Dental E2 SG

What are common indications for dental extraction?

Severe periodontitis, pulp necrosis, tooth resorption, stomatitis, fractures, traumatic malocclusion, crowding, unerupted teeth, unhealthy teeth in fracture lines, or failed endodontics.

When is endodontic therapy an alternative to extraction?

Pulp necrosis, fractured adult teeth, and some traumatic malocclusions.

What systemic conditions may contraindicate extraction?

CHF, uremia, uncontrolled endocrine disease, severe coagulopathy, or untreated leukemia/lymphoma.

Why is previous radiation therapy a concern for dental extraction?

Increased risk of osteonecrosis and poor wound healing.

What is a simple/closed extraction?

Extraction without a gingival flap or bone removal; also called uncomplicated/nonsurgical.

What is a surgical/open extraction?

Extraction requiring gingival incision, bone removal, and/or tooth sectioning.

What is elevation?

Using a lever to fatigue/tear the PDL and expand alveolar bone to remove the tooth.

What is luxation?

Cutting/severing the periodontal ligament to loosen the tooth.

What is the difference between elevators and luxators?

Elevators act as levers and tear PDL; luxators act as wedges and cut PDL.

Why are pre-extraction dental radiographs REQUIRED?

To establish diagnosis, justify extraction, and plan surgery.

Why are post-extraction radiographs REQUIRED?

To verify extraction and document results, including retained fragments.

Advantages/disadvantages of lateral recumbency for dental surgery?

Better fluid drainage but only one side evaluated at a time.

Advantages/disadvantages of dorsal recumbency?

Better visualization and caudal maxillary access but greater risk of fluid pooling.

How is aspiration prevented during dental surgery?

Cuffed ET tube, pharyngeal pack, suction, positioning, and water control.

What oral rinse reduces bacteria before extraction?

0.05% chlorhexidine.

What should be removed before dental extraction?

Calculus.

What are the 3 fundamental steps of successful extraction?

Adequate visualization, unimpeded removal pathway, and controlled force.

Why should a mucogingival flap have a wide base?

To preserve blood supply and promote healing.

Where should flap edges lie to prevent dehiscence?

Over intact bone.

How is tension-free flap closure achieved?

Adequate flap size and periosteal releasing incision.

Where should vertical releasing incisions be placed?

At line angles of adjacent teeth.

Which teeth commonly undergo simple extraction?

Single-rooted or fused-root teeth; canine teeth generally require surgical extraction.

How should cat incisors be extracted?

Luxation may reduce damage to adjacent teeth.

Where are instruments placed for cat incisors and dog mandibular incisors?

Mesially and distally because teeth are flattened in that direction.

What is special about the maxillary third incisor in dogs?

Triangular cross-section; may require a flap and placement along mesial-palatal/distal-palatal surfaces.

What instruments are used for deciduous tooth extraction?

Narrow luxators or a Fahrenkrug curved elevator.

What must be avoided when extracting deciduous teeth?

Deep lingual penetration and rotational forces that may damage permanent teeth or fracture the root.

Should the gingiva be closed after a simple extraction?

Yes, close the remaining socket even without a flap.

What suture is used for typical extraction closure?

4-0 or 5-0 Monocryl in a simple interrupted pattern.

Which teeth commonly require surgical extraction?

Maxillary PM4, mandibular M1, canines, healthy-rooted premolars, and sometimes maxillary third incisors.

What are common indications for extracting a two-rooted tooth?

Fracture, periodontal disease, or nonvital tooth.

Which structures are at risk when extracting mandibular M1?

Mandibular canal and mandible itself (jaw fracture).

What flap is commonly used for maxillary canine extraction?

Three-cornered/L-shaped mucogingival flap.

What major complication must be avoided during maxillary canine extraction?

Penetration of nasal cavity.

How much canine root should be exposed before elevation in the notes?

Approximately one-third to one-half of root length.

Why shouldn't the maxillary canine root be tipped inward?

It can penetrate the nasal cavity.

What major complication is associated with mandibular canine extraction?

Iatrogenic mandibular fracture.

Where should bone NEVER be removed during mandibular canine extraction?

Lingual surface.

What flap is used for mandibular canine extraction?

Three-cornered or envelope flap.

What is the purpose of notching the alveolus at the CEJ?

Create room for an elevator or luxator.

Why smooth sharp alveolar bone before closure?

Prevent irritation/trauma and facilitate healing.

What instrument can perform a periosteal release?

Iris scissors or LaGrange scissors.

What is the purpose of a Miller bone curette?

Debride granulation tissue, bone fragments, and debris from alveolus.

What scalpel blades are listed for oral surgery?

#15 or #15C.

What are common round bur sizes listed?

½, 1, 2, 4, and 6.

What are examples of taper fissure crosscut burs?

699L, 701, 701L, and 702.

How should a high-speed handpiece be held?

Modified pen grasp with a finger resting on patient for control.

What happens if a bur gets stuck in gauze/soft tissue?

Remove and replace bur or risk turbine damage.

What drugs are used for multimodal extraction analgesia?

