

moves center of rotation apically to prevent root fracture

expands alveolus and widens PDL space

40
Q

Where should the force of luxating the tooth with forceps come from

A

straight wrist with force generating from shoulder and upper arm, not the wrist

41
Q

Using the forceps, you are primarily buccal at first with less lingual, then you do what

A

rotate the tooth gently after mobilization

42
Q

What is the force that removes the tooth from the socket

A

slight traction, usually buccal is the final step

43
Q

What are the five steps of post-extraction socket care

A

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

44
Q

Seat the beak of the 150/151 forceps with a firm and deliberate apical pressure which does what three things

A

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

45
Q

This type of motion (150/151) works well, especially for multi-rooted teeth

A

figure-8 or ratchet

46
Q

This forcep is designed to engage the furcation of the lower molar; no corn is needed to engage

A

mandibular #23 cowhorn

47
Q

How should you seat the #23 forcep

A

seat into furcation with a “pumping” up and down action before buccal/lingual rotation; this will help close the beaks together

48
Q

Which side, buccal or lingual, should you seat the #23 forcep first?

A

lingual

49
Q

Once te #23 forcep is seated, what motion is used to remove the tooth

A

buccal-lingual action or figure-8 motion

50
Q

There is a less of a rotational movement to remove these teeth

A

maxillary laterals

51
Q

These teeth have long roots and are difficult to extract, they often require a mucoperiosteal flap

A

maxillary canines

52
Q

This bone is heavier than buccal bone

A

palatal bone

53
Q

These teeth often have two roots which don’t separate until the apical 1/3 which is difficult for rotation and often fracture

A

maxillary 1st premolars

54
Q

These teeth usually have just one root so rotational moment is more useful

A

maxillary 2nd premolars

55
Q

Which forceps are used for the maxillary 1st and 2nd molars

A

150
53 R and L
88 R and L

56
Q

Apply moderate pressure in which direction to maxillary 1st and 2nds

A

lingual

57
Q

Which root is more favorable to fracture on maxillary molars

A

buccal

58
Q

Second maxillary molars typically have roots that do this, which make the extraction simpler

A

root fusion

59
Q

These teeth have somewhat conical roots and flatten with thin buccal bone

A

mandibular incisors/canines

60
Q

Which forceps are used for mandibular incisors and premolars

A

151

Ash

61
Q

These teeth are the easiest to extract, very conical straight roots; important to use rotational forces

A

mandibular premolars

SP15 Oral Surgery (7 decks)

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