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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

A

True

25
Q

T/F: Never used the buccal/lingual plates at the gingival line as
fulcrum

A

True

26
Q

The ONLY elevators that use all 3 principles
• Lever
• Wedge
• Wheel and Axel

A

Straight gouge elevators

27
Q
  • 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
A

Forceps

28
Q

What is the order used for forceps forces?

A
  • Apical
  • Buccal
  • Lingual
  • Rotational
  • Traction
29
Q

____ 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

A

Apical force

30
Q

Where should forceps be placed on the tooth structure to avoid root fracture?

A

Below CEJ on root structure

31
Q

Is the buccal or lingual plate usually thinner?

A

Buccal plate usually thinner

32
Q

____ 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

A

• Buccal force

33
Q

____ forceps force

  • Similar to buccal force, but with lingual/palatal bony expansion
  • Rare to get lingual plate or palatal plate fracture with this force
A

Lingual force

34
Q

____ forceps force

  • Create internal expansion of socket
  • Best application is teeth with single conical roots
  • Least chance to fracture bony plates, roots, or tooth
A

Rotational force

35
Q

____ 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

A

Traction force

36
Q

When delivering a tooth which direction should it be delivered? B or L? Why?

A

Buccally to that buccal root will fracture more often than palatal root

37
Q

Does force in an extraction need to be controlled or uncontrolled?

A

Controlled

38
Q

•______ extraction technique
• Simple extraction →elevators and forceps
• Most frequently used technique for extraction
• Always attempted first
- If not successful, surgical extraction is next

A

Closed extraction technique

39
Q

What elevator is used to loosen the gingival attachment around a tooth?

A

9

40
Q

What are the 5 steps for closed extraction?

A
  • Loosening gingival attachment
  • Luxation with elevator
  • Proper adaptation of forceps
  • Luxation of tooth with forceps
  • Removal of tooth from socket
41
Q

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?

A

45 degree angle

42
Q 
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
A

OPPOSITE HAND

43
Q

What tooth?

  • Primarily rotational
  • # 13 forceps
A

Maxillary incisors

44
Q
  • Longest tooth
  • Combination of all 5 forces (mild rotational)
  • Fracture buccal plate very common
  • Upper Universal #150 forceps
A

Maxillary canine

45
Q

• 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

A

Maxillary 1st premolar

46
Q
  • Thick, blunt root
  • Usually relatively simple extraction
  • # 150 forceps
A

Maxillary 2nd premolar

47
Q

• 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

A

Maxillary Molars

48
Q

• One tooth that can be frequently removed with

elevators only

A

Maxillary 3rd molar

49
Q

• 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

A

Mandibular anterior teeth

50
Q

• 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

A

Mandibular premolars

51
Q

• 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

A

Mandibular molars

52
Q

______ 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

A

COWHORN

53
Q

How often is the lingual nerve oriented superior to lingual cortex crest?

A

~15%

54
Q 
• 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
A

DECIDUOUS TEETH

55
Q

If deciduous tooth root fractures off and can’t be retrieved easily, what do you do?

A

Leave it

56
Q

Do you curette the socket of an extracted primary tooth?

A

No

57
Q

When is curettage highly indicated for tooth socket?

A

PA pathology

58
Q

How long should pt bite on piece of gauze after extraction socket after extraction?

A

1 hour firmly

Oral Surgery 1 (11 decks)

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