EXODONTIA

SIMPLE
___

By DANISSA
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INSTRUMENTS

E&D
1. E&D SET
2. KIDNEY DISH, 2 PLASTIC CUPS, HYDROGEN PEROXIDE
3. GAUZES (8), COTTON PALET FOR COLD TEST
4. COLD TEST AND EPT (take ept paste as well)
5. SUCTION TIP

EXO

1. GLUCOMETER, BP SET
2. PARACETAMOL TAB AND GAUZE SET
3. TOPICAL LA
4. LA SYRINGE, SHORT NEEDLE (infiltration)LONG (if nerve block), 1
CATRIDGE, NEEDLE STAND
5. COUPLAND ELEVATOR (3 SIZES), MAXILLARY MOLAR FORCEP,
6. NORMAL SALINE, SYRINGE, IV BRANULA (ASK NURSE TO REMOVE
NEEDLE)

Borang

1. Catatan rawatan x 3 (cont treatment done with e&d paper)

2. If OPG indicated (trauma/fracture, periapical lesion-cyst, third molar) isi
borang dan dapat cop taksiran bendahari kat kaunter daftar pt
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EXO PROCEDURES
1. History taking, examination E&D (ask weight), Investigations (EPT & COLD), Xray

2. EXTRACTION CONDITION : Extent of carious lesion, Tender to percussion/palpation,

Mobility, Morphology of root

3. INFORM FINDINGS AND EXO PROCEDURES AND GET PT CONSENT

4. Check vital signs (bp (<140/90, blood glucose <14mmhg)
5. dry injection surface with gauze, apply topical LA(benzocaine), ask to bite gauze at the
area and wait 1-2 min.
6. Meanwhile load LA. inform pt gonna inject. If pain means angkat tangan/kaki. Check
patency of needle (droplets). Inform pt that u gonna inject slowly to reduce pain. Inject
buccal first and stop palatal LA when tissue blanches. Always give LA at the apex of
root. Follow root for more accurate LA s
7. Always stand at right side of pt (7 o clock). Use mouth mirror to retract lips if ant teeth.
Ask pt to breath and Inject LA (16/26 -2 buccal infiltration, Mand -LA).
8. LA site : buccal- needle place in a sideway to tooth (if letak straight it goes into nose), at
mucogingival junction (few mm away only from apex). Palatal . imaginarinary line from
gingival margin of tooth to midline/ apex preferably. massage after give LA to diffuse the
LA

Must see blanching and solution is bitter. Rinse after LA. Wait 3-5mins to achieve LA.

9. Numbness. Ask (numb/swollen sensation). Perio probe check at sulcus junction . poke
all sulcus surface of tooth
10. Coupland (3 size)- expand and elevate socket. Support labial and lingual with ur tangan
kiri for support on adjacent tooth to prevent trauma. Insert in long axis of tooth at buccal
side and form C shape. Start with smallest coupland then change to bigger, .
11. Forcep- Choose depend on crown size. adapt (beak at cej , x crown). ALWAYs have
SUPPORT by grabbing adjacent tooth. Then move labialy. Stop and wait few seconds
with continuous force there as u encounter resistance to allow bone exoansion.
12. Prefer to take out buccaly but if got bone resorption at lingual (less resistance) go take
out in lingual.
13. After take out ASSESS TOOTH FRACTURE - inspect root shape and palpate root apex
for any sharp areas.

14. Normal saline indicated only if got root fragments. Irrigate till fluid clear not cloudy. Then
use gauze to compress socket converge to achieve hemostasis(blodd clot x dislodge)

15. Put gauze ask to gigit. If no opposing tooth put 2-3 layers of gauze . wait few minutes.
Remove gauze and check for blood clot (hemostatsis achieved)
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16. Post -op oinstructions & discharge with painkillers, Give MC (dr print, so tell the time pt
work on that day and the workplace)

TIPS :

1. PAIN on horizontal percussion (perio lesion-periodontitis that may reach apex,

character : vital pulp, bone loss (due to pocket/perio prob),local factors present-
calculus)- prognosis to reattachment is questionable.
2. Kalau x de crown -
- Straight luxator - break periosteum, detach PDL from crown and root (x luxate)
- Elevators : warwick james : to luxate. Wedge in between 2 teeth, small twist of
wrist with a lift and turn the handle of elevator. (Insert, Adapt, luxate). Luxate
distobuccally (so fulcrum at mesiobuccal) as it is thinner bone and also follow
root curvature.
- Forceps : root / cow’s horn. Single beak at bifurcation at bucal side to lock
furcation). Turn buccolingually and stay a while. X BE HARSH can break crown
3. If difficult to extract, use big circular motion to extract using forcep

Watch : https://www.youtube.com/channel/UCMqwPP5XH-jkj4d3lUyXWug/videos

Root elevators : https://www.youtube.com/watch?v=eVHPsaaOsnU

How to use forceps : https://www.youtube.com/watch?v=uIk5LarLeHg

- (concave handle rest on palms)

PAEDS
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RECALL

New case (>2 restorable caries)- Rehabilitation (mixed dentition, PRR,

restoration, SCC, exo, pulpotomy)- Recall (do new e&d if >3 caries)
EMERGENCY (draining abscess, acute dental trauma)

Complete case - (last seen with good oral hygiene, terminate if requested/poor attendance,
referred to specialist)

First ever dental visit should be 6 months a4 first tooth erupt or at age of 1

AIM OF TREATMENT : caries free at recall, intact restoration, stop caries progression, modify
OH & diet, change behaviour, no pain , restore form and function

RECALL

- Basically for pt assessment, ot only caries

- APPOINMENT BASED ON CAIRES RISK ASSESMMENT AND CRA CHANGE IN EVERY
RECALL PERIOD
- Dental HX: previous LA, compliance , FRANKL behaviour

(1- definitively positive : interested, enjoying, laughing

2- positive : cooperative but reserved, cautious ‘aah’, follow instructions

3- negative : withdraw, uncooperative

4 - Definitively negative : refuse treatment, forceful crying , in distress

Brushing habit

- Technique (good dexterity- BASS method, poor- ROLL (apex to occlusal),

primary teeth- FONES (circulatory)
- Supervision (

Behaviour mx
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1. Tell-show-do
2. Reinforcement - praise in positive frankl by words or toys
3. Remodelling - siblings/parents
4. Voice control - to reduce disruptive behaviour and gain attention
5. Desensitisation - for anxious child, cont treatment when pt accept

Age continuum and risk factors

0-5 : bottle feeding, young : soda pop, trauma.

YOUNG ADULT : smoke, drug abuse, bulimia, aneroxia,

MIDDLE ADULT : periodontal disease, xerrostomia.

OLDER ADULT : impaired home care

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ENDODONTIK
RCT

MATERIALS : Topical LA, RUBBER DAM set, flos, clamp, e&d, kidney, k5 file, metric
ruler, apex locator,

Temporary resto : another white powder, cavitone, fuji 7 (COLOUR BCS EASY TO
REMOVE LATER)

Procedure :

1. Clean the canal debridement, may block so bend a bit the needle
2. Shape the wall of canal (thick needle)
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ROOT PLANNING :

1. TOPICAL LA
2. LA INFILTRATION, CHECK NUMBNESS
3. CLEAN POCKET WITH CHLORO HEXIDINE (BLUE MOUTHWASH_ USING IV BRANULA
AND SYRINGE)
4. USE MANUAL SCALLER- ADAPT, STROKE
5. CHECK ROUGHNESS USING EXPLORER. IF GOT ROUGH CLEAR IT
6. AT LAST CLEAN WITH CHLOROHEXIDINE
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PERIO
SCALLING

Instruments

REQUEST INSTRUMENT

1. e&d set, kidney dish, gauze

2. Scaler set,
3. Slow speed hand piece
4. High suction tip
5. Prophylaxis paste
6. Floss
7. Hydrogen peroxide
8. Check water level in AGP

BAWA SENDIRI

1. BIB, CROCODILE CLIP

2. SUCTION TIP
3. DAPPEN GLASS AND BRISTLE BRUSH
4. TISSUE
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CONS
INSTRUMENTS

REQUEST INSTRUMENT

1. E&D, KIDNEY,
2. RUBBER DAM SET
3. LA SYRINGE
4. SLOW & HIGH SPEED HANDPIECE, MICROMOTOR
5. SCISSORS
6. SPOON EXCAVATOR SMALL AND MEDIUM
7. PLASTIC INSTRUMENT
8. CONDENSER/PLUGGER
9. CARVER
10. DYCAL APPLICATOR
11. TOWEL
12. TOFFLEMIRE

PINJAM

1. CLAMP AND FLOSS

2. TOFFLEMIRE BAND
3. TRIPLE SYRINGE
4. HYDROGEN PEROXIDE
5. BUR- ROUND STAINLESS STEEL, FLAT FISSURE BUR
6. CELLULAR STRIP IF ( ANTERIOR TEETH), ABRASION (CERVICAL MATRIX)
7. LIGHT CURE (DAH CHARGE) AND SHIELD
8. FINISHING AND POLISHING KIT
9. TOPICAL LA

BAWA

- BIB, SUCTION TIP, CUPX2

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ABRASION

1. DRY AREA
2. DO CAVITY PREP IF NOT SEEN ANY POTENTIAL AREA
3. APPLY DENTIN CONDITIONER, BRUSH AGITATE FOR 20 SEC
4. WASH AND DRY
5. APPLY GIC FUJI 2 CAPSULE , THEN PUT CERVICAL MATRIX . HOLD
6. FINISHING USING SLOW SPEED WHITE STINE FLAME SHAPED
7. Apply vaseline and POLISH USING GIC FINISHING ANF POLISHING KIT

CR ANTERIOR

Tooth 22 AND 24

1. END SET, KIDNEY DISH, GAUZE, COTTON ROLL, CR choose shade, bekas letak
CR, mandrel
2. TOPICAL LA, GAUZE, SHORT NEEDLE, SYRINGE, CATRIDGE,
3. RUBBER DAM SET, RUBBER DAM, RUBBER WEDGE BLUEX2, PREMOLAR CLAMP,
ANTERIOR CLAMP, FLOSS, PEN,
4. Slow and h/s handpiece, triple syringe
5. STAINLESS STEEL ROUND BUR (s/s) - caries

Round diamond (h/s)- intact enamel

FLAT FISSURE DIAMOND BUR (h/s)- cavity prep

6. Spoon excavator, dycal applicator, LC unit, etch,bond, CR plastic instrument,

cellulite strip, create contact point
7. If got excess restoration use finishing n polishing strip
8. Cocoa butter, Flame shaped white stone (h/s). Polishing kit CR (if palatal-pear
shaped/ tebal cone red stone), soflex disc (mesial/distal). Check excess/ defect
using probe
9. Floss
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Request instrument

1. End , kidney
2. Rubber dam set
3. LA syringe,
4. spoon excavator (SIZE NUMBER)
5. Dycal applicator
6. Plastic instrument
7. Cement plugger
8. Towel

Mintak

1. CR shade
2. Cartridge, short needle, Topical LA
3. Floss (x4), wedge bluex2, premolar clamp and anterior clamp
4. High speed and low speed hand piece
5. Bur (ss round bur (s/s), round diamond bur (h/s), flat fissure diamond bur (h/s).
Tapered diamond bur (h/s) )
6. LATER - liner, etch, bonding, CR
7. Cellulite strip, LC unit, finish and polishing strip, white stone (h/s),
8. Cocoa butter, CR polishing kit, soflex disc

Sediakan

1. Hydrogen peroxide, gown,bib, plastic apron, surgical mask, headcap,

2. plastic cup x2, suction tip
3. Gauze, high janker, CR box oren
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PROSTHO
https://www.slideshare.net/ffofr/complete-dentures-3history-and-exam (USEFUL NOTES)

SECONDARY IMPRESSION

● Full - eugenol
● Partial denture - alginate

Instruments

- Special tray
- Bur to trim
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- Green stick , fire, water to dip border moulding

- lecron
- Bowl, spatula
- Chinese paper
- Alginate
- E&D set
- Vaseline

Procedures

1. Try fitting the special tray with pt, if over extended at sulcus, mark with
pen and then trim using denture bur
2. Ask pt to raise tongue, if displace, lingual is over extended
3. Border moulding - labial, right, left, lingual (anterior), lingually right, left
- Protrude tongue, tongue to palate ,right, left, swallow x2
4. Trim lingually below border using lecron, apply vaseline surrounding pt
mouth
5. Then pour alginate. Same instructions
6. Disinfect send to lab

Notes :

RETENTION (displacement away from tissue)

- Mandible : Tissue - floor of mouth posture , tongue position, peripheral

seal
- Maxilla : tissue - tuberosity, height of residual ridge (avoid lateral
displacement), palatal vault shape, saliva, compressebility of palatal seal
- Mechanical : undercut
- Physiological : saliva viscosity
- Muscle
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SUPPORT (displacement TOWARDS tissue)

- MANDIBLE : retromolar pad, alveolar ridge contours(broader), buccal shelf

area (more access)
- Maxilla : alveolar ridge contour, palatal shelf area
- Both has keratinized mucosa (has bundle of fibrils, add strength and resist
force). Normally found at masticatory mucosa (hard palate, gingiva
tongue. (other than lining mucosa)

STABILITY (firm, stead, resist horizontal, functional, rotational stress)

Mandible : alveolar ridge height, tongue position, muscle, flabby, movable

denture bearing surface

MAxilla : alveolar ridge height, tuberosity, flabby tissue