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Oral Surgery 1 > Principles of Uncomplicated Exodontia > Flashcards

Principles of Uncomplicated Exodontia Flashcards

1
Q 
ESSENTIALS OF \_\_\_\_\_\_\_
• Finesse 
• Dexterity and Skill
• Controlled force
• Firm steady pressure
• Knowledge of what to treat and what to refer out
A

EXODONTIA

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2
Q

Can pts feel pressure or pain with local anesthetic?

A

Pressure

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3
Q

What are the 3 Basic pharmacologic options available to reduce stress?

A
  • Pre-operative oral sedation (valium)
  • Nitrous oxide analgesia
  • Intravenous Sedation
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4
Q 
\_\_\_\_\_\_\_\_\_ FOR TOOTH REMOVAL
• Severe uncontrolled metabolic issues
• Uncontrolled lymphoma/leukemia 
• Concern for infection due to 
nonfunctioning white cells
• Bleeding concern due to nonfunctioning 
platelets
• Pregnancy in 1st and 3rd trimester
• Uncontrolled Blood/Bleeding disorders
• Uncontrolled cardiac issues
• Unstable angina
• Recent MI
• Malignant hypertension
• Uncontrolled dysrhythmias
A

CONTRAINDICATIONS

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5
Q

Department policy for impacted third molar
evaluation is an ________
radiograph of good diagnostic quality

A

ORTHOPANTOMOGRAM (PANO)

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6
Q

Transmit the force with the more stable and powerful upper arm and shoulder or
the wrist or hands?

A

upper arm and shoulder

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7
Q
  • Increased stress on deltoids and trapezius muscles

* Causes fatigue which could potentiate mistakes at the end of the workday

A

Elbows flailing

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8
Q

• Operator in front position
• Chair recline so maxillary occlusal plane is 60º to 90º to the
floor
• Mouth at level of elbow
• Patient’s head turned towards or away operator to degree
necessary for appropriate visualization

A

Maxilla

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9
Q

Where does the operator sit for max extractions?

A

In front of pt

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10
Q

How is the pt positioned in the chair for max extractions?

A

Max arch 60-90 degrees from floor

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11
Q

Where does dental operator stand for mand extractions?

A

Behind pts

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12
Q

How is pt positioned for mand extractions?

A

Mand parallel to floor

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13
Q

What are the 3 principles involved in tooth extraction using the instruments?

A
  • The LEVER
  • The WEDGE
  • The WHEEL AND AXLE
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14
Q

What instruments are used as levers?

A

Elevators

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15
Q

What class lever in the mandible?

A

Class 3

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16
Q

What class lever is created with elevators?

A

Class 1 lever

Small movement causes large force

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17
Q

What 2 types of instruments are used as wedges?

A

Elevator

Forceps

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18
Q

can be used to expand, split, and displace portions of

the substance that receives it

A

Wedge

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19
Q

What instrument is used a the wheel and axle?

A

Cryer elevators

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20
Q

What is the indication for cryer elevators?

A

Root tip extraction where one root is still firmly in tooth

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21
Q

What portion of the cryer elevators serves as the axel?

A

Handle

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22
Q

What portion of the cryer elevators serves as the wheel?

A

Tip of elevator

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23
Q

• Used to LUXATE teeth, not to remove them
• Minimizes root fracture
• Requires fulcrum point from finger
- Can potentially extract 3rd molars

A

Dental elevators

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24
Q

T/F: Never use adjacent tooth as fulcrum, UNLESS the tooth is also
to be extracted

