-
Clinical assessment of extraction
- access: opening, location
- mobility: perio disease, hypercementosis, ankylosis(primary molars)
- crown condition: caries, restoration
-
radiographic requirements
- exposure
- position
- processing
- recent
- visible during procedure
- relationship to vital structures
- root configuration
-
What effect does endo have on roots as it relates to extraction?
- brittle: internally weakened through shaping
- ankylosis
-
maxillary extraction positioning
- occlusal plane 60 degree angle with floor
- height: operator elbow
- pt head straight for anteriors
- toward operator for posterior
-
mandibular extraction position
- more upright when open occlusal plane parallel to floor
- use bite block
- 120 degree angle at operator elbow
-
elevator
- primarily lever (long lever arm, short effector arm)
- transmit modest force into small movement against greater resistance
- purchase point (crane pick)
-
wedge
- beaks of forceps
- straight elevator into PDL
-
wheel & axel
- triangular, pennant elevator
- multirooted tooth
-
forceps
- wedge beaks: expand bony socket
- remove tooth
- 1. apical pressure: bony expansion, displace center of rotation apically (decrease fracture risk)
- 2. buccal force: expand buccal plate, does cause lingual apical pressure
- 3. lingual force: expand linguocrestal bone
- 4. rotational pressure: usually for single conical rooted teeth
- 5. fractional forces: deliver tooth after adquately expanded.
-
which teeth are typically weaker lingually?
mandibular molars
-
extraction requirements for success
- 1. access and visualization
- 2. unimpeded removal pathway
- 3. contolled force
-
closed extraction steps
- 1. loosen soft tissue (woodson elevator, no 9 periosteal elevator)
- a. confirm anesthesia
- b. allow proper forcep positioning
- 2. luxation w/ dental elevator
- 3. adapt forceps to tooth
- 4. luxation with forceps
- a. apically seat
- b. buccal lingual slow deliberate force
- c. hold force for several seconds
- 5. removal from socket
-
when is a tooth removed
- after:
- 1. bone is expanded
- 2. PDL is disrupted
-
Maxillary forceps
- anterior & premolars: 150, 150A
- molars: 53R, 53L, 89, 90(aka upper cowhorn)
-
mandibular forceps
- anteriors & premolars:151, 151A, english ashe
- molars: 17, 23(squeeze into bifurcation), 222 (erupted 3rds)
-
primary forceps
150S, 151S
-
Should extraction socket be debrided or curretaged?
NO, unless periapical lesion and granuloma or debris
-
what complication does granulation tissue in socket pose?
excessive bleeding
-
post op care
- 1. remove granuloma cyst or debris
- 2. compress buccolingual plates
- 3. remove bony projections
|
|
