Removal of Teeth: Complex Procedures Flashcards
What is the general idea regarding surgical extraction
To make the tooth smaller or the hole bigger!
- Not when near sinus
- Not when on top of mandibular canal
- Not when extracting molars
When not to use a straight elevator directly
- Section tooth
- Remove residual root
- Can use purchase points to level out
Cryer elevator
- Take down bone so you can get purchase point with elevator.
- Expose root end and push it down
- Vertical incision should end over solid bone
Flap and bone removal
- Used when you expect you will later place an implant at the site
- Used to preserve good bone height
- Add synthetic bone material into socket, place membrane (resorbable or not) over the graft material
- Use an INTERRUPTED SUTURE closure
Socket preservation
- Section so that a multirooted tooth becomes two single rooted teeth
- Can section through crown or cut one root off at furcation
What to do when a mandibular molar will not budge
Which is more likely to cause damage to an adjacent tooth, a straight elevator or a cryer?
Cryer
- Section roots
- Work elevator apically, it may be enough to remove root
- If you can identify a small tip of the root you can work an elevator into the space between the root tip and alveolus
- Can be done with or without a flap
What to do when a maxillary molar crown has fractured off
- Don’t ever use upward pressure
2. Instead use a flap procedure or make a bone window at the apex of the tooth
What to do when the tooth is near the maxillary sinus
Variants (Objective 1)
You must be careful not to perforate the sinus
Maxillary molar near maxillary sinus
V#1
Make patient aware of potential paresthesia
Mandibular molar on IAN
V#1
You cannot simply rotate these out of the socket using forceps
Multi-rooted Canines
Dilaceration of which incisor
Central
V1
Be careful so that you don’t take away that part of the bone when you do the extraction and expose the sinus
Free-standing molar near tuberosity
V1
May be able to expose the bone or surgically remove the tooth. Also, close to the sinus, may dislodge the adjacent restoration
Hypercementosis
V1
Follow the lamina dura. If it is intact then you aren’t looking at pathology
How to distinguish mental foramen from pathology
- Start with sulcular incision with a 15 blade placed at gingival margin
- Gentle elevation with periosteal elevator. Pointed end to broader end
- Always stay on bone, try not to tear periosteum or there will be more swelling
Surgical flap design
A tooth with 2+ indicators of moderate difficulty should…..
have consideration given to performing the extraction in the oral surgery clinic
Teeth with any indicators of high difficulty…
Should be discussed with an oral surgeon
This ASA class is a moderate indicator
3
this age group is a moderate indicator
55-65
- ASA 4 or 5
- History of difficulty achieving anesthesia
- Uncooperative
- Significant limitation in opening mouth
- History of severe anxiety
- Older than 65
- Severe pain and swelling
Patient Indicators of high difficulty of extraction
- Extreme difficulty obtaining/interpreting x-rays
- Impacted teeth, 3rd molar, extreme inclination, extreme crowding, extreme rotation
- Extensive restoration with missing tooth structure, significant deviation from normal form, missing complete buccal or lingual tooth structure
- Large adjacent exostoses, isolated posterior tooth
- Pneumatized sinus around roots, widely divergent or dilacerated roots, bulbous roots, hypercementosis, ankylosed teeth
Diagnostic and Tx Considerations that present a high degree of difficulty
- Teeth with post and core
Additional considerations that make a tooth highly difficult to extract
