Uncomplicated Exodontia Flashcards
What is the significance of chair position for forceps?
- Better adaptation of forceps to tooth
- Keep wrist straight and arm close to your body
What will incorrect chair position lead to with forceps?
Severe discomfort / muscle strain after extraction usually caused by
* Inappropriate arm position
* Inappropriate force
* Not lack of exercise or muscle mass
True/false
Adjust chair higher for better vision, because, if you cannot see, you can’t operate.
False
When do you need to see for an extraction?
Only time to see is → Proper adaptation of forceps to tooth
Once Forceps is in correct position → Perfect field vision is no longer necessary
Do you need to be able to see for root tip removal?
Yes
Maxillary occlusal plane is _______⁰ to the floor
45⁰ to 60⁰
Surgeon Position for Maxillary Extractions
- Patient’s shoulder are at level of surgeon’s elbow
- Standing at 7 or 8 o’clock position
- Feet spaced apart for stability
- Non dominant hand need to provide stability and counter traction force
Mandibular Occlusal Plane should be
- Parallel to floor
- At the level of surgeon’s elbow or lower
Surgeon Position for Mandibular Extractions
- Standing at 7 or 8 o’clock position
- Feet Spaced apart for stability
- Non dominant hand need to provide stability and counter traction force
Other popular OMS Position for Maxillary Extraction
- 12 o’clock position
- Patient fully reclined
- Forceps grasped with palm up
- Keep arm close to body
— Reduce fatigue - Caution!!
— Much easier for object getting into
airway.
— Throat screen is necessary!!!
Why do you need to be careful if you are extracting the maxillary at 12 o’clock while patient is reclined?
- Much easier for object getting into airway.
- Throat screen is necessary!!!
How is expansion of the bony socket achieved with forceps?
Achieved by using tooth as a dilating instrument
What are the necessary factors for successful “forcep extractions”?
- Sufficient tooth structure
- “correct” root pattern of the tooth
— So one can dilate sufficiently to allow complete dislocation of the tooth - Elastic bone for proper “expansion”
— Bone elasticity is maximal in young bone and ↓ with age
Overzealous effort on socket dilation through excessive or too rapidly applied force can lead to…
Root Fracture
Insertion of a “wedge” or “Wedges” between tooth root and bony socket causes…
tooth to rise in its socket
Move forceps _______ during extraction process
apically
What would buccal pressure to do the socket and the PDL?
- Expand socket on buccal side
- Detach PDL on the lingual side
________ of the socket serve as fulcrum of rotation
Middle
More apical the forceps adaptation the ________ the fulcrum distance
shorter
More uniform dilation of socket→ reduce root fracture
What is a figure 8 movement?
- Combination of buccal, lingual and rotation → “Figure-eight” movement
- Example: Central Incisor
— Basic movement is rotation, because round/ovoid and conical shaped structure
— “unscrew” fashion may also help in combination with “Figure-eight”
How should the grasp look like?
- Wrist needs to remain STRAIGHT
- Maxillary extraction
— Hand is beneath forceps - Mandibular extraction
— Hand is on top of forceps - FIRM grasp and comfortable
What can improper forcep adaptation lead to?
- Tooth Fracture
- Slippage of the instrument
- Injury to adjacent teeth
- Inordinately difficult extractions
What is the process for forcep adapation?
- Direct vision
— Only time you may have to assume “uncomfortable position” for a few seconds until proper facial-lingual forceps adaptation - Apply beaks of the forceps to crown
- Follow the long axis of tooth apically with force
- Ensure proper seating of forceps to the most apical position possible
- Continuously sustain apical pressure and maintain this adaptive process
What is a comfortable extraction pose?
Feet apart, back straight, arm close to your body with wrist straight, neck bent only minimally
What is the chain of muscle movement for an extraction?
Hand→wrist→elbow→shoulder
What is the three step process for adapating forceps to the tooth?
- Continue adaptation of forceps to tooth and seat it apically
- Movement of Extraction are executed
- Non-dominant hand grasp the alveolar process
Exert just the “right” pressure which you feel “safe” to prevent…
tooth fracture
Caution: novice usually apply insufficient pressure
Extraction in the Maxillary Arch uses a _____ grasp
“Pinch-grasp”
* Thumb and index finger on either side of alveolar process adjacent to the tooth
Extraction in the Mandibular Arch uses what two grasps?
