11 Extractions I

MAXILLA ONLY: 108, 109, 110

208, 209, 210

What are the three rooted teeth in dogs?

106, 107

206, 207

306, 307, 308, 309, 310

406, 407, 408, 409, 410

What are the two rooted teeth in dogs?

101, 102, 103, 104, 105

201, 202, 203, 204, 205

301, 302, 303, 304, 305, 311

401, 402, 403, 404, 405, 411

What are the single rooted teeth in dogs?

MAXILLA ONLY: 108

208

What are the three rooted teeth in cats?

107, 109

207, 209

307, 308, 309

407, 408, 409

What are the two rooted teeth in cats?

incisors, canines, 106 and 206

What are the single rooted teeth in cats?

Parotid: opens near maxilary 4th premolar

Zygomatic: opens near 1st and 2nd maxillary molars

What is the difference in the opening between the parotid and zygomatic ducts?

Simple extraction, close/nonsurgical extraction

This is an extraction not requiring a gingival incision or sectioning of the tooth

Surgical extraction, open/complicated extraction

This is an extraction that requires a gingival incision, bone removal, and or sectioning of the tooth

Elevation

This is the process by which the periodontal ligament is *fatigued or torn* and alveolar bone is expanded to facilitate removal of the tooth from the alveolus

Luxation

This is the process by which the periodontal ligament is *cut or severed* to loosen teeth from the surrounding alveolar bone

1. *Ethics* (disarming procedures like removing canine teeth on an aggressive dog)

2. *Severe systemic disease* (congestive heart failure, uremia, coagulopathies)

3. *previous radiation therapy* (leads to osteonecrosis bc the radiation has damaged pathways for healing)

What are some contraindications for extractions?

Endodontic therapy

Pulp necrosis, fractured adult teeth and traumatic malocclusion are all indications for extractions, but what other possibility is there?

1. adequate visualization

2. unimpeded pathway

3. CONTROLLED force

What are the 3 fundamental steps for successful extraction?

4-0 or 5-0 absorbable (often monocryl)

What type of suture should you use for dental extractions?

Elevators AKA levers

This instrument transmits a modest force into a small movement against great resistance, where the rotation in the periodontal ligament space utilized the surrounding alveolar bone as a fulcrum

Luxator AKA wedge

This instrument directs pressure apically once in the periodontal ligament space. They are made of softer metal and cannot be used as a lever

Elevator

What is this, applying apical pressure to rip or exhaust the periodontal ligament?

Luxator (wedge)

What is this, used to tear the periodontal ligament?

Twist and pull

When extracting with forceps, it is recommended to *twist and pull* or *rotate and twist back and forth*

Suction tip

What is A in the dental machine?

Air/water syringe

What is B in the dental machine?

High speed handpiece

What is C in the dental machine?

Low speed handpiece

What is D in the dental machine?

Optional second high speed handpiece

What is E in the dental machine?

Fiber optic light

What is F in the dental machine?

Suction bottle

What is G in the dental machine?

Exhaust air bottle/filter

What is H in the dental machine?

Pressure regulator

What is I in the dental machine?

Compressor tank

What is J in the dental machine?

Suction rheostat (foot pedal)

What is K in the dental machine?

Rheostat (foot pedal)

What is L in the dental machine?

They can only rotate in ONE DIRECTION (so if you get gauze or soft tissue stuck in it you need to get a new bur or you'll damage the turbine)

What do you need to know about the direction of the turbines in the high speed handpiece?

The smaller of the two larger holes (1) is where the oil goes to lubricate the turbines

What is the difference between oil and water holes?

701 cross cut taper fissure bur

What is this, used to remove hard tissue quickly?

Inverted cone bur

What is this, used to make an undercut?

Diamond bur

What is this, used for crown preparation procedures?

#4 round bur

What is this, used for penetrating bone or tooth material?

Cutting surface of a taper fissure bur

What is this, used for sectioning teeth?

Round burs of different size

What is this?

To show you the proper hand position for holding a luxator or elevator

What is this for?

Preserve blood supply and non-tension closure

What are some surgical principles of good flap design?

Design A is preferred (left). These incisions are oblique to allow a wide base flap since the flap needs to be 2x as wide as the defect you're trying to cover. Design B (right) will not work because it will not allow for adequate surgical exposure and cut off blood supply

Which flap design is preferred and why?

Image A: wedge/luxator cutting the periodontal lig.

Image B: elevator (wheel and axle style) to rip and tear

Which image shows the wedge/luxator? Which image shows elevator/lever?

Before AND after radiographs are REQUIRED for extraction patients

When should you do x-rays for extraction patients and why?

NSAIDs, gabapentin, locoregional block combo. Soft food for 5-7 days. No chew toys or treats for 7-10 days. Ice packs. Oral chlorhexidine twice daily after meals. No abx normally

What is the post-op care like for dental extractions?

Does NOT apply to canine teeth (will cause oronasal fistulae if you don't do flap)

Typically, closed/simple extractions WITHOUT flap creation are indicated for single rooted teeth. Which single rooted teeth does this principle NOT APPLY TO?

ALWAYS close the gingiva even if you didn't make a flap

Even when you do closed extraction technique, what do you ALWAYS do?

TRUE

TRUE OR FALSE: luxators are made of softer steel and are NOT intended for rotational forces

Maxillary PM4, Mandibular M1, Canine teeth

PLUS maxillary/mandibular premolars not affected by advance stage periodontal disease AND maxillary 3rd incisor not affected by advance stage periodontal disease (because the root is bigger than other incisors)

Which teeth, when requiring extraction, typically need it to be surgical/open?

Fracture, periodontal disease, non-vital tooth

Why would you do surgical extractions on 2 rooted teeth?

Fracture, periodontal disease, non-vital tooth

Why would you do surgical extraction in the maxillary canine teeth?

Maxillary canine extraction

What is this sequence of events indicating?

Diamond bur (coarse grit)

How can you remove alveolar bone across the root surface to expose the root and periodontal ligament in canine maxillary extractions?

Not recommended until you have perfected your feather touch

You can use a 701L for maxillary canine extractions and alveolar bone removal. But it is not recommended until you can do what?

Using LaGrange scissors

How can you perform periosteal release in surgical maxillary canine extractions? What tool do you use?

Mandibular canine

Which teeth, when surgically extracted, are the most likely to cause jaw fracture, and should NEVER be removed on the lingual aspect of the tooth because of this?

Fracture, periodontal disease, non-vital tooth

What are the surgical extraction indications for mandibular canines?

Do not penetrate into nasal cavity

What structure do you have to be careful of when doing surgical extraction of the maxillary canine?

05 on top and 05 and 06 on bottom

What teeth are cats missing compared to dogs?

Might have to cut across frenulum

What structure might you have to cut across to make a flap for felines in mandibular canines but should be AVOIDED in large breed dogs?