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58 Cards in this Set
- Front
- Back
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1. What are some indications for removal of teeth?
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1. Caries
2. Pulpal necrosis 3. Orthodontic reasons 4. Malposed teeth 5. Cracked teeth 6. Impacted teeth 7. Supernumerary teeth |
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2. What are some indications for removal of teeth?
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8. Teeth associated with pathologic lesions
9. Radiation therapy 10. Teeth involved in jaw fractures 11. Financial issues |
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3. What is the most common (and accepted) reason to extract a tooth?
What is an orthodontic reason for extracting a tooth? What tooth is most commonly extracted for orthodontic purposes? If a patient has pulpal necrosis why may endodontic treatment not be reasible? |
Severely decayed and non-restorable
tooth Malocclusion with crowding or malposed teeth First pre-molar Tooth is non-restorable or $ issues |
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4. What can an undetectable vertical fracture through the crown and root of a tooth cause?
What can happen to a tooth treated w/ root canal therapy? |
Pain in a tooth that appears to be otherwise unremarkable
Become brittle and frequently fractures into the bifurcation |
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5. Why may an impacted tooth not be unable to erupt into the mouth?
Five reasons |
1. Infection
2. Pathology -caries, periodontal pockets 3. Orthodontic reasons 4. Prevent periodontal pockets 5. Prevent decay in distal surface of adjacent teeth |
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6. What teeth should be removed prior to receiving radiation?
What is osteoradionecrosis? Why would teeth involved with jaw fractures need to be removed? |
Teeth that are in poor health and that are in the line of radiation therapy
Avascular necrosis of bone Teeth are also fractures or get in way of proper reduction for the fracture |
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7. What are some systemic contraindications for the removal of teeth?
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1. Uncontrolled metabolic disease
-Brittle Diabetes -End stage renal disease 2. Blood disorders -leukemia -lymphoma 3. Severe uncontrolled cardiac diseases 4. Severe bleeding diathesis |
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8. What are some cardiac disease that are contraindications for removal of teeth?
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1. MI
2. Unstable angina pectoris 3. Uncontrolled hypertension 4. Uncontrolled dysrhythmias |
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9. What are two severe bleeding diathesis that are contraindications for removal of teeth?
What are some drugs that are contraindications for removal of teeth? (four drugs) |
1. Hemophilia
2. Platelet disorders **need administration of coagulation factors or transfusion 1. Corticosteriods 2. Immunosupressive agents 3. Bisphosphonates 4. Cancer chemo agents |
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10. What are some local contraindications for the removal of teeth?
Four reasons |
1. Teeth in the line of radiation
-hyperbaric oxygen therapy 2. Teeth located w/in an area of tumor 3. Severe pericoronitis 4. Acute dentoalveolar abscess where there is limited access |
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11. What happen with hyperbaric oxygen therapy if a tooth is removed?
Why should a tooth not be removed if located in an area of tumor? |
Get "dives" before and after extraction
Extraction could disseminate malignant cells and thereby seed metastases |
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12. What is the clinical evaluation for removal of a tooth?
Four things... |
1. Access to the tooth
2. Mobility of the tooth 3. Condition of the crown 4. Thickness of surrounding bone |
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13. What things are assessed when determining access to a tooth for removal?
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1. Can patient open or is there trismus
2. Infection, muscle spasm, TMJ disorder **may have to do surgical approach instead of elevator forceps 3. Location and position in dental arch **crowed or malposed teeth may require surgical approach |
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14. When assessing the mobility of a tooth for removal what is considered?
(two things) What does ankylosed mean? When evaluating the condition of the crown what is the crown assessed for? (three things) |
1. Periodontal disease
2. Ankylosed Below occlusal plane and locked in 1. Extensive decay 2. Large restorations 3. Endodontic treatment |
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15. Why is the thickness of the bone evaluated?
What must the radiography of any tooth to be removed show? |
Normal thickness means non-complicated extraction
Bony exostosis means surgical procedure Proper contrast and density that shows... -entire tooth w/ root tips -adjacent structures (maxillary sinus, inferior alveolar nerve, mental nerve) |
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16. How does the density of the bone affect the extraction procedure?
What aspects of the roots contribute to whether the procedure will be non-complicated or surgical? |
1. Less dense -> easier procedure
-radiolucent 2. Denser bone -> difficult procedure -radiopaque Size Shape Normal or abnormal # roots Curvature Divergence Associated pathology |
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17. What are the three basic necessities for surgery?
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1. Visibility
2. Access 3. Good assistance |
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18. What does visibility depend upon?
(three things) What does access depend upon? (three things) |
1. Adequate access
2. Adequate light 3. Surgical field free of blood 1. Patients ability to open mouth 2. Adequate retraction 3. On occasion creation of surgical flap |
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19. What are the characteristics of a good assistant?
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1. Know the type of surgery to be done
2. Can anticipate needed instruments 3. Can keep surgical field clear of blood w/o interfering w/ surgeon |
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20. What anesthesia is used at school?
