4 - Extraction of permanent teeth in normoposition (incomplete, see ppt for technique and materials)

What is Syndesmotomy?

Disinsertion of circular ligament of periodontium and detatchment of marginal gingiva

How is luxation performed?

With elevators: M-D and Bc-Lg/Pt

How is Prehension performed?

With special forceps adapted to neck of the tooth

• Apical as possible

• On healthy tooth

• Active part parallel to long axis of tooth

How is traction performed?

Smooth, firm movements with increasing amplitude

• Bc-Pt/lg

• Rotation

What is avulsion?

Extraction of tooth from the socket

What is the correct positioning for upper Maxilla extraction?

• Patient 45º, head hyperextended

• Dentist in front of patients head

• Left hand seperates cheek and protects structures

What anaesthesia is used for maxillary extraction?

• Buccal periapical infiltrative

• Upper posterior ANB (pm and m), and upper middle/anterior (I and C)

• Nasopalatine (I and C) or anterior palatine (M and PM)

What are characteristics of Maxillary extractions?

• Simpler than mandibular

• Spongy (diploic) bone

• No articulation

• Good visibility and better access - Less saliva/blood + no tongue

What is instruments arae used for upper incisor extraction?

Straight elevator/luxator

Upper incisive forceps

Extraction technique for upper incisors?

Syndesmotomy

Prehension - narrow valve forceps

Luxation - Bc-Pt + rotation (in Li, less amplitude in Bc than Pt)

Rotation

Traction - downwards and forwards

CI close to nostrils and nasopalatine foramina

Upper canine extraction material + techique?

Straight elevator + incisor/premolar or wide forceps

Syndesmotomy

Luxation - careful bucally, wider towards Pt

Rotational - short movemenets

Traction - downwards and forwards

First upper premolar extraction material + technique?

Straight elevator + upper PM forceps

Syndesmotomy

Luxation - bc + pt

Prehension - apically

Traction - downwards and forwards

Danger of fracture

Anatomy to be aware of for extraction of upper Central incisors?

Close to Nostril and nasopalatine foramina

Apex towards distal

Powerful root, elliptical section

Anatomy to be aware of for extraction of upper lateral incisors?

Apex has Distopalatal curve

Tooth axis angled towards palate (thick buccal cortical)

Fine root, narrower MD oval section

Anatomy to be aware of for extraction of Upper canine?

Relation with nostrils and maxillary sinus

Apex curved distobucally

Thin buccal cortical, thick internal

Long powerful root, flattened MD

Anatomy to be aware of for extraction of first upper premolars?

Close to maxillary sinus

2 roots (thin and fragile)

Anatomy to be aware of for extraction of upper second premolar?

Very close to maxillary sinus

Siingle conical, oval root, flattened MD

Anatomy to be aware of for extraction of first upper molar?

Direct relationship with maxillary sinus

3 divergent roots towards apical - Pt, MBc, DBc (in thickness order)

Traction buccally, down and out (all U+L Molars)

Anatomy to be aware of for extraction of Second upper molar?

Close to maxillary sinus

Palatine root close to posterior palatine foramina

3 roots

Anatomy to be aware of for extraction of upper third molar?

Distally close to maxillary tuberosity (fragile, careful when extracting)

Close to maxillary sinus and posterior palatine foramina

No upward movements because of sinus

What is the extraction technique for inaccessible upper 3rd molars?

1st luxation with elevator

2nd luxation and traction with forceps

Anaesthesia for mandibular extraction?

Periapical infiltrative for incisors and canines

Inferior alveolar nerve block for PM and M, buccal and lingual

Anatomy to be aware of for extraction of lower incisors?

Conical root, flattened md, apex distally curved

Thick buccal cortex, lingual thinner (though increased in laterals)

avoid rotation

Anatomy to be aware of for extraction of lower canines?

Powerful root

Dense bone apically and lingually, thin bucally

Anatomy to be aware of for extraction of lower premolars?

Close to mental foramina

Straight, strong conical root, flat md

Narrow neck is weak spot

Anatomy to be aware of for extraction of Lower first molar?

Mesial root large, tapered and flat

Distal root longer

Cow horn/parrot peak (2 points)

How to extract a lower second molar with separated vs fused roots?

Separated - lateral traction

Fused - Luxate to distal with elevator or physick