SA Dental Extractions Flashcards
Describe pulp necrosis
- Pulp is the living soft tissue of the tooth; becomes inflamed (pulpitis) or exposed and bacteria enters
- Then results in periapical pathology; tooth root abscess, sinus tracts, oronasal fistula, osteomyelitis
Name some dental situations where the ‘to extract or not to extract’ question would be asked
- Periodontitis
- Pulp necrosis
- Persistent deciduous teeth or malocclusions
- Abnormal response to normal plaque levels
- Dental fractures
- Tooth resorption
- Mobile teeth
- Caries
What are the names given to abnormal response to normal plaque levels in cats and dogs
- Chronic gingivostomatitis in cats
- Chronic ulcerative paradontal stomatitis in dogs
What is the main benefit of mobile teeth?
Usually, the easiest teeth to remove as periodontal lig. already very weakened
What is a closed extraction technique?
Closed extraction is performed without making an incision through the gingiva other than through the gingival sulcus
Which teeth is closed extraction used for?
- Small, single-rooted teeth (incisors)
- Mobile teeth with significant periodontal disease
- 1st and 2nd PMs
Which instruments are required for closed extraction
- Correct technique
- Elevator, luxator, scalpel, extraction forceps
- Practice and patience
What is the best technique for closed extraction
Combination of luxation and elevation
Describe luxating a tooth
- Apply controlled pushing force to periodontal space with luxator’s sharp blade
- Aim: to cut through the periodontal ligament attachments in direction of root apex
Describe elevation of a tooth
- Apply sustained, rotational force to the tooth, using alveolar bone as fulcrum
- Aim: to fatigue the periodontal ligament and ultimately tear its attachments
Once luxated and elevated how can the tooth be extracted?
Gripping as close to the root, apply gentle rotation to detach the entire tooth from the alveolus
Aim: removal of the tooth with no root remains or fractures
Describe surgical extraction
Surgical extraction involves vertical releasing incisions through the gingiva, as well as bone removal and/or tooth sectioning
Which teeth is surgical extraction used for?
- Most multi-rooted teeth
- Canines
- Tooth resorption or retained roots
- Bizarre root morphology (diagnosed via x-ray)
Which instruments are required for surgical extraction?
- Knowledge of tooth root morphology
- High speed burr (round + cutting heads)
- Gingival flaps
- Periosteal elevator, luxator, elevator
- Dental radiography extremely helpful/necessary
Name the 3 different flaps that can be made for surgical extraction of a tooth
- Envelope flap
- Triangle flap
- Pedicle flap
Describe the envelope flap technique
- Gingival sulcus incision but no ‘releasing incisions’ performed
- Useful for PM tooth where FP is usually close to gumline
- Good for crown amps in cats
Describe the triangle flap technique
- Sulcal incision +1 releasing incision
- Creates a drape-like flap, easy to close
- Perfect for triangular rooted teeth like the maxillary 4th PM
Describe the pedicle flap technique
- Involves 2 releasing incisions
- Grants extensive access to alveolar space
How must dental flaps be closed?
By primary intention
Describe the periosteal elevation surgical extraction technique
- Elevate the mucoperiosteal flap away from the underlying bone
- Use pushing/rotating strokes to reveal alveolus