Local blocks, NSAIDs, gabapentin, and opioids as indicated.

How long should soft food be given after extraction?

5-7 days.

How long avoid chew toys/treats after extraction?

7-10 days.

When may brushing resume after extraction?

3-4 days if extraction site avoided; otherwise wait about 7 days.

When is the typical postoperative extraction recheck?

2 weeks.

Are antibiotics routinely necessary after dental extraction?

No, typically not.

What are the basic steps of surgical extraction?

Flap, remove alveolar bone, section multirooted tooth, elevate roots, periosteal release, suture closure.

What flap is used for maxillary fourth premolar (PM4) extraction?

Triangular three-cornered flap.

How wide should a flap base be relative to its defect?

About twice the size of area being covered.

What ducts must be protected during maxillary PM4 extraction?

Parotid and zygomatic salivary ducts.

How many roots does maxillary PM4 have?

Three: distal, mesiobuccal, and mesiopalatal.

What is the general PM4 extraction order in the notes?

Section/elevate distal root, then mesiobuccal root, then mesiopalatal root.

Why remove part of distal cusp during PM4 extraction?

Permit distal root elevation without pressure on maxillary first molar.

What adjacent tooth must be protected during PM4 extraction?

Maxillary first molar (109/209).

Why apply counterpressure during PM4 elevation?

Prevent slipping and trauma to the eye.

What is indicated for crown amputation in cats?

Type 2 tooth resorption with replacement-resorbed root and absent PDL.

What contraindicates feline crown amputation?

Type 1 resorption or endodontic disease.

What should generally be done with retained root fragments?

Attempt removal.

When may leaving a small root fragment be considered?

High-risk/unstable patient, fragment under 4 mm, or major danger to surrounding structures; follow-up required.

What is an exception for leaving roots during extraction?

End-stage root resorption.

What follow-up is required if a root tip is intentionally retained?

Repeat oral examination and dental radiographs.

What commonly causes fractured root tips?

Aggressive elevation, inadequate bone removal, ankylosis, hypercementosis, dilaceration, or incomplete sectioning.

How are fractured root tips prevented?

Patient elevation, adequate bone removal, and pre-extraction radiographs.

Why are retained fractured root tips concerning?

Pain and infection from pulp necrosis, especially with preexisting endodontic/periodontal disease.

What is the first step when retrieving a fractured root tip?

Take multiple dental radiographs to localize tip and nearby structures.

Where can fractured root tips become displaced?

Nasal cavity, maxillary recess, mandibular canal, or retrobulbar space.

What should NOT be done when removing a deep fractured root tip?

Blind apical elevation or pulverizing the root with a high-speed bur.

What is recommended for a root tip displaced into nasal passages?

Referral to a dental specialist.

What causes fractured alveolar bone during extraction?

Excessive elevation force or forceps use without adequate elevation.

How is fractured alveolar bone managed?

Remove loose fragments and smooth sharp edges.

Which extractions have high risk of iatrogenic mandibular fracture?

Mandibular canine (dogs/cats) and mandibular first molar in small dogs.

Why is mandibular M1 especially risky in small dogs?

The tooth is disproportionately large relative to the mandible.

How is extraction-related hemorrhage managed?

Direct pressure, possible Gelfoam/Vetspon, and flap closure.

Which dental roots lie close to the orbit in dogs?

Maxillary PM4 and first/second molars.

How can orbital injury be prevented during extraction?

Know regional anatomy, use short finger stops, and elevate gently with control.

What is the most common mechanical cause of flap dehiscence?

Closure under tension.

Other causes of flap dehiscence?

Poor flap design, sutures unsupported by bone, occlusal trauma, or postoperative chewing/pawing.

How can flap dehiscence be treated?

Surgical repair, delayed repair, or second-intention healing with monitoring.

Why consider referral for flap dehiscence?

The first repair attempt offers the best chance for successful healing.

What is lip entrapment after extraction?

Remaining mandibular canine contacts/ulcerates the upper lip following maxillary canine removal.

Which species commonly develops post-extraction lip entrapment?

Cats.

How may persistent lip entrapment be treated?

Mandibular canine crown reduction/endodontics or extraction.

What is an oronasal fistula?

Abnormal communication between oral and nasal cavities, often associated with maxillary canine disease/extraction.

How is an oronasal fistula typically repaired?

Tension-free single-layer mucoperiosteal flap with sutures supported over bone.

Should bone graft material be placed into an oronasal fistula?

No, not according to the notes.

What is the most important feature of fistula repair?

Proper flap design, periosteal release, and tension-free closure.

What type of bone forms first during fracture healing?

Woven bone.

What is lamellar bone?

Mature, remodeled bone with organized collagen.

What does Wolff's law state?

Bone adapts to the mechanical loads placed on it.

What are GP/ER responsibilities for maxillofacial fractures?

Triage, stabilize, provide nutritional support, refer once stable, and manage follow-up.

What feeding tube is usually adequate for jaw fracture support?

Esophagostomy feeding tube.

Why is an NG tube inadequate for long-term jaw fracture nutrition?

It does not provide suitable long-term support in these notes.