25
T/F: Never used the buccal/lingual plates at the gingival line as fulcrum
True
26
The ONLY elevators that use all 3 principles • Lever • Wedge • Wheel and Axel
Straight gouge elevators
27
* The PRIMARY instrument for removal of teeth * Goals: * Expansion of bony socket by movement of the tooth against alveolar socket * Separation of the PDL attachment * Removal of tooth from socket
Forceps
28
What is the order used for forceps forces?
* Apical * Buccal * Lingual * Rotational * Traction
29
____ forceps force • The first force applied • Used on all teeth • Seat forceps beak on firm root structure • Expands crestal bony cortex • Displace center of rotation as apically as possible • Reduces apical root fracture • If fulcrum is too high, there is increased force placed on apical region of root →root fracture
Apical force
30
Where should forceps be placed on the tooth structure to avoid root fracture?
Below CEJ on root structure
31
Is the buccal or lingual plate usually thinner?
Buccal plate usually thinner
32
____ forceps force • After apical force applied • Most frequently used to expand socket • Buccal plate usually thinner than palatal or lingual plate • Possible to fracture buccal plate without expansion of socket if large buccal force and thin alveolus present
• Buccal force
33
____ forceps force * Similar to buccal force, but with lingual/palatal bony expansion * Rare to get lingual plate or palatal plate fracture with this force
Lingual force
34
____ forceps force * Create internal expansion of socket * Best application is teeth with single conical roots * Least chance to fracture bony plates, roots, or tooth
Rotational force
35
____ forceps force • Limited to the final phase of the extraction process • To deliver the tooth • Should be very minimal force • If proper bony expansion and PDL disjunction achieved with previous applied force
Traction force
36
When delivering a tooth which direction should it be delivered? B or L? Why?
Buccally to that buccal root will fracture more often than palatal root
37
Does force in an extraction need to be controlled or uncontrolled?
Controlled
38
•______ extraction technique • Simple extraction →elevators and forceps • Most frequently used technique for extraction • Always attempted first - If not successful, surgical extraction is next
Closed extraction technique
39
What elevator is used to loosen the gingival attachment around a tooth?
#9
40
What are the 5 steps for closed extraction?
* Loosening gingival attachment * Luxation with elevator * Proper adaptation of forceps * Luxation of tooth with forceps * Removal of tooth from socket
41
What angle should the elevators be inserted in the gingival tissue in relation to the tooth in order to loosen gingival attachment and luxate the tooth?
45 degree angle
42
``` ROLE OF _________ • Reflect cheek, lips, possibly tongue • Stabilize patient head • Support lower jaw • Prevent damage to TMJ • Support alveolar process • Feel cortex expanding • Stabilize neighboring dentition ```
OPPOSITE HAND
43
What tooth? * Primarily rotational * #13 forceps
Maxillary incisors
44
* Longest tooth * Combination of all 5 forces (mild rotational) * Fracture buccal plate very common * Upper Universal #150 forceps
Maxillary canine
45
• Highest chance of all premolars to have multiple roots • Buccal force > palatal force • Want to break buccal root instead of palatal root • Avoid rotational force • #150 forceps
Maxillary 1st premolar
46
* Thick, blunt root * Usually relatively simple extraction * #150 forceps
Maxillary 2nd premolar
47
• Can be difficult due to large divergent roots and proximity of sinus • Apical force, with slow steady buccal force with less palatal force (buccal plate thinner) • #150 vs #88 R/L vs #53 R/L
Maxillary Molars
48
• One tooth that can be frequently removed with | elevators only
Maxillary 3rd molar
49
• Apical →buccal & lingual (equal pressure) → rotational →labial traction • Roots and buccal bone fracture very easily • Be sure the smooth sharp areas of bone • Lower universal #151 vs #13 Ash forceps
Mandibular anterior teeth
50
• Next to max central incisors & max 2nd premolars, lower premolars are among the easier to extract • #151 vs #13 • Apical →buccal & lingual (equal force) → rotational (short and conical roots) →buccal traction
Mandibular premolars
51
• Like max first molar, can be the most difficult of all teeth to deliver • Long, strong, divergent roots • Buccal and lingual bone more dense • Roots may converge at apex (“locking” tooth into place) • #23 Cowhorn forceps vs #17
Mandibular molars
52
______ FORCEPS USE • Seat lingual beak first, then buccal beak • Can easily crush crestal lingual cortex and inadvertently severe lingual nerve • Lingual nerve is on average ~ 2.5 mm medial and inferior to lingual cortex crest • ~15% lingual nerve is oriented superior to lingual cortex crest • Push beaks apically • Pumping motion vs Rocking motions vs gentle rotational movements • Squeeze handles together as beaks come together in the bifurcation • Figure of 8 motion • Occlusal plane of tooth will elevate above remaining mandibular occlusal plane • Gradual traction to deliver
COWHORN
53
How often is the lingual nerve oriented superior to lingual cortex crest?
~15%
54
``` • Roots are long and thin • Easy to fracture • If unable to retrieve small root segment, leave it in place and advise the parent • If deciduous molar roots grasp around permanent crown, tooth should be surgically sectioned • DO NOT CURETTE SOCKET • Do not want to damage permanent bud underneath ```
DECIDUOUS TEETH
55
If deciduous tooth root fractures off and can't be retrieved easily, what do you do?
Leave it
56
Do you curette the socket of an extracted primary tooth?
No
57
When is curettage highly indicated for tooth socket?
PA pathology
58
How long should pt bite on piece of gauze after extraction socket after extraction?
1 hour firmly

Oral Surgery 1 (11 decks)

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