Mandibular sling grasp
* Counteract forces of extraction
* Prevent injury to TM joint
“pinch-grasp” + bite block
* Support TM joint
* Bite block on the opposite
___________ should be used when working on mandibular Teeth
Bite block
minimize trauma to TMJ
Basic Extraction Movements include…
Apical, Buccal, Lingual, Rotation and Traction
Anatomical consideration will determine if you were to apply…
Buccal-Lingual vs Rotation Movement
1’ anatomical consideration associated with removal of teeth are:
- Comparative thickness of alveolar bone
— Buccal and lingual side of tooth
What are the features of the maxillary alveolar bone on the facial?
Usually thin with little trabeculation, frequently fenestrated
What are the features of the maxillary alveolar bone on the palatal?
Cortical bone is thicker and trabeculation more pronounced
Maxillary teeth are delivered to the
_______
buccal
What are the features of the mandibular alveolar bone on the facial?
- Usually thinner than lingual anterior to molar region
- Equal to or thicker than lingual in the molar region
Mandibular anterior and premolar are delivered to the _______
buccal
Mandibular molars are delivered with more emphasis on ________
lingual
True/false
Shape of the roots determines buccal-lingual or rotation movements are used
true
ex:
* Maxillary central incisor
— Round cross-section and conical
— Rotation movement
* Maxillary First molar
— 3 roots
— Buccal-Lingual movement
What is the root morphology of the maxillary incisors?
- Central: long straight conical roots
- Lateral: slender conical roots often curved distal
What is the alveolar bone like around the maxillary incisors?
- Thin buccal, thick palatal
What forcep selections and applications are used on maxillary incisors?
- # 1, #99C, #150, Ash.
- Adapt below free gingiva on root surface
- Parallel to long axis of the tooth
- Firm apical pressure to seat forceps
- Sever epithelial attachment
What is the extraction movement used for maxillary incisors?
- Rotation and Traction
- Less rotation and little more buccal palatal force on Lateral incisors due to distal curvature of root
What is the root morphology of the maxillary canines?
- Longest Root & Ovoid shape
- Broader buccal-lingually than mesial-distally
- Distal Curvature
What is the alveolar bone like around the maxillary canines?
- Canine Prominent
- Thin buccal bone & easily fractured
What forcep selections and applications are used on maxillary canine?
- # 150
- Apply forceps as far apically as possible for maximum leverage
What is the extraction movement used for maxillary canines?
- Rotation with buccal and Palatal
- Buccal-lingual > Rotation
movement - If buccal plate is fracture but still nicely attached to periosteum → leave the bone in place
What is the root morphology of the maxillary first premolars?
- 2 roots dividing beyond the apical half of the root
- Distal Curvature and fine/spindly toward apex
What is the alveolar bone like around the maxillary 1st premolars?
- Buccal thinner than palatal
What forcep selections and applications are used on maxillary 1st premolars?
- # 150 and #150-A
What is the extraction movement used for maxillary 1st premolars?
- Traction only ( only tooth in mouth)
— Not much rotary due to bifurcated roots - Excessive buccal-palatal will fracture those small root tips
What is the root morphology of the maxillary second premolars?
- Root is thicker than 1st premo
- Rarely bifurcated →less risk in fracture
What is the alveolar bone like around the maxillary second premolars?
- Buccal thinner, Palatal thicker
- Delivery should be Buccal
What forcep selections and applications are used on maxillary second premolars?
- # 150, #150-A
- Adapt forceps as far apically as possible
What is the extraction movement used for maxillary second premolars?
- Buccal and Palatal
- Ovoid root allow some rotation
What is the root morphology of the maxillary 1st molar?
3 roots
* Large conical bucally curved palatal root
* 2 buccal facial roots are thin and susceptible to fracture
* Sometimes extremely divergent
What is the alveolar bone like around the maxillary 1st molar?
- Thin buccal and fenestrated
What forcep selections and applications are used on maxillary 1st molar?
53 R & L, #89-90, #88 R & L, #150
- # 53: crown intact
- # 89-90: seriously damaged crown— Forceps will engage tooth in buccal furcation while adapting to palatal root
- # 88 R & L:— Forceps will enter buccal furcation and to the side of the palatal root
— ↑ risk of damage soft tissue and bone - # 150: moderate to extensive bone loss— Usually adapt well enough
What is the extraction movement used for maxillary 1st molar?
- Buccal > Palatal movement
- Minimum Rotation
— Trifurcated root and proximity of
adjacent teeth - If close to maxillary sinus, must inform patient of potential oroantral fistula
- If Sinus is very close AND tooth is solidly anchored in bone → Reflect a flap and Section the tooth
What is the root morphology of the maxillary 2nd molar?
- Similar to first molar but less divergent
- Frequently fused with one large conical root
What is the alveolar bone like around the maxillary 2nd molar?
