3 - Basic surgical technique Flashcards
What are the stages of surgery?
- consent
- surgical pause/safety checklist
- anaesthesia
- access
- (bone removal)
- (tooth divison)
- debridement
- suture
- achieve homeostasis
- POI
- (post-operative medication)
Describe the consent required for oral surgery.
- GA requires written consent
- LA requires verbal consent although it is good practice to obtain written as well
- consent must be obtained using simple language (no jargon)
What is involved in the surgical pause?
- safety checklist
- site marked
- equipment checked
- checked it is the correct patient
- ensure patient knows what procedure is going to happen
Describe surgical access.
- a larger flap gives better visualisation and large flaps heal at the rate as smaller ones
- preserve adjacent soft tissues where possible
- consider post-op aesthetics if in the anterior
- wide base incision is better for circulation
How should you use a scalpel when making an incision?
- one firm continuous stroke
- no sharp angles
- flap reflection should be down to the bone (periosteum)
How should you manage a flap during surgery?
- keep tissue moist
- do not crush tissues
How should flaps be closed?
- using sutures
- flaps should not be closed under tension as this will cause the flap to pull open during healing
Describe a 3 sided flap.
2 relieving incisions mesial and distal to the tooth being extracted
Describe a 2 sided flap.
1 relieving incision mensal OR distal to tooth being extracted (also known as an envelope flap)
What is the role of soft tissue retraction?
- protection of soft tissues
- gain better access to operative field
- flap design facilities retraction
What should be used to retract soft tissues?
- Howarth’s periosteal elevator
- rake retractor
Why are air driven handpieces not used in oral surgery?
May lead to surgical emphysema (air driven into soft tissues, can be life threatening)
What is used for bone removal and tooth division?
- electric straight handpiece with saline cooled bur
- round or fissure tungsten carbide burs
Where do you remove bone during a surgical extraction?
Form a gutter around the buccal side of the tooth
How should you divide a tooth for extraction?
Remove crown and the divide the roots
What are the principals of elevator use?
- avoid using excessive force
- support instrument to avoid injuring soft tissues
- force should be applied away from major structures
- always use under direct vision
- do not use adjacent tooth as fulcrum
What can elevators be used for?
- point of application for forceps
- loosen teeth prior to forceps
- extraction
- removal of retained roots
- removal of root apices
What are the 3 actions when using an elevator?
- wheel and axel
- wedge
- lever
What are the different methods of bone debridement?
- physical
- irrigation
- suction
Describe physical debridement.
- bone file or handpiece to remove sharp bony edges
- Mitchell’s trimmer or Victoria curette to remove soft tissue debris
Describe irrigation used for debridement.
Sterile saline injected into socket and under soft tissue using a blunt needle
Describe suction used for debridement.
Aspirate under socket
What are the aims of suturing?
- compress blood vessel to achieve homeostasis
- reposition tissues
- cover bone
- prevent wound breakdown
- encourage healing by primary intention
Define healing by primary intention.
When tissues are approximated to prevent loss of tissue, should heal with a thin, neat scar
Describe non-absorbable sutures.
- used when extended retention is required
- must be removed post op
- used to close OAF or exposure of ectopic canines
Describe absorbable sutures.
- hold tissues edges together temporarily
- used when removal of suture is not possible or desirable
- don’t usually require review
- breakdown via absorption of water into filament to degrade polymer
Describe monofilament sutures.
- single strand
- pass easily through tissue
- resistant to bacterial colonisation
- excellent for aesthetics
- difficult to manage
Describe polyfilament sutures.
- several filaments twisted together
- easier to handle
- prone to wicking (oral fluid can move along suture and cause infection)
What are the different suture types?
- curved
- triangular cross-section
- round cross-section
What are the most commonly used suture types in dentistry?
- 1/2 circle
- 3/8 circle
What can be used peri-operatively to achieve haemostasis?
- LA with vasoconstrictor
- diathermy
- bone wax
What can be used post-operatively to achieve haemostasis?
- pressure
- LA infiltration
- diathermy
- surgicel sutured into socket
- sutures
What post op medication advice should you give?
- analgesia advice not prescriptions
- antibiotics occasionally but not routinely
What nerve should be considered when removing lower third molars?
- lingual
- inferior alveolar
- mylohyoid
- buccal
