Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS3 CLINICAL Oral Surgery > Basic Oral Surgery Techniques > Flashcards

Basic Oral Surgery Techniques Flashcards

1
Q

What are the basic principles of oral surgery

A

risk assessment
aseptic technique
minimal trauma to hard and soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why do we do a risk assessment

A

for good planning so we can consider any local anatomical structures and plan the steps

so we can consider any medications that may impact bleeding and healing in the medical history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the environment for oral surgery

A
  • Cross infection control and surgical etiquette is required

* However, a theatre environment is not required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is a radiological assessment required

A

• We need to know what the roots look like and what the local anatomy is and this will help us perioperatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the stages of surgery

A
  • Consent
  • Surgical pause/safety checklist
  • Anaesthesia
  • Access
  • Bone removal as necessary
  • Tooth division as necessary
  • Debridement as necessary
  • Suture
  • Achieve haemostasis
  • Post-operative instructions
  • Post-operative medications
  • Follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What kind of consent is required for oral surgery

A

written

Need to ensure the px understands what is happening and the risks involved before signing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the surgical safety checklist include

A

developed by WHO and adapted

Check we have the right px, we are operating on the correct side and everything is prepared at the beginning of the procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the things we aim for with surgical access

A

maximal access with minimal trauma
preserve adjacent soft tissues
want to remove the mucoperiosteum, not the mucosa alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the main principles of surgical access

A
  • Wide-based incision to allow maintenance of the circulation and perfusion to prevent the tissues from becoming necrotic
    • Use a scalpel in one firm continuous stroke so that the mucoperiosteum is lifted
    • No sharp angles as we don’t want thin strips of tissue that are at risk of necrosis
    • Adequate sized flap
    • Flap reflection should be down to bone and done cleanly as the more periosteum that is damaged the more pain
    • Minimise trauma to dental papillae
    • No crushing
    • Keep tissues moist
    • Ensure that flap margins and sutures will lie on sound bone as this will allow support to the soft tissues to heal well and prevent wound breakdown
    • Make sure wounds are not closed under tension
    • Aim for healing by primary intention to minimise scarring as more scarring is associated with secondary intention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do we do for a 3 sided flap

A
  • Common
  • Relieving incisions are made at a distance of one tooth unit each from the tooth treated
  • Involves a distal relieving incision, a crevicular incision and a mesial relieving incision
  • Don’t go too distal and there is risk of lingual nerve damage
  • Follow the external oblique ridge instead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do we do for an envelope flap

A
  • Pretty much the same as the 3 sided but there is no mesial relieving incision
    • The crevicular incision either extends to the midway along the 7 or even further
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does soft tissue retraction allow for

A
  • Allows for access to the operative field

* Allows for protection of the soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What facilitates retraction

A

flap design

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What instruments are used for soft tissue retraction

A

• The instruments used for this are Howarth’s periosteal elevator or rake retractor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we remove bone

A

often we do it by ‘guttering’’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does bone removal allow for

A

elevation
removal of the crown of the tooth
splitting the tooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the elevators

A

couplands, warwick james and cryers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the principles of use for elevators

A

○ They give a mechanical advantage
○ Avoid excessive force as there is a risk of jaw fracture
○ Support the instrument to avoid injury to the patient should the instrument slip
○ Ensure applied force is directed away from the major sutures e.g anturm, Id canal and the mental nerve
○ Always use elevators under direct vision
○ Nerve use an adjacent tooth as a fulcrum unless it too is to be extracted
○ Keep elevators sharp and in good shape, discard if blunt or bent
○ Establish an effective and logical point of application
○ Careful debridement after the use of elevators to remove any bone fragments that have been created

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the uses of elevators

A

o provide a point of application for forceps
○ To loosen teeth prior to using forceps
○ To extract a tooth without using forceps
○ Removal of multiple root stumps
○ Removal of retained roots
Removal of root apices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 3 basic actions of elevators

