Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques

Dry socket, also termed fibrinolytic osteitis or alveolar osteitis, is a complication of tooth exodontia. A dry socket lesion is a post-extraction socket that exhibits exposed bone that is not covered by a blood clot or healing epithelium and exists inside or around the perimeter of the socket or alveolus for days after the extraction procedure. This article describes dry socket lesions; reviews the basic clinical techniques of treating different manifestations of dry socket lesions; and shows how microscope level loupe magnification of 6× to 8× or greater, combined with co-axial illumination or a dental operating microscope, facilitate more precise treatment of dry socket lesions. The author examines the scientific validity of the proposed causes of dry socket lesions (such as bacteria, inflammation, fibrinolysis, or traumatic extractions) and the scientific validity of different terminologies used to describe dry socket lesions. This article also presents an alternative model of what causes dry socket lesions, based on evidence from dental literature. Although the clinical techniques for treating dry socket lesions seem empirically correct, more evidence is required to determine the causes of dry socket lesions.

Post and core build-ups in crown and bridge abutments: Bio-mechanical advantages and disadvantages

Dentists often place post and core buildups on endodontically treated abutments for crown and bridge restorations. This article analyzes the bio-mechanical purposes, advantages and disadvantages of placing a core or a post and core in an endodontically treated tooth and reviews literature on post and core biomechanics. The author assesses the scientific rationale of the claim that the main purpose of a post is to retain a core, or the claim that posts weaken teeth. More likely, the main function of a post is to help prevent the abutment, on which a crown is cemented, from fracturing such that the abutment separates from the tooth root, at a fracture plane that is located approximately and theoretically at the level of the crown (or ferrule) margin. A post essentially improves the ferrule effect that is provided by the partial fixed denture prosthesis. This paper also explores the difference between bio-mechanical failures of crowns caused by lack of retention or excess taper, versus failures due to a sub-optimal ferrule effect in crown and bridge prostheses.

Post and core build-ups in crown and bridge abutments: Bio-mechanical advantages and disadvantages

Dentists often place post and core buildups on endodontically treated abutments for crown and bridge restorations. This article analyzes the bio-mechanical purposes, advantages and disadvantages of placing a core or a post and core in an endodontically treated tooth and reviews literature on post and core biomechanics. The author assesses the scientific rationale of the claim that the main purpose of a post is to retain a core, or the claim that posts weaken teeth. More likely, the main function of a post is to help prevent the abutment, on which a crown is cemented, from fracturing such that the abutment separates from the tooth root, at a fracture plane that is located approximately and theoretically at the level of the crown (or ferrule) margin. A post essentially improves the ferrule effect that is provided by the partial fixed denture prosthesis. This paper also explores the difference between bio-mechanical failures of crowns caused by lack of retention or excess taper, versus failures due to a sub-optimal ferrule effect in crown and bridge prostheses.

Use of elevator instruments when luxating and extracting teeth in dentistry: clinical techniques

In dentistry, elevator instruments are used to luxate teeth, and this technique imparts forces to tooth particles that sever the periodontal ligament around tooth roots inside the socket and expand alveolar bone around tooth particles. These effects can result in extraction of the tooth particles or facilitate systematic forceps extraction of the tooth particles. This article presents basic oral surgery techniques for applying elevators to luxate teeth. Determination of the optimal luxation technique requires understanding of the functions of the straight elevator and the Cryer elevator, the concept of purchase points, how the design elements of elevator working ends and tips influence the functionality of an elevator, application of forces to tooth particles, sectioning teeth at furcations, and bone removal to facilitate luxation. The effectiveness of tooth particle luxation is influenced by elevator tip shape and size, the magnitude and the vectors of forces applied to the tooth particle by the tip, and sectioning and bone removal within the operating field. Controlled extraction procedures are facilitated by a dental operating microscope or the magnification of binocular surgical loupes telescopes, combined with co-axial illumination.