I need help w/ extraction

[DancingKoala]

Hi guys.
I have my first extraction case coming up and I was wondering if you guys can help me 🙂

1. 150 forcep for upper, 151 forcep for lower teeth, and cowhorn for lower molars.
Q. Does it matter if I use 150 or 151 for incisors, canines, premolars or molars?

2. Cut PDL, use straight elevator, and then use forceps
Q. I read that we are not allowed to fulcrum on adjacent tooth, or buccal/lingual alveolar bones. Is PDL space big enough for straight elevator to enter? I thought PDL space was extremely narrow but the tip of the straight elevator looks very thick. I am not sure if the elevator can actually enter PDL space. And is there a way to tell that the elevator entered PDL space instead of sulcus? I don't want to put the elevator into the sulcus and elevate or it will damage the gum tissue.

3. bone graft, suture and membrane
Q. what are the cases that we don't have to use bone graft, membrane cover, or suture?
Q. what type of suture (chromic, braided, resorbable...etc) and technique (x shape, straight shape) do you use to tie suture.

4. I need to extract two teeth for ortho patient. I am guessing that upper first premolars need to be extracted. When I use 150 forcep, do I grab and move buccolingually or make 8 shape? or do I need to look at the x-ray and see how many roots they have before I decide?


I know that I have asked a lot of questions. I would appreciate it if you can answer any of these. Thank you so much in advance.

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[turbodoc]

Light, Suction and Access
150 for upper teeth, 151 for lower teeth, except in children, then use the (S) version
Cut PDL, I use a 12 Blade
Elevate with 301 (takes experience to know how long)
Rarely use Freeze Dried Demineralized Bone Graft
PepGen P-15
4-0 Absorbable Suture with a C-6 Needle
Maxillary premolars tend to tip more to the buccal, Mandibular premolars tend to release to the lingual.
Use a figure 8 motion with lower molars
Hope that helps.

 

[Halcion]

Correct me if I am wrong, but I assume you are working on a relatively young patient since it is ortho extractions?

After patient is numb, you can take the periosteal elevator to release PDL (rather than a 12 blade). Take the 301 elevator and be sure to use it in more of an apical direction, this will allow you to create a good purchase point. Continue to elevate until the tooth is mobile enough to apply forceps. You can use 150 for all uppers (universal forcep for maxillary) and 151 for all lowers (universal forcep for mandibular).

Since the patient is having extractions for ortho, you will not need a bone graft. And you shouldn't need sutures. The only time I have used a bone graft is if the patient is to receive an implant at the extraction site, and sometimes (although rarely) in the canine eminence areas in immediate denture patients. The only time I use sutures is if I am placing a bone graft (usually figure 8 technique) and when a full thickness flap has been reflected (interrupted or continuous). These should be simple extractions, not surgical, so you shouldn't have to reflect a flap, or place a suture. Once the tooth is out, irrigate, check for sinus exposure, and place cotton gauze over site. You shouldn't have to curette, unless there is a lot of debris/infection/granulation tissue.

Hope this helps!

 

[Halcion]

And ask faculty for guidance! Good luck on your first case!

 

[Vapor1122]

1) You can use the 150 for the upper canines, but I find it much, much easier with the #1 forcep, which is what it was designed for.
2) The elevator will actually widen the PDL space, but you need to work it apically in order to create that extra space. Bone is firm, but it's usually soft enough that you can wedge the elevator down there after some well-placed deliberate wiggling. Once you've done that, begin with the wheel-and-axle motions that you've read about. The tooth will start to luxate and migrate coronally. Drive the elevator further apical, and repeat. Once you think you have enough mobility, take to the forceps, do some buccal-lingual movement, and deliver. (Note: for upper first premolars, the palatal root is often shorter and thinner, so you can easily break that root if you're too aggressive with the buccal-lingual motion. Don't be too eager; remember, the elevator should do the bulk of the work.) Have fun!

 

[caffeinehigh]

Light, Suction and Access
150 for upper teeth, 151 for lower teeth, except in children, then use the (S) version
Cut PDL, I use a 12 Blade
Elevate with 301 (takes experience to know how long)
Rarely use Freeze Dried Demineralized Bone Graft
PepGen P-15
4-0 Absorbable Suture with a C-6 Needle
Maxillary premolars tend to tip more to the buccal, Mandibular premolars tend to release to the lingual.
Use a figure 8 motion with lower molars
Hope that helps.

Do you have any evidence that supports the use of pepgen over allografts? 👎