A

wheel and axle
wedge
lever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the wheel and axle motion

A

§ This is when you elevate the tooth to allow the point of the instrument to engage into the tooth and the opposite end sits on some bone and then elevate it out while rotating the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the wedge motion

A

§ In the majority of cases you need to incorporate some wheel and axle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the lever motion

A

§ Avoid if inexperienced

§ Risk of fracturing underlying bone if not done properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which action can be used

A

any

all 3 can be used in combination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the points of applications for elevators

A 
○ Mesial
		○ Buccal
		○ Distal
		○ Superior (upper teeth)
		○ Mesial/buccal alternately
		○ Inferior (lower teeth)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do we do physical debridement

A

○ Bone file or handpiece to remove sharp bony edges

○ Use a Mitchell’s trimmer or Victoria curette to remove soft tissue debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do we irrigate the socket

A

○ Sterile saline into socket and under flaps and use suction to remove debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is suction for during debridement and curettage

A

○ Aspirate under flap to remove debris

○ Check socket for retained apices etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is suturing done for

A

• Suturing is done to approximate tissues and compress blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the aims of suturing

A 
○ Reposition tissues
		○ Cover bone
		○ Prevent wound breakdown 
		○ Achieve haemostasis
		○ Encourage healing by primary intention
31
Q

What are the types of sutures

A

○ Non-absorbable
○ Absorbable
○ Monofilament
○ Polyfilament

32
Q

What are the absorbable sutures made of

A

synthetic polymer

33
Q

What are absorbable sutures for

A

Holds tissue edges together temporarily
Used if the removal of the suture is not possible or desirable
Review may not be required

34
Q

How are absorbable sutures broken down

A

○ Vicryl-breakdown occurs via absorption of water into filaments causing the polymer to degrade via hydrolysis
○ The glycolide and lactide copolymer are broken down to glyoclic and lactic acid which are absorbed and metabolised by the body
○ They last for a week or two

35
Q

What are examples of absorbable sutures

A

velosorb and vicrylrapide

36
Q

When are non absorbable sutures used

A

○ If extended retention periods are required these will be used
○ Must be removed postoperatively
○ Used for closure of an oral antral fistula or exposure of a canine tooth

37
Q

What are examples of non absorbable sutures

A

prolene and mersilk

38
Q

What are monofilament sutures

A

○ Single strand

39
Q

What are the advantages of monofilament sutures

A

Pass easily through tissues

Resistant to bacterial colonisation as its one material rather than the lots seen in poly which is at risk of wicking and moving a lot which can result in infection (not common though)

40
Q

What are polyfilament sutures

A

○ Several filaments twisted together

41
Q

What are examples of monofilament sutures

A

E.g are prolene and ethilon

42
Q

What are advantages of polyfilament sutures

A

○ Easier to handle

43
Q

What is the disadvantage of polyfilament sutures

A

Prone to wicking

Oral fluids and bacteria move along the length of the suture and can result in infection

44
Q

What are examples of polyfilament sutures

A

Velosorb and mersilk are examples

45
Q

What are different types of shapes of suture needles1/

A 
straight
1/2 circle (common)
1/2 curve
3/8 circle (common)
others exist too
46
Q

What is the cross sections for suture needles

A

can be triangular - can be cutting or reverse cutting

round (taper)

47
Q

How do you hold a suture needle

A

it has a swaged end, a body and a point

you grab the needle with a needle holder by the swaged end

48
Q

What are different ways of doing a suture for an 8 (3 sided flap)