- Thinner buccal than Palatal
What forcep selections and applications are used on maxillary 2nd molar?
- # 89-90 or 88 (R or L)—Trifurcated roots
- # 53 R & L, #150— Fused Roots
What is the extraction movement used for maxillary 2nd molar?
- Buccal and Palatal
- Buccal delivery + Traction
What is the root morphology of the maxillary 3rd molar?
Extremely variable
What is the alveolar bone like around the maxillary 3rd molar?
Buccal thinner than Palatal
What forcep selections and applications are used on maxillary 3rd molar?
- # 210-S, #150
What is the extraction movement used for maxillary 3rd molar?
- Buccal and Palatal with Traction
- Delivery Buccal or Distal
What is the greatest difficulty with maxillary third molars?
Fractured root tips will cause you great difficulty
What forceps do you use to remove maxillary root fragments?
Forceps #286
* Maxillary crown missing but still enough solid tooth structure left
* May not even need full flap, but usually small envelop flap is needed
What are the extraction movements for maxillary root fragments?
Rotation and Traction
What forceps do you use to remove primary maxillary teeth?
150-S
What are the extraction movements for primary maxillary teeth?
- Placement of Forceps (#150-S)
- Movement to Labial
- Movement to Palatal
- Rotary Movement
- Reverse Rotary movement
- Extraction of tooth in path of least resistance
If primary molar’s root encircles the permanent premolar below what do you do?
need to carefully section the primary molar to avoid damage to the premolar
What is the root morphology of the mandibular incisors and canines?
- Incisors
— Long thin root
— Fracture frequently - Canine
— Longer & heavier
What is the alveolar bone like around the mandibular incisors and canines?
- Buccal bone is quite thin
- Maybe thick bone around canine root
What forcep selections and applications are used on mandibular incisors and canines?
- # 74, #74-N,#74-extra N, #203, #151, Ash
What is the extraction movement used for mandibular incisors and canines?
Labial and lingual with some rotation and traction
What is the root morphology of the mandibular premolars?
- Conical & slender, usually straight
- Occasional bifurcation possible
What is the alveolar bone like around the mandibular premolars?
- Thinner @ buccal
What forcep selections and applications are used on mandibular premolars?
- # 151, #151-A, #74
What is the extraction movement used for mandibular premolars?
- Buccal, Lingual, Rotation and
Traction
What is the root morphology of the mandibular 1st and 2nd molars?
- 1st Molar
— Bifurcated with divergent roots
— Mesial Root is slender mesiodistally & curved distally
— Mesial root has ↑chance of fracture than distal root - 2nd Molar
— Less divergent, often fused or conical
What is the alveolar bone like around the mandibular 1st and 2nd molars?
- 1st Molar
— Nearly equal thickness buccal lingually, BUT lingual often being thinner - 2nd Molar
— Lingual is usually thinner.
What forcep selections and applications are used on mandibular 1st and 2nd molars?
- # 23 ( Cowhorn forceps)— Engage bifurcated teeth @ furcation area
- # 17— For slight furcation or less divergent teeth
- # 151 (Universal lower)
What is the extraction movement used for mandibular 1st and 2nd molars?
- Forceps adapted at cervix of tooth, forcibly close the handle. Usually it will apply inward and apical pressure, Tooth will lift out of socket
- Combination of buccal-lingual movement of Delivery to the Lingual
What is the root morphology of the mandibular 3rd molars?
- Usually Bifurcated
- Variable shape
What forcep selections and applications are used on mandibular 3rd molars?
- # 23 if bifurcated
- # 222, #151 if not bifurcated
What is the extraction movement used for mandibular 3rd molars?
- Buccal-Lingual movement
- Delivery to Lingual
Why do you need to beware of erupted mandibular third molars?
- Extremely dense bone
- Erupted 3rd molars are MORE difficult to remove than the initial appearance may suggest
What forceps are used to remove mandibular root fragments?
151, #74, #74-N
What are the extraction movements used for mandibular root fragments?
Labial and lingual with some rotation and traction
What forceps are used on primary mandibular teeth?
151-S
What extraction movements are used on primary mandibular teeth?
- Placement of Forceps (#151-S)
- Movement to buccal
- Movement to lingual
- Stronger movement again to buccal
- Stronger movement again to lingual
- Extraction of tooth in path of least resistance
If a Tooth does NOT move with normal force, Forceps should be abandoned and proceed with…
More advanced surgical approaches
* A flap must be raised and obstructing bone removed
* Multirooted tooth, it must be divided and removed in sections
If you do not follow this advice, and explosive fracture of the alveolar bone is possible
