3rd molar surgery Flashcards
What are the standard problems for all patients undergoing surgery
- Pain
- Swelling
- Bleeding
- Bruising
- Infection
- Dry socket
- Difficulty opening
- Damage/ sensitivity to adjacent teeth
Which cranial nerve causes the most issues during third molar surgery
The trigeminal nerve
Other than the branches of the trigeminal nerve which other nerves cause problems in third molar surgery
Chorda tympani
Which branches of the trigeminal nerve cause the most issues
The lingual nerve
Inferior alveolar nerve
When is the lingual nerve at risk
- During the incision
- Flap retraction
- Lingual split porcedure
- Removal of fractured bone of socket
- Tooth sectioning
- Over aggressive removal of retained follicle
- Deep suturing
- Absent lingual plate
List somr specific risks for mandibular third malt surgery
- Temporary or permanently altered or loss of sensation to the: lower lip, skin of the chin, gums of the lower teeth, lower teeth, tongue and taste
- Trismus
- Time off work
- Significant swelling or bruising that can spread to the neck
- Rarely hospital admission required
What must you tel the patient before agreeing to cary out 3rd molar surgery
Must tell them of the risk and note down you have told them
What steps must you carry out before thinking of doing surgery
- History
- Assessment and examination
- Investigations
- Diagnosis
- Treatment plan
List the 4 basic surgical principles
- Good anaesthesia
- Minimal trauma
- Good planning
- anatomical knowledge
Why is important we follow the 4 princess of basic surgery
- Avoids physical and psychological stress
- Reduction in pain
- Lower risk of infection
- Reduced swelling
- Rapid healing
Which local anaesthetic techniques do we carry out on patients before 3rd moral surgery
Inferior alveolar dental block with lidocaine
AND
Long buccal with articaine
What is operculectomy
A surgical procedure to remove the affected soft tissue covering the partially erupted tooth
Why do we carry out an operculectomy
To improve oral hygiene
Which tissues do we have to be careful of when carrying out third molar surgery
Periosteum
What does the periosteum contain
Cells responsible for bone remodelling
What must we preserve when carrying out 3rd molar surgery
Consider bone and preserve it as much as possible
What must we be careful of if we elevate the third molar
Could fracture the distal of the 7
What pre op can you give patients before third molar surgery
Pre op 400mg ibuprofen
rarely pre op steroids
Which local anaesthetic techniques do we carry out on patients before 3rd moral surgery
Inferior alveolar dental block with 2% lidocaine and 1:80,000 adrenaline
AND
Long buccal with 4% articaine 1:100,000 adrenaline
What post op can you give patients following third molar surgery
Post op 400mg ibuprofen
1g paracetamol 4 times a day for 48 hours
Warm salt water rinse 4 times a day for a week
What MUST we be careful of when carrying out third molar surgery
Make sure no air gets forced into soft tissues or sockets
NO AIR ROTERS
What can happen if air gets forced into the soft tissues or socket
Patient can develop surgical emphysema leading to swelling of the face
Talk through the basic principles of flap design
- Base bigger than free margin
- Width of the base should be bigger than the length of the flap
- Axial blood supply
- Margins on sound bone
- Preserve vital structures
- Access
- Uncomplicated closure
When do we raise flaps
Usually in mandibular third molars not maxillary
What post operative care must we tell the patient
- Expect the worst
- Regular analgesia
- No smoking or vaping for a week
- Post op next day
- Give written contact details to patient for advise and emergencies
What complications can arise with third molar surgery
- LA
- Damage to adjacent teeth
- Extraction of th wrong tooth
- Displacement of root/tooth fragment
- Aspiration
- Instrument fracture
- Soft tissue damge
- TMJ dislocation
- Mandible fracture
- Nerve damage
- Fractured tuberosity
- Burn
What is a coronectomy
Removal of the crown from the roots of a healthy tooth in healthy patients indicated to prevent inferior alveolar nerve injury in high risk patients
Give some guidelines regarding which teeth can have a coronectomy
- Teeth with associated infection should be excluded
2. Teeth that are mobile should be excluded
What can happen in some coronectomys
- Late migration of the root fragment may occur
2. Leaving the retained roots fragment at east 3mm inferior to the crest of the bone seems appropriate
List soem contraindication for a coronectomy
- Caries with pulpal invovlement
- Apical disease
- Mobility of roots
- Association pathology
- Pre orthographic surgery
- Immunocompromsied
- Pre radiotherapy
