Routine Extraction Flashcards
Goals of using forceps (2)
- Expansion of bony socket
2. Tractional force (removal)
Six basic forcep moves
Apical buccal lingual rotational tractional circular
Which forcep movement is first?
Apical (expand bony socket)
When pressing crown buccally, what direction does root apex move?
Lingually
Which movements are only good on conical roots?
Rotational
figure of eight as well….
Key points of arm and hand positioning (3)
Elbow in
Straight wrist
-Palm Down (mandibular)
-Palm up (Maxillary)
Sequence of the 5 steps for routine extraction
- Loosen soft tissue attachment
- Luxation (Elevator)
- Adapt forceps
- Luxate WITH forceps
- Traction (final removal)
Step 1 loosen soft tissue:
What instrument?
Why is it done? (2)
Periosteal elevator (curette)
- Seating forceps more apically
- assures anestesia
Step 2 Luxation with elevator
Where is it positioned?
Technique? (2)
PERPENDICULAR btwn teeth
- STRONG, slow pressure
- inferior blade rests on and uses fulcrum of BONE
- With superior blade on extracted tooth.
Step 3 adapt forceps
Which beak applied first?
LINGUAL!!!!!!!! (harder to see)
Step 4 luxation with forceps
Where is the lingual bone NOT thicker than buccal?
Mandibular molars (the more posterior the thinner lingual bone)
Step 5 Removal of tooth from socket
*Be gentle should come out easily
Which direction is this delicate force applied?
Buccally
-clinically: follow growth pattern where possible
What is a pinch-grasp?
It is with your left hand, feeling on the buccal and lingual surfaces of alveolar bone. on MAXILLA
Why do you use a pinch-grasp? (3)
- Retract tissues
- Stabilize patients head
- Detect possible alveolar fractures
What a mandibular sling grasp?
Index and first finger are used same a pinch grasp and other fingers hold mandible extraorally.
-this helps stabilize mandible
What are two ways of protecting patient during a mand extraction?
- Bite block (mouth prop)
2. Mandibular sling grasp
Maxillay incisor root morphology
- central
- Lateral (2)
Central- long conical
Lateral- SLENDER and distal curve
Maxillary incisor Forcep selection (3)
- 150
- 1
- 99
Maxillary Canines (root morphology) (2)
Longest roots of all
ovoid: broader buccal-Lingually!
Maxillary Canines Alveolar bone*
The labial (facial/buccal) bone is quite thin and fractures easily!
Maxillary Canines Forceps 1 (or 3, clinically)
- 150
2. and 3: 1 and 99 also
Maxillary Canines
-what is your action if LABIAL plate fractures?
-Separate bone from root with: periosteal elevator
***Bone still attached to periosteum will be vital, otherwise it will die and should be removed
ANSWER ONLY
Maxillary 1st Premolar root morph (3)
- Usually has 2 roots
- Apex is thin
- Apex has distal curvature
Maxillary 1st Premolar Forceps (2)
- 150
2. 150A
Maxillary 1st Premolar Extraction steps/technique (3)
- Elevator luxation as much as possible
- Remember: palatal root easily fractures
- More dependent on tractional force to deliver tooth
Maxillary 2st Premolar root morphology (3)
- RARELY bifurcated
- Thick
- Blunt apex
Maxillary 1st and 2nd molars root morphology (2)
- 3 roots (palatal largest)
- Buccal roots are curved and thin
Maxillary 1st and 2nd molars: sinus proximity concerns
Worry about breaking into sinus
-consider surgical extraction
Maxillary 1st and 2nd molars Forceps
- Intact (2)
- Gross Decay (4)
- Extensive bone loss or conical(2)
intact ( 53 R and L)
Gross (88 R and L AND 89,90)
Extensive bone loss (150 and 210)
Maxillary 3rd molar root morph (2)
conical/fused and variable
Maxillary 3rd molar Forcep
210-S
Mandibular anteriors root morph (4)
*The roots are ovoid and longest B-L —> Ex: 0
straight
- thin incisors
- thick canines
Mandibular anteriors Forceps (2)
- 151
2. 74 Ashe
Mandibular anteriors Removal concern
When removing multiple, do not rotate because the ovoid shape will break interdental alveolar bone
Mandibular Premolars Root morph (2)
- long, slender
2. Rarely bifurcated
Mandibular Premolars forceps (3)
- 151
- 151 A
- 74 Ashe
Mandibular Premolars what movement is: “it’s super effective” for extraction
*Rotational
Mandibular 1st and 2nd molars root morph
Bifurcated
- 1st more divergent
- 2nd more often fused-conical
Mandibular 1st molar alveolar bone
It is essentially equal width/strength as the buccal
Mandibular 1st and 2nd molars
- intact
- gross
- fused roots
intact - 17
gross - 23
fused roots - 222
- Mandibular 2nd molars technique for 17
- only unique direction of removal
-Remove occlusal lingually* (not buccally)
Mandibular 1st and 2nd molars technique for 23
Appose the beaks while resting on cortical plates as fulcrums!
Mandibular 3rd molars Root morph
All effed up
-fused conical or bifurcated
Mandibular 3rd molars forcep
222
*erupted MAND 3rds are still difficult even if erupted, IF they are in occlusion
ANSWER
If you can’t get alveolar expansion, what is the concern and reason for using a surgical route instead?
Massive fracture of alveolar bone (or roots too…)
What are the only things that indicate debridement walls of alveolus? (5)
- Calculus
- Amalgam
- Tooth fragment
- Loose bone*****
- Granulation tissue
What two components of the socket aid in proper healing?
PDL fragments and (bleeding) bony walls
What should you palpate for in a bony socket?
-how to fix?
Sharp edges of bone
-use bone file
