How to Extract Teeth in Dentistry | Power Dental Instruments — Transcript

Full transcript

1. 0:00hey guys this is the first of many videos to  be released in our new oral surgery playlist
2. 0:04I'm going to be demonstrating how to do simple  extractions and introducing you to some of the
3. 0:08instruments that we use and as we go along I'm  going to be dropping in some physiology on how
4. 0:12the body is reacting while we carry out this  procedure as well as the healing process I hope
5. 0:16you guys find this video useful a quick story  before we get started so this is me minding my
6. 0:20own business at the Birmingham Dentistry show  when I came across Kyle at Power Group Dental
7. 0:24from the US I caught a glimpse of some oral  surgery equipment and rushed over like a kid
8. 0:28to Candy he started showing me his equip and I  was like oh damn this is a bit out of my budget
9. 0:32I'll just buy this little measly periotome and be  on my way I fell so in love with the instrument
10. 0:36I actually contacted him a few months later and  I was like let's do something together you have
11. 0:40some amazing instruments that I'd love to try  and I have a platform where I can share these
12. 0:43instruments with other colleagues who would be  interested in seeing what's out there next thing
13. 0:47you know he actually sent some over to me to give  an honest review this is not a sponsored video
14. 0:51there's no money that exchanged hands I told Kyle  if I don't like something I'm going to say it and
15. 0:55he was cool with that okay let's get started let's  assume you find a patient that's fit well you've
16. 1:01got your radiograph and diagnosis and you've  checked that they're completely anesthetized
17. 1:04all the way around and within the two the first  thing you always need is a plan A and A Plan B
18. 1:09a great teacher of mine once told me that if you  make no progress within 5 minutes move on to the
19. 1:15next plan you need to use the radaph to assess  the coronal and apical pathology bone height
20. 1:19and quality root morphology and the presence of  a ladura and the PDL space or if there is ankis
21. 1:25anywhere along the route for a simple extraction  you basically need three types of instruments Lu
22. 1:30ators elevators and forceps there are other  instruments and materials you could use which
23. 1:35are more relevant to at traumatic extractions like  scalpel periotomes mitual trimmers degranulation
24. 1:41instruments and burs amongst many many more and  this will be covered in a separate video at some
25. 1:46point in the future so first you'll want to reach  for your luxators initially these could look a
26. 1:50bit like elevators but by the end of this video  you'll be able to tell the difference quite easily
27. 1:54the purpose of the luxators is to wedge in between  the bone and the tooth tear the PDL and create an
28. 1:59application point for your elevators the way that  you would create an application point is by coming
29. 2:05in by the long axis of the tooth and rotating  10:00 to 2:00 back and forth depending on the
30. 2:11application point and pushing the bone away from  the tooth I generally start misio buckle and then
31. 2:16move to disto Buckley and kind of play about with  it like that depending on the root morphology the
32. 2:21important thing to note while removing teeth is  that you should never be leaning on adjacent teeth
33. 2:26unless you're planning to remove that one also if  you start leaning on the adjacent tooth you could
34. 2:29damage the adjacent tooth either by making  it mobile or damaging the PDL possibly having
35. 2:34long-term inflammatory effects on the roots of the  neighboring teeth also the reason that you'd use
36. 2:38a luxator meally or distally is because buckly or  Pally or more importantly lingually if you slip it
37. 2:45could be really dangerous for the patient or you  could destroy a thin Buckle plate also note down
38. 2:49how I hold the luxators and later on the elevators  too when you hold it in the palm of your hand like
39. 2:55this with your index finger on the shank you  have way more control over the luxator movement
40. 3:00and are less likely to slip so the reason  I really like the power dental luxus kit is
41. 3:03because they're extremely thin which is going  to help me wedge in between the bone and the
42. 3:08root the worry with them being so thin and being  made out of stainless steel is that they would
43. 3:12be more brittle and likely to fracture but of  course these luxators are made out of nickel
44. 3:16titanium now if you know me you know that I love  nickel titanium materials because they have that