A

1 on distal relieving incision, 2 on mesial reliving incision

1 on distal reliving incision, 1 on mesial reliving vision and 1 distal to 7

49
Q

How would you do the sutures for a envelope flap on an 8

A

1 on distal receiving incision and distal to 7

50
Q

How can haemostasis be achieved peri-operatively

A

○ LA with vasoconstrictor
○ Artery forceps
○ Diathermy
○ Bone wax

51
Q

How can haemostasis be achieved post-operatively

A 
○ Pressure
○ LA infiltration
○ Diathermy
○ WHVP
○ Surgicel
sutures
52
Q

What are the 4 nerves than can be damaged in removal of the third molars

A

lingual
inferior alveolar
mylohyoid
buccal

53
Q

Why is the lingual nerve at risk

A

it is above the lingual plate in 15-18% of cases

54
Q

When is the lingual nerve at risk

A 
□ Incision of flap
				□ Raising of buccal and lingual flaps
				□ Retraction of flap
				□ Bone removal
Extraction with forceps
55
Q

What is analgesia for removal of third molar

A

○ Ibuprofen
○ Paracetamol
Co-codamo

56
Q

What are complications of third molar removal

A 
○ Pain 
		○ Swelling
		○ Bruising
		○ Bleeding
		○ Trismus
		○ Infection
		○ Dry socket
		○ Paraesthesia/anaesthesia of the lip and chin with or without the tongue which can be temporary or permanent
57
Q

What is peri-radicular surgery

A

Done for endodontics, it is surgery to the external root surface

58
Q

When is peri-radicular surgery considered

A

This type of surgery is considered where previous endo tx has failed and re-root tx is the preferred option

59
Q

What are the stages of peri-radicular surgery

A
  1. LA
    1. Flap design
    2. Bone removal
    3. Curettage
    4. Apicectomy
    5. Retrograde prep and filling
    6. Wound closure
60
Q

What are the aims of peri-radicular surgery

A

○ Establish a root seal at the apex of a tooth or at the point of perforation of a lateral perforation

○To remove existing infection

61
Q

What are the possible flap designs

A

semi lunar
triangular (2 sided)
rectangular (3 sided)

62
Q

What is issues with semi lunar flap design

A 
reduced access
only good for apical lesions
scarring
dysesthesia due to transecting nerve fibres
less gingival recession
63
Q

How much bone removal is required for peri-raidulcar surgery

A

○ Depends one extent of the lesion - there may already be a breach in bone due to the infection
○ Try to be conservative and still allow access

64
Q

Describe the process of removing the apex in peri-radicular surgery

A

○ Remove 3mm
○ Minimal angle to allow visualisation
○ Try to keep cut at right angles to root to minimise surface area
○ Allows curettage

65
Q

What is root end preparation

A

○ Ultra sonic
§ Cleans canal
§ Creates 3mm preparation within canal
§ Removes contaminated root filling
○ Bur
§ Preparation usually out with confines of canal
§ Don’t use burs for inside the canal

66
Q

What materials can be used for retrograde seal

A

amalgam (historical)
zinc oxide/eugenol
MTA

67
Q

What are the advantages of zinc eugenol /oxide for retrograde seal

A

§ Cheap
§ Easy to use
§ Radiopaque
§ Bacteriostatic

68
Q

What are the disadvantages of zinc eugenol /oxide for retrograde seal

A

§ Sensitive to moisture
§ May resorb
§ Doesn’t promote cementogenesis

69
Q

What are the advantages of MTA for retrograde seal

A

§ Moisture resistant
§ Promotes cementogenesis
Very good seal

70
Q

What are the disadvantages of MTA for retrograde seal

A

§ Expensive
§ Long setting time
§ Difficult to use

71
Q

How is wound closure done for peri-radicular surgery

A

○ Resorbable or non-resorbable sutures
○ 4.0
○ Replace papilla first
Then relieving incision

72
Q

What are the post-op instructions and review for peri-radicular surgery

A

○ Standard post op instructions
○ Review and ROS at one week
○ Post-op radiographs between 1-6 weeks
○ Further review 3-6 months later

73
Q

What are the reasons for failure of peri-radicular surgery

A

inadequate seal
inadequate support
split roots
soft tissue defect over apex post-op

BDS3 CLINICAL Oral Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions