Extraction Technique

Question 1

What type of ET tube should we use for extractions?

Answer 1

•want to have an inflated cuff and be careful in cats and small dogs. Low pressure and high volume cuff!!!!! Soft type is better so when you move the head it will bend but not occlude

Question 2

What could we use in extraction to prevent debris down the trachea?

Answer 2

Sponge pack

Question 3

What analgesia will we give?

Answer 3

Pre med

LA

Question 4

How will we give LA?

Answer 4

Going around the foramen not in it

Question 5

Do we use antibiotics in the healthy patient?

Answer 5

NO! Not unless there is justification for it

Question 6

What is equivalent to surgical clipping and scrubbing?

Answer 6

Scale and polish

Question 7

Why do we need to flush the mouth?

Answer 7

As paste can inhibit healing

Question 8

What can we use to disinfect the mouth?

Answer 8

•Chlorhexidine gluconate as it is antimicrobial and can be used as a mouth rinse

Question 9

What are these 4 images?

Answer 9

• Top left – elevators and luxators (main hand instrument for closed extractors)
• Bottom left – periosteal elevators. (main use is surgical extraction where we make soft tissue flaps through to the bone, and then from the bone to the roots)
• Top right- Need good visualisation and keep soft tissue out the way – don’t want to damage with drills or instruments
• Bottom right – burrs; different patterns for the cutting of different teeth

Question 10

What is a luxator? What do we use it for? What shouldnt we do with it?

Answer 10

•modified scalpel blade, - want to cut the periodontal ligament fibres suspending the teeth! What we don’t want to do is rotate.

Question 11

How does an elevator work?

Answer 11

•Advance down the tooth and it will tend to move away. Fibres on that side – broken down. On the far side the fibres are crushed. If the fibres are stretched (10-20seconds) they will fatigue! Hold it there do not wiggle about loads (which is what people do.

Question 12

what is the difference between simple and surgical extraction?

Answer 12

Simple has no tissue flap

Question 13

What happens if there is a complication with simple extraction?

Answer 13

Can move to surgical

Question 14

Where is surgical extraction used alot?

Answer 14

Multi rooted teeth and canines

Question 15

Why do we take radiographs?

Answer 15

• have a look at anatomy and have a direct idead of whats happening
• Know whether we have complication

Question 16

What is going on in these two images?

Answer 16

• Yellow arrow – huge root which is bigger than crown
• Right – danger of taking out deciduous teeth and little bone (with developing adult teeth) – easy to damage them and we wouldn’t know they were there unless we radiograph.

Question 17

What is going on in these four images?

Answer 17

• Top left – super numeri roots
• Bottom left - Globular end to the root – common in cats
• Top right - Cats most frequently suffer resorptive lesions. This makes extraction very difficult and may not get normal root removed
• Bottom right – resorptive lesion – prone to a fracture

Question 18

What is the first stage in a simple extraction?

Answer 18

• First stage is to take scalpel blade into the sulcus (between tooth and gum) – need to cut attachment.
• Use 15 or 11
• This gives up space for out luxator or elevator and reduces the chances of slippage

Question 19

What is going on in these 2 images of closed extraction step 2?

Answer 19

• Some people vertical cut – dotted arrows
• Simpler to take out a diagram – left picture. Leave two pyramids sat on top
• Solid arrows – direction you may now move the luxator or elevator
• Vertical cut – will drive you into the bone rather than lig
• Diamond – direct the instrument parallel to the line of ligament space. Less likely to spur fingers on crown too.
• Right – maxillary molar, as well as the diamond it also shows how you may wish to take off the enamel bulges. Gives a straight line access.

Question 20

How would we section a tooth?

Answer 20

•Identify furcation and We will need to use a high speed drill with burr to section

Question 21

What can be seen with the black and tranparent instrument?

Answer 21

• 1st – transparent instrument, then put a mall twist which will give squeeze away
• Black – if you section you can squeeze away by advancing a small instrument and rotate (pinched in place) 10-120 seconds. Then get more loosening and then repeat with increased gauges of instrument.

Question 22

If we need to flush alveolus what shouldwe use?

Answer 22

Hartmanns or saline

Question 23

What must we have left behind after tooth removal and why?

Answer 23

Nice blood clot as this will do the healing, and we want it free of debris and for it to stay in place.

Question 24

What does a black dot mean on the tooth?

Answer 24

Exposed necrotic pulp

Question 25

How should you hold instrument and why?

Answer 25

* Left lower – left hand supports jaw with a finger round tooth, right hand hold instrument. Finger far down shaft (fingers normally closer together) – to allow good control and if there was a slip the fingers would just bump into each other. Finger together!!!! * Good control, patience, do not force and have a good technique. * Then move the instrument around the tooth as different areas are loosened. As you can see in this picture there is a tooth close by and only one damaged. Do not want to loosed surrounding tooth or damage the crown with metal – so do not level off one tooth to loosen the other! * Safe places to use instrument – labial aspect and the lingual aspect. NOT ENOUGH ROOM medial and distal – end up loosen/damaged other incisors.

Question 26

How do you get to the point of actually removing the tooth?

Answer 26

•Work either side and deeper and deeper. Then when you feel you have a good mobility you can then take a pair of extraction forceps and place low down to gently remove it. Use a pulling motion parallel to the axis of the root . You can use a small amount of rotation – but do not lever.

Question 27

How can you remove a multi rooted tooth?

Answer 27

* Multi root (similar to single root)– loosen sulcus and then section into a number of single roots * If you are only removing one tooth – you may need to loosen sulcus around next tooth * In may cases there is a diseased tooth and therefore you may see furcation and can see the space to place the burr. * Retract gingiva and place the burr into furcation and then cut a diamond Right lower – burr has cut the fist cut and about to do second cut. Leaving two stumpy single teeth which can be treated the same as the incisor

Question 28

Discuss post op and home care

Answer 28

* Normal feeding - but offer soft food too * Analgesia for 3-5 dyas (longer if surgery was traumatic) * Review in approx 7 days, can be with VN (Best the VN who saw surgery) * Contact if worried * Instigate oral homecare from day 2 - can use chlorhexidine gluconate to start with i needed * Review with VN every 3-6months