45. 3:20memory recoil that I really really like you might  have heard me speak about the Garrison strategy
46. 3:25clamp for Class 2 Composites in the past and the  way it bounces back into its original position
47. 3:30because it has that larger modulus of elasticity  which means it's more flexible and less likely to
48. 3:35plastically or permanently deform or you can bring  it closer to home and think about stainless steel
49. 3:39k files compared to night ey files it's the same  thing here because these luxators are made of a
50. 3:43flexible night ey material they can be thinner  without the bigger risk of fracturing as easily
51. 3:48meaning you can get deeper into the socket along  the Route creating a better application point for
52. 3:53your elevators the other nice thing about these  luxators are these serrations this means that
53. 3:58they're more likely to grip into the roof and  engage them without accidentally slipping and
54. 4:02these specific luxators can also be used as  elevators for that reason so this kit comes
55. 4:07in different sizes we have a 2.5 3.5 and 4.5  width and it can also come in either a straight
56. 4:12or curved Edge I personally use one of each width  for all of my extractions I usually start with a
57. 4:17straight 2.5 mm then go to a straight or curved  3.5 and then finish on a curved 4.5 it really
58. 4:24depends on the root morphology that I'm trying  to match once you've created your application
59. 4:28point you then need to pick pick up some elevators  this is generally what they look like and their
60. 4:32purpose is very obvious to elevate the tooth out  of the socket and get it moving coronally the way
61. 4:37that you do this is by engaging the root in the  perpendicular direction or twisting or Levering
62. 4:42against the alviola bone to lift the tooth out  of the socket like this this is basically causing
63. 4:47further bony socket expansion allowing more space  for the tooth to be extracted again the nice thing
64. 4:51about the power twist elevators is that they're  quite a bit thicker and have more of a curve at
65. 4:56the tip to assist in that rotational movement and  again these have sharp serration to engage The
66. 5:01Roots you don't really need the whole kit in my  opinion if you're just getting started and these
67. 5:04instruments can be bought separately the kit comes  with a couple of elevators and four periotomes
68. 5:09the periotomes will kind of cover a bit more in  the atomatic extractions video and why that's so
69. 5:14important but basically they're used to tear the  PDL and don't really have many other purposes do
70. 5:18not use them to elevate what I really like about  these is actually the ergonomic handles which give
71. 5:23me a bit more of a tactile sense for the movements  that I'm doing on the teeth with the elevators
72. 5:27you can still insert them from the aort direction  and then go at a 40 to 90° angle from the Buckle
73. 5:33Direction unlike with regular luxators but like I  said earlier with the power luxators you can also
74. 5:38use them to elevate because of the serration  which prevents slipping and damaging of the
75. 5:42soft tissues and because they're more flexible  they're less likely to break you usually find
76. 5:46that luxators are much sharper than elevators  and that's usually the biggest tell for if an
77. 5:50instrument is a luxator or an elevator traditional  elevators include coupons in different sizes work
78. 5:56James and criers so when are you supposed to move  on from a size one coupons to a size two or a size
79. 6:01three it's when you're no longer achieving any  additional movement from the rotation of the size
80. 6:06one then you move up to the size two I've never  really used a war James and I think they're quite
81. 6:09irrelevant but some oral surgeons swear by them I  don't really know what the big deal is and I can
82. 6:14pretty much remove any tooth in the mouth with  other instruments if you really like War James
83. 6:18just put a comment down below explaining why and  maybe I'll give it another try I rarely use criers
84. 6:22too to be honest they can be useful to break thin  inter radicular bone or to pry out fractured root
85. 6:28but like I said I rarely use them too but they do  have their place in all honesty because the power
86. 6:32luxator kit is so good I usually just stick with  that unless there's a tooth that just won't budge
87. 6:37despite me having moved to the largest luxator  I'll move on to my elevators in the power kit
88. 6:42so because I use these luxators at elevators  to I would switch from a size 2.5 mm luxator
89. 6:46to a 3.5 when the 2.5 is no longer creating that  additional movement then I would go to a 4.5 if
90. 6:53the 3.5 is no longer giving me that additional  movement and finally I'll move on to my elevator
91. 6:57if my 4.5 luxator isn't giving me that additional  movement you can also find that you may be going
92. 7:02back and forth between luxators and elevators or  even just multiple different types of luxators to
93. 7:07get a deeper application Point generally I even  skip the couplons and go straight for the forceps
94. 7:11because I've been using my luxators as elevators  if you guys have found this video useful so far
95. 7:16then feel free to give it a like And subscribe  it really helps us push our content out there the
96. 7:20purpose of the forceps are to further expand the  bone and to deliver the tooth you start by placing
97. 7:25the beaks of the forceps buckly and palatally  engaging deep into the roots or the bation of
98. 7:30a Moler for example the forceps are then used in  two movements the first movement is with apical
99. 7:35pressure which prevents the root from fracturing  in the Apex and then while maintaining the first
100. 7:39movement the second movement is a controlled and  purposeful lateral movement depending on the root
101. 7:44morphology following the path of least resistance  this usually follows the curvatures of the roots
102. 7:49and will disrupt the perodontal membrane after a  minute or so of waiting for the blood to fill in
103. 7:53the socket you then start integrating coronal  movements instead of apical movements once you
104. 7:58feel the socket has expanded a bit and with these  motions you will be able to extract the tooth in
105. 8:03a less damaging way without any sudden jerks  this will ensure a more pleasant experience
106. 8:08for the patient not only during the extraction but  also during recovery looking at the power Dental
107. 8:13forceps they call them the attics there are a few  features that I particularly like when comparing
108. 8:18them to regular forceps if you look at the inside  of the beaks there are tiny serrations which help
109. 8:23grip the tooth so much more than regular foret  this means I don't actually need to put any
110. 8:27kind of squeezing pressure on the handles can  focus more on the minor motor feedback given to
111. 8:32me through the tooth and can decide how it will  respond based on the directional movements that
112. 8:36I make more easily decreasing the likelihood of  me fracturing the tooth if you look at the design
113. 8:41of them all of them become narrower at the tip of  the beaks this means they can engage further down
114. 8:45the roote because the wider tip won't be able to  exactly follow the circular shape of the root and
115. 8:51when you look at the beaks they're also curved  which helps to match the shape of the route also
116. 8:55because the overall size is smaller you have  more control over the forceps and can gain
117. 8:59access to harder to reach areas the nice thing  about the Moler forceps is that they can be used
118. 9:04for both sides of the mouth as opposed to  traditional forceps whereby there's a right
119. 9:08and a left foret the uppers also have a bayonet  style Contra angle for better access posteriorly
120. 9:14the last thing I'm going to say about them is that  they have these nice little grips on the handles
121. 9:18I found that that's a common theme of all the  power Dental instruments there's a lot of thought
122. 9:21that has gone behind every feature of these  instruments and realistically I can only think
123. 9:25of two downsides one I wish the luxators had a  wider handle more similar to that of the elevator
124. 9:31series I just found it gives me a bit more control  and secondly that these are premium products at
125. 9:35premium prices they're not for everyone if you're  into extractions oral surgery or implantology like
126. 9:40I am I'd say they're an amazing investment  and you just take out the odd Simple Mobile
127. 9:44tooth here or there then maybe it's not worth it  for you on the flip side if you're taking fewer
128. 9:48teeth out then you'd be less confident using  any odd instrument and so actually this would
129. 9:52definitely make your life easier if you guys are  interested in power dental tools then feel free
130. 9:57to have a look in the description for if there's  any promo codes the other few styles of forceps
131. 10:01you might see around are root forceps cow horns  or bayonets the inzer forceps in the kit usually
132. 10:07cover for these as they're quite narrow at the  tips of the beaks and so I never find that need
133. 10:11to use the root forceps in some rare occasions  I find myself actually delivering roots that
134. 10:16have mobilized within the socket with something  more nimble like mosquito foret with regards to
135. 10:20cow horns these have sharp beaks and will engage  further down under the fication all you need to
136. 10:24do is squeeze and one of two things will happen  either the tooth will pop out or it will fracture
137. 10:28in half if the tooth snaps that also makes life  easy because the fragments will come out easily
138. 10:33finally bayonets are used for extracting upper  posterior molers but the upper Moler foret from
139. 10:37the power dental kit have the same Contra angle  anyway with much better features another important
140. 10:42factor is utilizing your supporting hand if you're  extracting a lower right tooth you will need to
141. 10:46sit the patient at a 45° angle and support their  jaw with your pinky ring and middle finger with
142. 10:52your index finger Buckle of the tooth and your  thumb lingual of the tooth if you're extracting
143. 10:57a lower left tooth you need to sit the patient at  a 45° angle and come in front of them and support
144. 11:03their jaw with your thumb and your index finger  buckly and your middle finger lingually for upper
145. 11:07teeth always lie the patient completely flat and  raise the chair ask your nurse to support their
146. 11:11head as you drive your forceps apically and place  your thumb platal of the tooth and index finger
147. 11:17buckly now that the tooth has been extracted  and you've checked it's all come out with no
148. 11:21roots left behind we need to understand what comes  after clean the socket of any granulation tissue
149. 11:26and pathology and make sure there are no sharp  or thin bits of bone which can necrose using a
150. 11:31mitual strammer or a spoon excavator and then  flushing the socket with some sterile saline
151. 11:35then you're going to want to achieve hemostasis  using pressure by asking the patient to bite down
152. 11:40on a bit of cause wound healing can be summarized  into four stages hemostasis and coagulation the
153. 11:45inflammatory phase the proliferative phase and  finally modeling and remodeling within a matter
154. 11:49of minutes and hours there will be some vasil  constriction and the exposed collagen fibers
155. 11:54from the PDL will result in Fon Vilan factors  and thromboxane attracting platelets the clotting
156. 11:59Cascade will result in thrombin and an unshed  fiber Network a clot will form and be composed
157. 12:05of red and white blood cells platelets and fibrin  within the first day then the inflammatory phase
158. 12:10will ramp up and within 2 to 3 days where the  white blood cells called upon from the cytoid
159. 12:15and the growth factors will start to phagocytose  the debris and Make Way for new tissue formation
160. 12:21within a week granulation tissue will replace the  blood clot after 2 weeks the granulation tissue is
161. 12:26replaced by connective tissue and after 1 month  epithe alization would have occurred within the
162. 12:31proliferative phase there is a rapid deposition  of provisional Matrix which is later replaced by
163. 12:37woven bone almost entirely at 6 to 8 weeks the  woven bone is basically mineralized tissue in a
164. 12:42connective tissue Matrix lined by osteoblasts  and contains a large amount of osteocytes and
165. 12:48this woven bone develops around blood vessels to  form the harves in system and is encouraged by
166. 12:53bone morphogenic proteins or bmps finally the Bony  remodeling Phase 6 3 to 6 months and is a transfer
167. 12:59of this woven bone to Lamela bone and bone marrow  encouraged by growth factors like wrankle there
168. 13:04are so many ways of extracting teeth in this video  I have covered the basics that I think you need to
169. 13:09know as well as some of my favorite instruments if  you're interested in the power Dental instruments
170. 13:13that I mentioned then feel free to check  out their online shop using the link in our
171. 13:16description below I'll be releasing a video on at  trumatic extractions as part of the oral surgery
172. 13:21playlist as soon as possible and if you guys like  this video then make sure you hit the like button
173. 13:25and subscribe for more Dental educational  content feel free to also check out our new
174. 13:29newsletter if you guys want updates on videos  that we release or free content that we'll be
175. 13:33uploading on there hope you guys found that useful  and we'll see you guys in the next video bye