Dental Extractions Overview

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Questions and Answers

Which teeth are most commonly affected by impaction?

Mandibular third molars (correct)

Maxillary lateral incisors

Mandibular second premolars

Maxillary canines

Which indication is NOT typically associated with tooth extractions?

Poorly controlled hypertension (correct)

Endodontic issues

Orthodontic needs

Severe caries

What is a common contraindication for tooth extractions in patients with systemic conditions?

Diabetes (correct)

Mild asthma

Recent orthodontic treatment

History of dental caries

Which tooth is least likely to be congenitally missing?

Mandibular central incisors Signup and view all the answers

In which condition might a tooth extraction actually be contra-indicated?

History of head and neck radiation Signup and view all the answers

What is often a concern for patient safety when treating those with a history of bisphosphonate therapy?

Potential for medication-related osteonecrosis of the jaw (MRONJ) Signup and view all the answers

Which extraction indication is associated with severe crowding?

Orthodontic needs Signup and view all the answers

When performing an extraction for impacted teeth, what is considered a typical step in the procedure?

Administer local anesthesia Signup and view all the answers

What is the purpose of using a periosteal elevator during tooth extraction?

To sever soft tissue attachment Signup and view all the answers

Which direction should a maxillary third molar be delivered?

Distobuccally Signup and view all the answers

What is the primary difference between surgical and non-surgical extractions?

Non-surgical extractions do not involve the removal of bone Signup and view all the answers

When performing a tooth extraction, what is essential for successful delivery?

Sectioning of the tooth Signup and view all the answers

What should be avoided in patients post-extraction?

Vacuuming or using straws Signup and view all the answers

What is the function of curettage in tooth extraction?

To smooth the bone and prepare the socket Signup and view all the answers

Why is a gauze pack recommended immediately post-extraction?

To apply pressure and control bleeding Signup and view all the answers

In which scenario would a full-thickness flap be necessary?

When there are long or divergent roots Signup and view all the answers

What is the appropriate treatment for a severe allergic reaction characterized by difficulty breathing?

Epinephrine Signup and view all the answers

Which sign indicates a potential hypoglycemic condition?

Sweating and irritability Signup and view all the answers

What is the primary purpose of administering oxygen in cases of angina?

To alleviate ischemia of the heart Signup and view all the answers

Which treatment is appropriate for a patient who exhibits uncontrollable jerking and stupor during a seizure?

Diazepam Signup and view all the answers

What characterizes hyperventilation and its symptoms?

Breathing uncontrollably and low CO2 levels Signup and view all the answers

In case of myocardial infarction, what does the acronym MONA stand for in treating the patient?

Morphine, Oxygen, Nitroglycerin, Aspirin Signup and view all the answers

What should be done first for a patient showing signs of a stroke?

Provide oxygen and call EMS Signup and view all the answers

Which of the following is NOT an appropriate approach for managing hyperglycemia?

Giving IV dextrose Signup and view all the answers

What is the recommended position for a patient experiencing syncope?

Supine or left lateral decubitus Signup and view all the answers

What therapeutic measure is NOT typically used for angina?

Albuterol Signup and view all the answers

What is the primary treatment for alveolar osteitis?

Gauze pressure and hemostatic agents Signup and view all the answers

Which type of graft is capable of growing tissue?

Autograft Signup and view all the answers

What condition is most commonly associated with maxillary first molars?

Oro-antral communication Signup and view all the answers

What measurement is recommended from an adjacent natural tooth during implant placement?

3 mm Signup and view all the answers

What is the characteristic feature of a simple fracture?

Closed to the oral cavity Signup and view all the answers

Which stage of wound healing is characterized by blood clot stabilization?

Hemostasis Signup and view all the answers

Which type of TMJ disorder involves a 'lock' of the condyle in place?

Disc displacement without reduction Signup and view all the answers

What is the most common complication after a bisagittal split osteotomy?

Nerve damage Signup and view all the answers

What is the role of hemostatic agents in the treatment of alveolar osteitis?

Stabilize blood clot Signup and view all the answers

What is the immediate physiologic process during hemostasis in wound healing?

Vasoconstriction Signup and view all the answers

Which type of surgical treatment is used to obtain access to the superior joint space in TMJ disorders?

Arthrocentesis Signup and view all the answers

What is the most frequent location for obtaining a primary stability in implants?

Type I bone Signup and view all the answers

Which of the following is a reason for a flap's wide base during surgical design?

To avoid arteries and nerves Signup and view all the answers

What is the significant risk factor for alveolar osteitis post-extraction?

Smoking Signup and view all the answers

Study Notes

Extractions

Most commonly affected teeth are mandibular and maxillary third molars, and maxillary canines.
Impacted teeth and congenitally missing teeth are also common.
Maxillary and mandibular third molars, and mandibular second premolars, and maxillary lateral incisors are most commonly affected.
Indications for extractions include severe caries, endodontic issues, internal root resorption, periodontal issues, attachment loss, orthodontic issues, and severe tooth crowding.
Contraindications include poorly controlled medical conditions (like diabetes or bleeding disorders), immunocompromised conditions (leukemia, lymphoma), a history of head and neck radiation, increased risk of osteoradionecrosis, history of bisphosphonates, and increased risk of medication-related osteonecrosis of the jaw (MRONJ).