What do surgical procedures require? |
Local anesthesia alone or local anesthesia w/ nitrous oxide and oxygen inhalation analgesia
Block techniques are recommend b/c need greater surgical and anesthetic field |
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21. What are characteristics of the best chair positioning for extraction?
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1. Comfortable for patient & operator
2. Surgeon has max control of the forces of the elevators & forceps 3. Operator has stability & support 4. Arms can be close to body 5. Wrists can be kept straight **so force is delivered w/ arm and shoulder and not hand |
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22. How should the chair height be?
How is the chair back for lower extractions? Why? How are the beaks of the forceps placed on the teeth? |
Such that the operators forceps arm is in a slightly downward direction
Lower extractions - upward So occlusal plane is parallel to the floor and roots are perpendicular to the floor So the beaks are parallel to the long axis of the roots |
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23. Where is the operator most frequently standing during a lower extraction?
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To his/her dominant hand side of the patient and slightly in front of the patient
**exception is with English forceps, should be slightly behind patients shoulder |
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24. How is the chair positioned for a maxillary extraction?
How is the patient's head? As a result how is the occlusal plane and roots of maxillary teeth? How are the beaks of the forceps placed on the tooth? |
Tilted backward
Head is tilted back and chin up from the chest Occlusal plane is perpendicular to floor and roots are almost parallel to floor Parallel to the long axis of the tooth **patient's head can be turned towards operator to allow access and visibility |
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25. What mechanical principles and machines are used to remove teeth from the alveolar process?
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1. Lever
2. Wedge 3. Wheel and axel |
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26. What is the lever principle?
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A first class elevator transforms a small force and large movement applied to long arm to a great force and small movement to the short arm
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27. How is the lever principle applied to the removal of a tooth?
Three steps |
1. Purchase point is drilled into tooth
2. Crane pick elevator is placed into purchase point 3. Bone is used as fulcrum creating a first class lever |
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28. How is a wedge used?
How can a small straight elevator be used as a wedge? What does placement of the index finger on the adjacent tooth do? |
Wedge can be used to expand, split, and displace portions of substance that receives it
Expand the bone adjacent to a tooth root and displace it from its socket Helps control the apical forces and displacement of the elevator |
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29. How does the beaks of forceps act as a wedge?
What is used in the role of a wheel and axle machine? What are the primary instruments used to remove teeth from the alveolar process? |
When placed on a tooth in the correct position, acts as a wedge and expands bone and displaces the tooth
Triangular elevators Elevator and extraction forceps |
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30. What does the concave portion of the blade on an elevator face?
How is an elevator frequently used as? |
Faces the tooth to be removed
Used as a wedge to create space between the bone and the tooth **also used to luxate (displace/move/loosen) a tooth |
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31. When using an elevator how is wedged between the bone and the tooth?
How is the elevator moved? |
At a 45 degree angle
Rotated so the top edge of the elevator rotates into the tooth to be removed It is also moved apical to help elevated the tooth toward the occlusal |
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32. What is the goal of using forceps?
What five major motions can forceps apply to luxate the teeth and expand the bony socket? |
Expansion of the bony socket (wedge), movement of and removal of the tooth
1. Apical pressure 2. Buccal pressure 3. Lingual or palatal pressure 4. Rotational pressure 5. Tractional force |
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33. What does apical pressure cause?
What does apical pressure reduce? How should the beaks of the forceps be positioned? |
Expansion of bone and moves the center of rotation more apically
Reduces the chance of root fracture Positioned and repositioned apically on the tooth |
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34. What does buccal pressure result in?
What does too much force in a buccal direction also cause? What does this result in? |
Results in expansion of the buccal plate at the alveolar crest
Causes lingual pressure at the apex Result in root fracture |
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35. What does lingual or palatal pressure cause?
What is rotational pressure most appropriate for? |
Expansion of the lingual or palatal crestal bone
**need to avoid to much pressure on the buccal bone Single rooted conical shaped teeth **maxillary incisors and mandibular pre-molars |
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36. What is a tractional force?
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A small gentle force used for final removal
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37. When should a surgical flap technique be considered for extraction?
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1. Bone is very thick
2. Roots are badly hooked 3. Decay goes to apically 4. No access to tooth 5. Excessive force may have to be applied |
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38. What are the steps for closed extraction?
Five steps... |
1. Loosening of soft tissue attachment
2. Luxation of tooth w/ dental elevator 3. Adaption of forceps to the tooth 4. Luxation of tooth 5. Removal of tooth from sockety |
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39. What is the soft tissue attachment loosened from?
What is instrument is used? What does reflection of the soft tissue allow for? |
Loosening from cervical portion
#9 molt periosteal elevator Allows for better placement of elevator and then the forceps (more apical placement) **also give info about how anesthesized patient is |
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40. How is luxation of the tooth w/ a dental elevator performed?
