Lecture 10- Extractions 1

Simple extraction definition

Extraction without gingival incision or sectioning; closed/uncomplicated/nonsurgical extraction

Surgical extraction definition

Extraction requiring gingival incision, bone removal, and/or sectioning; open/complicated extraction

Elevation definition

Fatigue/tear PDL + expand alveolar bone using elevator as lever to lift tooth from alveolus

Luxation definition

Cut/sever PDL fibers using luxator wedged apically in PDL space; loosens tooth from alveolar bone

Dog teeth with 3 roots

108, 109, 110, 208, 209, 210

Dog teeth with 2 roots

106, 107, 206, 207, 306–310, 406–410

Dog teeth with 1 root

101–105, 201–205, 305, 311, 405, 411

Cat teeth with 3 roots

108, 208

Cat teeth with 2 roots

107, 109, 207, 209, 307–309, 407–409

Cat teeth with 1 root

Incisors, canines, 106, 206; MxPM2/MxM1 may have 1–2 fused roots

Mandibular canal location

Ventral 1/3 of mandible; contains inferior alveolar neurovascular bundle

Indications for extraction

Severe periodontitis; pulp necrosis; tooth resorption; stomatitis; fractured teeth; traumatic malocclusion; crowding; unerupted teeth; unhealthy teeth in fracture line; failed endodontics

Contraindications for extraction

Ethics (disarming); severe systemic dz (CHF, uremia, uncontrolled endocrine dz, coagulopathies, leukemia/lymphoma); prior radiation → osteonecrosis/poor healing

Three fundamental steps for extraction

Adequate visualization; unimpeded pathway; controlled force for luxation/elevation

Basic extraction pack instruments

Minnesota lip retractor; feline lip retractor; Miller bone curette; periosteal elevator; straight/winged elevators; small breed extraction forceps; needle holders; iris scissors; thumb forceps; scalpel handle

High‑speed handpiece bur types

Round burs (½–6); taper fissure crosscut (699L, 701, 701L, 702); diamond burs (extra coarse → extra fine)

Elevator vs luxator blade difference

Elevator semicircular blade → lever to fatigue/tear PDL; luxator flat blade → cuts PDL fibers

Air‑driven dental unit components

Suction tip; air‑water syringe; high‑speed handpiece; low‑speed handpiece; fiber‑optic light; suction bottle; exhaust air bottle; pressure regulator; compressor tank; suction rheostat; rheostat

Turbine rotation rule

Turbine rotates in only one direction; bur stuck in gauze/tissue requires removal + new bur to avoid turbine damage

Bur hole configuration

4‑hole = standard air/exhaust + chip air/water; 5‑hole = adds fiber optics; 6‑hole = adds electric current for light; oil goes in smaller hole

Round bur uses

Penetrating bone/tooth; sizes correlate with head diameter (#2, #4, #8)

Taper fissure bur uses

Sectioning teeth; cutting surface located on side of bur

Diamond bur uses

Smoothing bone; crown prep; coarse grit recommended for beginners

Flap design principles

Sufficient size; wide base for blood supply; flap edges must lie over intact bone; vertical releasing incisions at line angles for non‑tension closure

Incorrect flap incision risks

Incision over bone removal → empty space → dehiscence; incision across attached gingiva → gingival defect

Elevators biomechanical principle

Lever; rotation in PDL space uses alveolar bone as fulcrum; tears PDL

Luxators biomechanical principle

Wedge; apical pressure; cuts PDL; cannot be used as lever

Wheel‑and‑axle principle

Elevator handle = axle; blade = wheel; rotation between roots or root/alveolus loosens tooth

Proper hand position

Tennis‑ball grip; instrument secured in palm; index finger as stop to prevent deep penetration

Extraction forceps mechanics

Leverage: twist once then pull down/out in continuous movement; rotation/flailing not recommended

Suturing oral mucosa principles

Needle enters at 90°; rotate needle holder to pass through tissue; acute angle entry → tissue tearing

Pre‑extraction requirements

CBC/Chem/UA; intraoral radiographs REQUIRED for diagnosis + planning; remove calculus; PPE; water control (pharyngeal pack, cuffed ET tube, suction)

Patient positioning

Lateral → drainage, one side at a time; dorsal → visualize all teeth, better for caudal maxillary extractions, risk fluid pooling

Post‑operative care

Multimodal analgesia; nerve blocks; NSAIDs; gabapentin; soft food 5–7 days; avoid chew toys 7–10 days; brushing after 3–4 days (avoid site); chlorhexidine rinses; ice packs; recheck at 2 weeks; antibiotics usually NOT needed

Closed extraction definition

Extraction without flap; applies to single‑rooted/fused roots; NOT canine teeth; ALWAYS close gingiva with 4‑0/5‑0 Monocryl

Closed extraction tips: incisors

Cat incisors + dog mandibular incisors: place instruments mesial/distal; cat incisors best removed via luxation to avoid adjacent teeth

Closed extraction tips: dog maxillary incisors

1st/2nd incisors: elevator acceptable; 3rd incisor triangular → may require flap; best luxator placement mesial‑palatal/distal‑palatal

Deciduous extraction tips

Use narrow luxators/Fahrenkrug elevator; avoid deep lingual penetration; avoid rotation to prevent fracture of permanent tooth

Open extraction definition

Extraction requiring flap, bone removal, sectioning; applies to any tooth; commonly PM4, M1, canines, premolars without advanced periodontal dz, maxillary 3rd incisor

Open extraction steps (2‑rooted teeth)

Create mucoperiosteal flap; elevate gingiva/mucosa; remove coronal ½ alveolar bone; section roots with 701/701L; elevate each root; smooth bone; periosteal release; close with Monocryl

Open extraction: maxillary canine risks

Avoid nasal cavity penetration → iatrogenic oronasal fistula

Maxillary canine flap design

3‑cornered L‑shaped flap; vertical mesial incision; horizontal labial incision above PM1; elevate flap with periosteal elevator

Maxillary canine bone removal

Use coarse diamond bur or round bur; feather‑touch technique; expose ⅓–½ root length

Maxillary canine elevation

Avoid tipping root inward; elevate once loose; remove with forceps

Maxillary canine closure

Smooth bone; periosteal release; elevate 1–2 mm palatal tissue; close 4‑0 Monocryl caudal→rostral

Mandibular canine extraction risks

NEVER remove lingual bone → jaw fracture; avoid mental foramen neurovascular bundle

Mandibular canine flap

3‑cornered or envelope; vertical incision mesial to canine; horizontal across frenulum

Mandibular canine bone removal

Remove coronal ½ alveolar bone; coarse diamond bur recommended for beginners

Mandibular canine elevation risks

Forceful elevation mesiolingual → mandibular fracture; mesial‑palatal → ONF in maxillary canine

Mandibular canine closure

Smooth bone; periosteal release; close with 4‑0 Monocryl dogs, 5‑0 cats