Perform Simple Extractions EO 009.01

1. Perform Simple ExtractionsEO 009.01 UNCLASSIFIED//REL TO NATO/ISAF

2. Goals • Perform specific exams pertaining to the extraction of teeth • Determine indications for extraction • Determine the level of difficulty of extraction • Determine the appropriate instrumentation for the extraction • Determine the appropriate pre-operative and peri-operative pharmacotherapeutics

3. Goals • Determine the appropriate local anaesthetic techniques and solutions to provide profound analgesia • Perform appropriate elevation and forceps techniques • Render a timely and accurate decision as to need to change to surgical extraction • Perform curettage of socket

4. Goals • Perform Alveoloplasty • Establish Hemostasis • Determine need for and placement of sutures • Provide post-operative instructions • Prescribe appropriate post-operative medications

5. History • Review: • Chief complaint • History of present illness • Medical history • Present medications • Allergies • Habits and social history

6. Physical examination • Do the appropriate specific examination (vitality testing, percussion, probing, etc…) • Review the radiographs

7. Diagnosis • Once you have all the necessary information, you establish the diagnosis. • Once you have established the appropriate diagnosis, you elaborate a treatment plan

8. Severe decay Pulpal necrosis Odontalgia Severe periodontal disease Orthodontics Malposed teeth Cracked teeth Impacted teeth Preprosthetic extractions Supernumerary teeth Dentition associated with pathologic lesions Preradiation therapy Teeth associated with jaw fractures Aesthetics Economics Determine the indications for extractions

9. Determine the level of difficulty • You must correlate clinical and radiographic findings to provide the basis for estimating the degree of difficulty of the extractions • Clinical assessment: • The crown • Supporting structures • Adjacent structures

10. Determine the level of difficulty • Radiographical assessment: • The root • The bone • Final estimation • Access • Pre-extraction assessment

11. Risk of O-A Fistula

12. Risk of O-A Fistula

21. Prophylactic Antibiotics • AHA guidelines 2000 • Risks for endocardidits • High • Moderate • Negligible • Risk procedure • High-risk procedures • Prophylaxis not recommended

22. Prophylactic Antibiotics • Standard prophylaxis: • Amoxicillin: 2g PO 1h before procedure • Cannot take PO • Ampicillin: 2g IM/IV within 30min before procedure • Penicillin allergy • Clindamycin 600mg PO 1h before procedure • Azithromycin 500mg PO 1h before procedure

23. Patient Positioning

24. Instrumentation

25. Instrumentation - Elevator

26. Instrumentation - Forceps

27. Forceps

28. Instrumentation

29. Before you perform the extraction, always use a pharyngeal screen

30. Instrumentation

31. Maxillary Anterior Teeth

32. Instrumentation

36. Maxillary 1st Bicuspids

37. Instrumentation

38. Maxillary 2nd Bicuspids

39. Instrumentation

41. Instrumentation

42. Maxillary Molars

45. Forceps Selection

46. Mandibular Instrumentation

47. Mandibular Stabilization • Use of a Bite Block • Sling Support • Digital Support by Operator or Assistant

48. Mandibular Anterior Teeth

50. Mandibular Bicuspids