Unit 5- removal of permanent teeth in normoposition

What is syndesmotomy?

Initial cut of periodontium circular fibres- separates gingival margin tissues

Why is it easier to extract in maxilla than mandible 

Has spongy bone

No articulation 

Less saliva/blood and no tongue- better visibility and access

How does the root anatomy, anatomical relationships of upper central incisor effect exodontia? What materials should be used?

Powerful root, elliptical cross section, apex towards distal

Close to nasal floor and nasopalatine foramen- risk of perforation

Straight elevator, upper incisor forceps

How does the root anatomy, anatomical relationships of lower incisors effect exodontia? What materials should be used?

Conical root, flat MD

Buccal cortical plate- thick solid, lingual- thinner, but increased resistance in lingual cortical

Lower incisor forceps, 90 degrees and narrow valves, elevators 

Avoid rotation 

What is the exodontia technique for upper lateral incisors?(5)

Syndesmotomy- with straight elevator

Prehension with narrow valves forceps

Luxation with movements Bc (low amplitude) –Pt (greater amplitude)

Rotation carefully due to root curvatures

Traction downwards and forward

Why is extracting the upper canine difficult?

Very long root

Buccal cortical plate- thin vs thick palatally 

Syndesmotomy and luxation with straight elevator

Careful luxation towards Bc and wider towards Pt

Short rotational movements

Traction downwards and forward

What’s the difference in extracting as a 1st upper premolar?

Syndesmotomy and location with straight elevator 

Luxation

Never rotational movements

Traction 

Two thin fragile roots, very close to maxillary sinus, danger of root fracture 

What’s the difference between extracting upper 1st vs 2nd premolar?

Only 1 root

Can have some rotational movements 

What anatomical features should you consider when extracting a first upper molar?

3 divergent roots towards apical-

Pt- powerful, long and thick cone towards pt

MB- fine root, short and flattened MD

DB- thinner and flattened upwards

Direct relationship with the maxillary sinus (NO ROTATION)

What is the technique to extract an upper 1st molar?

Syndesmotomy and luxate (bc-pt) with straight elevator 

Grip- Palatal side- grip with a ribbed, straight valve

Buccal side- forceps beak positioned into the interradicular furcation

Circumduction- rotate

Traction 

Odontosection if roots too divergent or fractured 

How does the root anatomy and anatomical features effect extraction of 2nd upper molar?

3 roots- can be divergent or fused or separated or convergent 

Outer buccal cortical plate thicker due to zygomatic process 

Close to maxillary sinus, palatine root close to posterior palatine foramen 

X ray to see relationship with 3rd molar 

How does the root anatomy and anatomical features effect extraction of 3rd upper molar and its technique?

Number of roots vary, fused

Distal- maxillary tuberosity- fragile, can fracture

1st luxation with elevator- rotational, force down and backwards 

2nd luxation + traction with forceps- not fully open mouth 

How does the root anatomy and anatomical features effect extraction of lower canine?

Same as upper

How does the root anatomy and anatomical features effect extraction of lower premolars?

Single strong conical root, weak narrow neck, compact corticals

Careful of mental foramen

Same forceps as lower canines (110 degrees and large valves)

How does the root anatomy and anatomical features effect extraction of 1st lower molar?

2 roots=no rotation 

Mesial- large, tapered, flat md

Distal- longer, straight-ish

Compact cortical and strong interradicular septum

Luxate, prehension, laterality, traction towards bc

How does the root anatomy and anatomical features effect extraction of 2nd lower molar, how so you extract if fused bs separated?

2 smaller straight conical 

Compact thick cortical

If fused roots- luxate distal with elevator or physick 

Separated- lateral traction 

How does the root anatomy and anatomical features effect extraction of 3rd lower molar?

Thick buccal cortical

Do x ray

Technique same as 1st and 2nd molar

When is extraction of temporary teeth is indicated and what should you be cautious of?

Destructive caries or delay in replacement

X ray to assess relationship with definitive germs 

Permanent pm germ between temp molar roots