Extraction Procedure

Initial movements for extractions are typically buccal then lingual, due to the thinner buccal plate.
Rotary movement is used for single-rooted teeth, while apical pressure is used to expand the socket.
Surgical extractions may be necessary in cases of long or divergent roots, endodontic treatment, crown fracture, and retained roots.
These procedures often involve a full-thickness buccal flap to avoid lingual nerve damage, buccal bone removal, and interradicular or cortical bone sectioning.
Most initial movements in the procedure are buccal, then lingual (due to the thinner buccal plate).
Rotary movement used for single-rooted teeth
Apical pressure to expand the socket
Third molar extractions aim to eliminate periodontal problems, alleviate pain, and allow cleaning of second molars.
Maxillary third molars are delivered distobuccally.
Primary closure involves a physical closure of the wound after surgery.
Secondary closure involves leaving the wound open; healing occurs by granulation and contraction.
Post-op instructions include gauze pressure, a soft diet, no negative pressure, no smoking, and a salt water rinse after 24 hours.

Complications

Subperiosteal abscess can occur from infection under the periosteum due to trapped necrotic bone or tooth. Treatment involves irrigation to remove the bone or tooth.
Oro-antral communication (sinus exposure) involves the exposure of the sinus with maxillary first and second molars. Signs include 2 mm or less, 2-6mm and more than 6mm.
Alveolar osteitis (dry socket) is a multifactorial issue, associated with oral contraceptive use, smoking, and using straws and can be treated with pain control.
Nerve injury is a potential complication, especially with mandibular third molar extractions (IAN block).
Tooth displacement is another potential complication, depending on the molar location: maxillary sinus, infratemporal fossa, or submandibular space.
Bleeding is a common complication that can be managed with gauze pressure, sutures, and hemostatic agents.

Flap Design

Considerations include a wide base, over intact bone, vertical releases at line angles, and avoiding vital structures (arteries, nerves, thin tissue).
Flap types include trapezoid, envelope, and 3-cornered flaps.
Differences are based on the number of vertical releases. (0, 1, and 2).
Different flaps are used for different areas of the mouth and also for apicoectomy (surgical removal of the apex of a tooth root), particularly for maxillary anterior teeth.

Grafting

Types and sources: Autograft (same individual), Allograft (same species), Alloplastic (synthetic or natural materials), Xenograft (other species).
Grafting techniques are used to preserve ridges, restore bony defects, or increase ridge thickness.
Key aspects for grafting success are immunocompatibility, scaffold availability, presence of signals for tissue growth, and tissue growth capacity.

Implants

Endosteal implants are the most commonly-used type of implant.
Implant components include the implant body, cover screw, second stage surgery, implant analogue, abutment and screw, healing abutment, and impression copings.
Implant body is made of titanium, highly biocompatible, with varying diameters and lengths.
Forces exerted on implants are vertical, oblique, and horizontal, which are accounted for in implant design and placement.
Implant placement is guided by measurements such as distance from buccal/lingual plate, inferior border of mandible, maxillary sinus, and nasal cavity; minimum space requirements for teeth; from adjacent natural teeth; the IAN, adjacent implants, and mental nerve; and typical width of 4 mm.

Stability

Primary stability refers to the initial biomechanical stability of the implant.
Secondary stability relates to the long-term osseointegration of the implant.

Trauma & Surgery

Le Fort fractures are categorized into I, II, and III types, each involving different parts of the midface and nasal bones.
Orthognathic surgery is relevant for retrusive or protrusive mandible (such as Bisagittal split osteotomy [BSSO]) and vertical maxillary excess.
Mandibular fractures are common, categorized by location (condyle, angle, symphysis), and whether the fracture is closed or open (does it break the skin). Treatment involves simple, compound, greenstick, and comminuted types of fractures.

Trauma to Permanent Teeth

Different degrees of tooth displacement/trauma, and the appropriate treatment approaches, are discussed (concussion, subluxation, lateral luxation, intrusion, avulsion, extrusion, and types of fractures).
Different types of splinting/treatment timeframes are given for each type of trauma.
Cytology/brush and fine needle aspiration are biopsy techniques used to diagnose oral tissue lesions.

Wound Healing

Stages of wound healing are discussed in relation to oral trauma, including the initial hemostasis (clotting), inflammation stages, proliferation (cell growth and tissue repair), and maturation (long-term healing). Processes like vasoconstriction, blood clot formation, and macrophage migration are part of wound healing.
Temporal issues are important to consider when discussing TMJ jaw movement and disc displacement as maximum opening or deviation issues.
Maximal opening and deviation of jaw opening can be affected by disc displacement, and issues with reduction/no reduction and deviations to one side.

TMJ

Disc displacement with and without reduction are examined as possible TMJ issues.
Understanding of the various opening patterns (deflection, deviation) and possible pathologies (dislocation, ankylosis) is crucial.

Medical Emergencies

Conditions such as angina, myocardial infarction, epinephrine overdose, stroke, and diabetic complications are presented as possible medical emergencies in the oral and maxillofacial surgery setting. Symptoms, treatments, and preventive measures are provided for each condition.
Conditions such as anaphylactic shock, airway obstruction, asthma, hyperventilation, are covered to cover the broad range of issues that can impact the patient in the operating room. Symptoms, treatments, and preventive measures are provided for each condition.

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Description

This quiz covers the key concepts surrounding dental extractions, focusing on commonly affected teeth such as third molars and canines. It also discusses indications and contraindications for extraction procedures, as well as the basic techniques involved. Test your knowledge on important dental extraction criteria and procedures.