Basic Surgical Technique 1+2 Flashcards
What are the basic principles of surgical technique?
3
Risk assessment through planning and reviewing medical history.
Aseptic technique.
Minimizing trauma to hard and soft tissues.
Is a theatre environment always required for surgical procedures?
No, but cross-infection control is essential.
What is the role of radiological assessment in surgical planning?
It helps in evaluating anatomy, pathology, and potential complications before surgery.
List the stages of surgery in order.
Consent.
Surgical Pause/Safety Checklist.
Anaesthesia.
Access.
Bone removal as necessary.
Tooth division as necessary.
Debridement/Wound Management.
Suture.
Achieve haemostasis.
Post-operative instructions.
Post-operative medication.
Follow-up.
What should you consider when raising a flap during surgery?
Maximal access with minimal trauma.
Bigger flaps heal as quickly as smaller ones.
Preserve adjacent soft tissues.
Consider postoperative aesthetics.
What are the principles of surgical access?
Wide-based incisions for adequate circulation.
Use a scalpel in a firm, continuous stroke.
Avoid sharp angles, ensure adequate flap size.
Reflect flaps cleanly to the bone and minimize trauma.
Ensure flap margins lie on sound bone and wounds close without tension.
Why is soft tissue retraction critical in surgery?
what tool is used
It ensures access to the operative field, protects soft tissues, and is facilitated by proper flap design.
howarth’s periosteal elevator or rake retractor
What tools are used for bone removal and tooth division?
Electrical straight handpiece with saline or sterile water-cooled bur.
Round or fissure tungsten carbide burs.
Avoid air-driven handpieces to prevent surgical emphysema.
What are the principles for using elevators?
Use mechanical advantage without excessive force.
Support instruments to avoid injury.
Avoid adjacent teeth as fulcrums unless being extracted.
Always use sharp and well-maintained elevators.
Direct force away from major structures
What are the uses of elevators?
provide point of application in forceps
to loosen teeth prior to using forceps
to extract teeth without forceps
removal of multiple root stumps
removal of retained roots
removal of root apices
How is debridement performed post-extraction?
Physical: Use bone files, handpieces, or Mitchell’s trimmer to remove debris and bony edges
Irrigation: Flush socket and flap with sterile saline.
Suction: Remove debris and check for retained apices.
What are the aims of suturing?
Reposition tissues, cover bone, prevent wound breakdown, achieve haemostasis, and encourage healing by primary intention.
Differentiate between non-absorbable and absorbable sutures.
Non-absorbable: For extended retention; must be removed postoperatively. i.e closure of OAF
Absorbable: Temporary; breakdown via water absorption (e.g., Vicryl).
Compare monofilament and polyfilament sutures.
Monofilament: Single strand, resists bacterial colonization, passes easily through tissue.
Polyfilament: Twisted filaments, easier to handle, prone to wicking (increased infection risk).
What are the different cross-sections of suture needles?
Triangular: Cutting tip on inside.
Reverse Cutting: Cutting tip on outside.
Round (Taper): Non-cutting, for delicate tissues.
How can haemostasis be achieved during and after surgery?
Peri-operative: Use LA with vasoconstrictor, artery forceps, diathermy, or bone wax.
Post-operative: Apply pressure, use LA infiltration, diathermy, WHVP, Surgicel, or sutures.
What are critical post-operative instructions for patients?
Maintain hygiene, avoid disturbing the site, manage pain with prescribed medication, and seek immediate help for excessive bleeding or infection signs.
Why is follow-up important in surgical care?
To ensure proper healing, manage complications, and remove sutures if non-absorbable types were used.
What key questions should be considered when planning a surgical extraction?
What flap design is needed? - Based on access and nerve protection.
Where should bone removal be performed? - Minimal but sufficient for root elevation.
How should the root be elevated? - Using controlled force and correct instruments.
What are the next steps? - Checking for root fragments, irrigation.
How should the wound be sutured? - Type of suture, technique.
What post-op instructions should be given? - Pain control, hygiene, activity limitations.
Are post-op medications needed? - Analgesia, antimicrobial mouthwash.
What nerves are at risk during third molar surgery and why?
Lingual nerve (most at risk) – Positioned above the lingual plate in 15-18% of cases. At risk during flap incision, elevation, retraction, bone removal, and extraction.
Inferior alveolar nerve – Runs close to the lower third molar roots. Risk during osteotomy and elevation.
Mylohyoid nerve – Less commonly affected, at risk during deep dissections.
Buccal nerve – Can be stretched or damaged during retraction.
What are the major complications following lower third molar surgery?
Pain – Controlled with NSAIDs (ibuprofen, paracetamol, co-codamol).
Swelling – Peak at 48-72 hours due to inflammatory response.
Bruising – More common in older patients.
Bleeding – Initial pressure helps; consider suturing if persistent.
Trismus – Due to muscle trauma, worsened by infection.
Infection – Increased with poor hygiene and smoking.
Dry socket – Due to fibrinolysis of clot; risk factors include smoking and difficult extraction.
Nerve injury – Temporary or permanent paraesthesia/anesthesia of lip, chin, or tongue.
What are the key considerations when repairing an OAF?
Primary closure using buccal advancement flap – Most common technique.
Avoid excessive tension – Ensures better healing.
Post-op advice – Avoid nose blowing, use decongestants if needed.
Why is scoring the mucoperiosteum important in surgical procedures?
Allows better flap advancement.
Reduces tension at the suture line.
Prevents wound dehiscence.
Aids in primary closure, especially for OAF repairs.
What are the key aims and steps in peri-radicular surgery?
types of flap design
Aims: Remove infection, establish an apical seal, and prevent reinfection.
Flap design:
Semi-lunar flap: Limited access, risk of scarring, used for small apical lesions.
Triangular/Rectangular flap: Better access, preferred for larger surgeries.
Bone removal: Conservative approach to maintain stability.
Apical resection:
Remove 3mm to eliminate infected canals.
Keep resection perpendicular to the root to reduce surface area.
Root-end preparation:
Ultrasonic: Creates 3mm cavity, removes contaminants.
Bur: Less precise, risks over-preparation.
Retrograde filling materials:
MTA (Mineral Trioxide Aggregate): Best seal, promotes healing, expensive.
Zinc oxide-eugenol: Cheaper, but moisture-sensitive and may resorb.
Wound closure:
Use 4.0 sutures.
Replace papillae first to maintain aesthetics.
What are common reasons for peri-radicular surgery failure?
Poor seal: Inadequate root-end filling.
Missed anatomy: Extra roots or lateral canals.
Structural issues: Excessive root resection, split roots.
Soft tissue defects: Post-op exposure over the apex.
What is post op care for periradicular surgery?
Standard post op instructions
Follow-up at 1 week (ROS check).
Post-op radiograph at 1-6 weeks.
Further review at 3-6 months.
What are the reasons for failure?
Inadequate seal
* Extra root or bifid root
* Too little apex removed (“finning”)
* Seal of incorrect shape
* Lateral perforation problem
* Displacement of seal
* Lateral canals
Inadequate support
* Occlusal overload,
* Periodontal pockets,
* Excessive root resection
Split roots
Soft tissue defect over apex post op
