Basic Oral surgery techniques Flashcards
oral surgery basic principles
- risk assessment
- aseptic technique
- minimal trauma to hard and soft tissues
stages of surgery
- consent
- surgical pause/safety checklist
- anaesthesia
- access
- bone division if necessary
- tooth diviision as neccesary
- debridement/wound management
- suture
- achieve haemostasis
- post op instructions
- post op medications
- follow up
Surgical access - considerations
maximal access with minimal trauma
- bigger flaps heal just as quickly as smaller ones
- preserve adjacent soft tissues
- consider post op aesthetics
surgical access principles
- wide based incision
- use scalpel in one continuous stroke
- no sharp angles
- adequate sized flap
- flap reflection should be done cleanly and down to bone
- minimal trauma to dental papillae
- no crushing
- keep tissues moist
- ensure flap margins and sutures lie on sound bone
- make sure wounds are not closed under tension
- aim for healing by primary intention to minimise scarring
what handpiece is used for bone removal and tooth division and why?
- electrical straight handpiece with saline or sterile water
air driven handpicks may lead to surgical emphysema
What bur is used in surgical extraction?
Round or fissure tungsten carbide
Elevators - principles of use
- mechanical advantage
- avoid excessive force
- support instrument to avoid injury to patient should instrument slip
- ensure applied force is directed away from major structures e.g. mental nerve, ID canal
- always use under direct vision
- never use adjacent tooth as fulcrum unless it is to be extracted
- keep sharp and in good shape
- careful debridement after use to remove any bone fragments
Uses of elevators
- pride a point of application for forceps
- extract a tooth without use of forceps
- loosen teeth prior to forceps use
- removal of multiple root stumps
- removal of retained roots
- removal of root apices
Elevator technique - mechanics
3 basic actions
- wheel and axle
- wedge
- lever
how to undertake physical debridement following surgical extraction
- bone file or handpiece to remove sharp edges
- Mitchell’s trimmer or Victoria curette to remove soft tissue debris
irrigation following surgical extraction
sterile saline into socket and under flap
suction following surgical extraction
aspirate under flap to remove debris
- check socket for retained apices
suturing - aims
- reposition tissues
- cover bone
- prevent wound breakdown
- achieve haemostats
- encourage wound healing by primary intention
monofilament sutures -
- single strange
- pass easily through tissue
- resistant to bacterial colonisation
polyfilament sutures -
- several filaments twisted together
- easier to handle
- prone to wicking
- oral fluids and bacteria move along length of suture and can result in infection
Peri operative measures for haemostats achievement
- LA with vasoconstrictor
- artery forceps
- diathermy
- bone wax
post operative measures for haemostats achievement
- pressure
- la infiltration
- diathermy
- surgicel
- sutures
nerves that can be damaged from removal of lower third molars
- lingual
- inferior alveolar
- mylohyoid
- buccal
lower third molar removal - complications
- pain
- swelling
- bruising
- bleeding
- trismus
- infection
- dry socket
- parasthesia
aims of peri-radicular surgery
- establish a root seal at the apex of a tooth or at the point of perforation of a lateral perforation
- to remove existing infection
types of flaps for oral surgery
- semi-lunar
- triangular (2 sided)
- rectangular (3 sided)
semi lunar flap - downsides
- reduced access
- only good for apical lesions
- scaring
- dysaesthesia
BUT
less gingival recession
retrograde seal - options
- zinc oxide eugenol
- Mineral trioxide aggregate (MTA)