When is there minimal movement? |
MB line angle then DB line angle
**switch from small to larger elevator and then repeat If have teeth on both sides of the one being taken out |
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41. How are the forceps placed when adapting them to the tooth?
Which beak of the forcep is placed first? |
Subgingivaly to grasp root of tooth as apical as possible
Lingual or palatal |
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42. What are the steps in luxation of the tooth?
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1. Apical pressure is exerted to start expanding the surrounding bone
**forceps act as wedge 2. Repeated buccal and lingual pressure -slow, strong, steady pressure to expand the bone 3. Reseat the forceps more apical repositioning center of rotation more apical *reduce chance of root fracture |
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43. What force is used to remove the tooth from the socket?
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Slight tractional force to the occlusal and buccal
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44. What is the role of the non-forceps hand in the maxilla?
What is the role of the non-forceps hand in the mandible? |
Stabilize the maxilla and thus the patients head from moving when fores are applied via the forces
Stabilize the mandible and protect the TMJ from excessive movement and injury |
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45. For maxillary left posterior and anterior teeth where is the index finger and thumb of the non-forceps hand?
Why? |
To the buccal of the teeth retracting the lip and the thumb is on the palate
Aids in stabilization of head and give operator tactile ability of recognizing expansion of bone or movement of roots |
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46. What is used for removal of maxillary incisors?
What pressures are applied? How is the final rotation and why? |
150 universal or #1 anterior straight forceps
Apical, labial, palatal then mostly rotational To the distal **b/c incisor usually has a slight distal flare to apex of root |
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47. What is used to remove maxillary cuspid (canine)?
Why is it difficult to extract? How is the labial plate of alveolar bone? What is the extraction technique? |
Universal #150 or #1 forceps
Longest tooth in mouth Very thin so common than bone is removed w/ tooth Apical, labial, palatal, rotation and traction forces |
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48. How are the roots of maxillary first premolars?
What is used to remove maxillary premolars? What should be done to loosen roots? What forces are used? Which root is better to break if a root is broke? |
Two fine roots (buccal and palatal)
**division of roots may occur about 1/2 way down 150 or 150A forceps Luxate as much as possible w/ straight elevator Apical, buccal, palatal, traction forces **buccal force should be greater than palatal **no rotational force Break off buccal root b/c easier to retrieve |
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49. How is the root of the maxillary 2nd premolar?
How should the tooth be removed? How are the roots of the maxillary molars? |
Usually a single broad flat root
Remove to buccal and occlusal direction Two buccal roots and one palatal **roots may be divergent or fused |
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50. Why is the maxillary 1st molar a difficult tooth to remove?
What forceps can be used for maxillary molars? How is are maxillary molars removed? |
Due to thick bone & thick divergent roots
150 53R or L 210S (3rd molars) Apical, strong buccal, minimal palatal, delivery to bucco-occlusal |
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51. How are the beaks of the forceps placed for mandibular teeth extraction?
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1. Place lingual beak first then buccal beak
2. Beak is placed as far apical as possible 3. Beak is placed parallel to the long axis of the tooth |
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52. What forceps are used for mandibular anterior teeth?
What forces are applied? How is the tooth delivered? |
151 or anterior Ash forceps
Apical, labial, lingual, mesial distal rotation **attempt to preserve labial plate of bone Delivery to labial-incisal direction |
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53. Why are mandibular premolars considered to be among the easiest teeth to remove?
(two reasons) What forceps are used? What forces are used? How is delivery? |
1. Roots usually are conical & straight 2. Alveolar bone is thin on buccal
151 universal lower or anterior Ash forceps Apical, buccal, lingual, rotation **rotation is used more on these teeth than any other Delivery is occlusobuccal |
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54. Why is the mandibular molar considered difficult to extract?
What forceps can be used? How is the lingual plate in the lower 2nd molar? |
1. Thickness of bone buccal to 1st molar
2. Strong thick & often divergent roots 151 universal, #17, lower molar ash (English pattern) Lingual plate is thinner than buccal bone |
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55. What pressures applied in removal of mandibular molars?
How is the delivery? |
1. Strong apical pressure
2. Strong buccal pressure 3. Strong repeated buccolingual movement Delivery in bucco-occlusal direction |
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56. When is a cowhorn used on mandibular molars?
How is this done? How is the tooth delivered? |
If 1st or 2nd molars have bifurcated roots
**cowhorn is like double wedge 1. Place beak on lingual, then buccal 2. Squeeze gently 3. Pump vertical up & down to move beak into bifurcation Deliver tooth to bucco-occlusal |
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57. How are the roots in primary teeth?
What forceps can be used? How is pressure applied? |
Long and delicate
150S for maxillary, 151S for mandible Apical Buccal Lingual **slow, steady pressure **remove in path of least resistance |
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58. What should be used to debride the socket?
What should be done if granulation tissue is present on the inner surface of the gingiva? What should be done if there is sharp bone in the socket? |
Bone curette
Trime w/ curette, scissors, or hemostat Remove w/ ronguer and smooth w/ bone file |
