Surgery Flashcards
What is the difference between a luxator and an elevator
Luxators have thiner working ends with a sharp blade
Elevators are more rounded at the end, the blade is slightly more spoon shaped
Describe winged elevators
Working end that is well adapted to tooth shape
Narrow shaft better for visualisation
Metal is quite thin so can chip or blunt easily
How should an elevator or luxator be held?
Palm grasp - Tip of index finger placed on shaft no more than 1cm away from working tip
What should be ensured when choosing extraction forceps?
That the beaks of the forceps meet otherwise they are unable to grasp tiny teeth
What holds the tooth root into the alveolar socket?
Gingiva
Periodontal ligament
What is the first step of tooth root extraction?
Cut the gingival attachment
Use a scalpel blade and move slowly
What are the six steps of single root tooth extraction?
- Cut gingival ligament
- Insert luxator into periodontal ligament space
- Use an elevator to rotate tooth to break periodontal ligament
- Repeat step 3 around different points of the tooth
- Use extraction forceps to remove tooth
- Extract and inspect tooth
Describe how a luxator should be inserted into the periodontal ligament space
Hold instrument at 30º angle towards tooth and wedge luxator into gap
Attempt to walk luxator around the tooth, cutting periodontal ligament and widening gap
Avoid holding instrument parallel to the tooth and slipping onto alveolar bone
Describe use of an elevator in tooth extraction
Wedge in and rotate slowly around its own long axis
Avoid tilting or quick digging movements
Be patient
Repeat same rotation around long axis with tip slightly deeper
What technique should be used with the elevator on incisor teeth?
Four corners
Describe use of the extraction forceps in tooth removal
Apply beaks of forceps as far apically on the crown as possible
Rotate around tooth’s long axis
Apply traction once maximum point is reached
What should be used during a direct extraction of a multi-rooted tooth to cut the gingival attachment?
Dental drill with tapered fissure cutting bur
How should the dental drill be held?
Modified pen grasp
Describe operation of the dental drill
Always ensure water spray functions
Activate foot pedal fully for full-speed rotations before touching tooth
Alternate 2 seconds of pressure and drilling with one second of easing off
What should be done after cutting the gingival attachment with multi-rooted teeth?
Transsection of the tooth at the furcation by pointing the tip of the bur towards the furcation
Hold it at a slight angle
What shape should you transect with multirooted teeth and why?
Slight ‘V’ shape
Makes the elevator easier to insert
What needs to be confirmed before trying to remove multirooted tooth fragments?
Independent mobility of the segments by inserting an elevator and gently moving it
What is it helpful to do when sectioning 3-rooted teeth?
Reduce crown height first
What should be done with the maxillary 4th premolar tooth prior to extraction?
Remove distal overhang of the crown creating a space for the elevator
Take care not to cut into crown of molar 1
What are four possible complications of extractions?
Root fragmentation
Jaw bone necrosis
Iatrogenic jaw fracture
Oro-nasal fistula
What are the four indications for surgical extraction?
Big rooted teeth
Persistent deciduous canine teeth
Limitation of the risk of iatrogenic jaw bone fracture
Dealing with or preventing extraction complications
What are the two basic flap designs?
Envelope flap - no vertical release incisions
Flap with one or two release incisions
How many release incisions can be made for a small tooth?
One
How many incisions should be made for larger tooth surgical incisions?
Two divergent and longer incisions
- Provides a broader base
- Provides better exposure
Why should dental tissue be handled gently?
Oral mucosa is easily crushed by rough handling
Describe how to handle dental tissue during surgical extractions
Elevate slowly and gently with sharp periosteal elevators
Use fine-tipped atraumatic tissue forceps cautiously
Use retraction at the base of the flap more than holding onto and pulling the flap
What two structures should you take care not to cut into?
Neurovascular bundle that exits from infraorbital foramen
- Push it out of the way before making caudal oblique release incision for canine tooth extraction
Neurovascular bundle exiting from mental foramen
What should be taken care of when surgically extracting the maxillary 4th premolar?
Parotid duct and its orifice
Parotid papilla
- Must section the crown between the roots
What is one of the most common dental diseases in cats and what fraction of adult cats have it?
Tooth resorption
- 1/3 of adult cats have one or more lesions
Describe the pathogenesis of tooth resorption in cats
Teeth attacked by odontoclasts
Adhere to root surface and form resorptive lacunae
Vascular granulation tissue fills lesion and may be replaced by bone and cementum like tissue
Describe two anatomic landmarks of a healthy tooth on a radiograph
Lamina dura
- White line around root
Periodontal ligament space
- Thin black line around root
What does type 1 resorption look like on a radiograph?
Focal lesion with periodontal ligament around root still intact
What sort of extraction does a type 1 resorption need?
Standard extraction technique
How do type 2 tooth resorptions appear on a radiograph?
Root replacement or at least partial loss of periodontal ligament
How can type 2 resorption often be treated?
Crown amputation with intentional root retention
What is type 3 tooth resoprtion?
A combination of type 1 and 2
What is currently the only accepted option for tooth resorption treatment?
Extraction
In what three cases should crown amputation for treatment of type 2 resorptions not be used?
Presence of infection or inflammation at root level
Stomatitis patients
Patients with systemic condition comprimising immune response
What are the two options for treatment of tooth resorption in dogs?
Extract if supragingival or there is communication with the oral cavity
Leave in if subgingival and no sign of pain or inflammation
What are the 12 stages of surgical extractions?
- Plan flap design
- Cut gingival attachment using scalpel
- Perform release incisions
- Elevate the flap
- Reflect the flap to expose buccal jaw bone
- Remove exposed bone plate over root
- Cut deeper grooves along the root outlines
- Rotate tooth using elevator or luxator
- Inspect root apex
- Smooth down bony spikes - alveoloplasty
- Test and prepare flap for closure
- Close flap
Describe how release incisions should be made
Bold incisions through all layers right onto the bone
Cut depth towards dentinal ridge with control when nearing ridge
What action is required to elevate the flap during surgical extractions?
Firm action of pushing down onto the bone in a controlled push and twist action
Describe how to remove the exposed bone plate in a surgical extraction
Start where alveolar bone meets the crown
Remove buccal bone plate until about 80% is exposed
Don’t cut into root excessively
Describe how to make deeper grooves along the root outlines in a surgical extraction
Use a small size 1 or 1/2 round bur medially to cut a groove deeper than 50% of the tooth width
Don’t drill too deep as nasal cavity is nearby
Connect mesial and distal exposed root area by drilling a shallow line close to the root apex
Describe flap closure in a surgical extraction
No tension
5/0 or 4/0 monocryl or vicryl suture material
Reverse cutting, curved, 13-16mm needle
Take fairly big ‘bites’ about 3-5mm away from flap margin
Keep sutures 3-4mm apart
