Removal of Teeth: Complex Procedures

Question 1

What is the general idea regarding surgical extraction

Answer 1

To make the tooth smaller or the hole bigger!

Question 2

1. Not when near sinus
2. Not when on top of mandibular canal
3. Not when extracting molars

Answer 2

When not to use a straight elevator directly

Question 3

1. Section tooth
2. Remove residual root
3. Can use purchase points to level out

Answer 3

Cryer elevator

Question 4

1. Take down bone so you can get purchase point with elevator.
2. Expose root end and push it down
3. Vertical incision should end over solid bone

Answer 4

Flap and bone removal

Question 5

1. Used when you expect you will later place an implant at the site
2. Used to preserve good bone height
3. Add synthetic bone material into socket, place membrane (resorbable or not) over the graft material
4. Use an INTERRUPTED SUTURE closure

Answer 5

Socket preservation

Question 6

1. Section so that a multirooted tooth becomes two single rooted teeth
2. Can section through crown or cut one root off at furcation

Answer 6

What to do when a mandibular molar will not budge

Question 7

Which is more likely to cause damage to an adjacent tooth, a straight elevator or a cryer?

Answer 7

Cryer

Question 8

1. Section roots
2. Work elevator apically, it may be enough to remove root
3. If you can identify a small tip of the root you can work an elevator into the space between the root tip and alveolus
4. Can be done with or without a flap

Answer 8

What to do when a maxillary molar crown has fractured off

Question 9

1. Don’t ever use upward pressure

2. Instead use a flap procedure or make a bone window at the apex of the tooth

Answer 9

What to do when the tooth is near the maxillary sinus

Question 10

Variants (Objective 1)

You must be careful not to perforate the sinus

Answer 10

Maxillary molar near maxillary sinus

Question 11

V#1

Make patient aware of potential paresthesia

Answer 11

Mandibular molar on IAN

Question 12

V#1

You cannot simply rotate these out of the socket using forceps

Answer 12

Multi-rooted Canines

Question 13

Dilaceration of which incisor

Answer 13

Central

Question 14

V1

Be careful so that you don’t take away that part of the bone when you do the extraction and expose the sinus

Answer 14

Free-standing molar near tuberosity

Question 15

V1

May be able to expose the bone or surgically remove the tooth. Also, close to the sinus, may dislodge the adjacent restoration

Answer 15

Hypercementosis

Question 16

V1

Follow the lamina dura. If it is intact then you aren’t looking at pathology

Answer 16

How to distinguish mental foramen from pathology

Question 17

1. Start with sulcular incision with a 15 blade placed at gingival margin
2. Gentle elevation with periosteal elevator. Pointed end to broader end
3. Always stay on bone, try not to tear periosteum or there will be more swelling

Answer 17

Surgical flap design

Question 18

A tooth with 2+ indicators of moderate difficulty should…..

Answer 18

have consideration given to performing the extraction in the oral surgery clinic

Question 19

Teeth with any indicators of high difficulty…

Answer 19

Should be discussed with an oral surgeon

Question 20

This ASA class is a moderate indicator

Answer 20

3

Question 21

this age group is a moderate indicator

Answer 21

55-65

Question 22

1. ASA 4 or 5
2. History of difficulty achieving anesthesia
3. Uncooperative
4. Significant limitation in opening mouth
5. History of severe anxiety
6. Older than 65
7. Severe pain and swelling

Answer 22

Patient Indicators of high difficulty of extraction

Question 23

1. Extreme difficulty obtaining/interpreting x-rays
2. Impacted teeth, 3rd molar, extreme inclination, extreme crowding, extreme rotation
3. Extensive restoration with missing tooth structure, significant deviation from normal form, missing complete buccal or lingual tooth structure
4. Large adjacent exostoses, isolated posterior tooth
5. Pneumatized sinus around roots, widely divergent or dilacerated roots, bulbous roots, hypercementosis, ankylosed teeth

Answer 23

Diagnostic and Tx Considerations that present a high degree of difficulty

Question 24

1. Teeth with post and core

Answer 24

Additional considerations that make a tooth highly difficult to extract

Question 25

A patient with mild systemic disease (controlled)

Answer 25

ASA II

Question 26

A patient with severe systemic disease that is a constant threat to life

Answer 26

ASA IV

Question 27

1. Sulcular incision with #15 blade
2. Gentle elevation with periosteal elevator
3. Base should be broader than gingival margin
4. Place vertical incisions over solid bone
5. DO NOT section papilla

Answer 27

Surgical Flap Design

Question 28

This incision is used for a palatal torus

Answer 28

Y or double Y

Question 29

Generally, this should be placed more anterior to help with visability

Answer 29

vertical incision

Question 30

If you just want to expose apical area and not disturb gingival margins

Good if you have esthetic concerns

Answer 30

Semilunar incision