Basic Surgical Technique Flashcards
What are the basic principles of surgical technique?
Risk assessment
Aseptic technique
Minimal trauma to hard and soft tissues
What are the stages of surgery?
Consent
Surgical pause/safety checklist
Anaesthesia
Access
Bone removal as necessary
Tooth division as necessary
Debridement/wound management
Suture
Achieve haemeostasis
Post-op instructions
Post-op medication
Follow up
What is important in surgical access?
Maximal access with minimal trauma
Bigger flaps heal just as quickly as smaller ones
Preserve adjacent soft tissue
Consider post operative aesthetics
What are other important factors in surgical access?
Wide-based incision for circulation and perfusion
Use scalpel in one firm continuous stroke
No sharp angles
Adequate sized flap
Flap reflection should be down to bone and done cleanly
Minimise trauma to dental papillae
No crushing
Keep tissue moist
Ensure that flap margins and sutures will lie on sound bone
Make sure wounds are not closed under tension
Aim for healing by primary intention to minimise scarring
What is important in soft tissue retraction?
Access to operative field
Protection of soft tissues
Flap design facilitates retraction
Use Howarth’s periosteal elevator or rake retractor
Should be done with care
What are the different types of mucoperiosteal flaps?
3 sided
Envelope
How should bone removal be carried out?
Using an electrical straight handpiece with saline cooled bur
Air driven handpiece may lead to surgical emphysema
Use round or fissure tungsten carbide burs
Protect soft tissues
What are the principles of use of elevators?
Mechanical advantage
Avoid excessive force
Support the instrument to avoid injury to the patient should the instrument skip
Ensure applied force is direct away from major structures
Always use elevators under direct vision
Never use an adjacent tooth as a fulcrum unless it too is to be extracted
Keep elevators sharp and in good shape
Establish an effective and logical point of application
Careful debridement after the use of elevators to remove any bone fragments that have been created
What are the uses of elevators?
To provide a point of application for forceps
To loosen teeth prior to using forceps
To extract a tooth without the use of forceps
Removal of multiple root stumps
Removal of retained roots
Removal of root apices
What are the basic elevator actions?
Wheel and axle
Wedge
Lever
Where are the points of activation for elevators?
Mesial
Buccal
Distal
Superior - upper teeth
Inferior - lower teeth
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 Debridement
Sterile saline into socket and under flap
Describe Suction Debridement
Aspirate under flap to remove debris
Check socket for retained apices etc
What are the aims of suturing?
Reposition tissues
Cover bone
Prevent wound breakdown
Achieve haemeostasis
Encourage healing by primary intention
Describe non-absorbable sutures
Must be removed post-operatively
Required if there are extended retention periods
Used for closure of OAF or exposure of canine tooth
Describe polyfilament sutures
Easier to handle
Composed of several filaments twisted together
Prone to wicking - oral fluids and bacteria move along the length of the suture and can result in infection
Describe absorbable sutures
Hold tissue edges together temporarily
Vicryl-breakdown via absorption of water into filaments causes polymer to degrade
Describe monofilament sutures
Single strand
Pass easily through tissue
Resistant to bacteria colonisation
What suture needles are most commonly used?
1/2 circle
3/8 circle
What are the different cross sections of suture needles?
Triangle
Round
What are the parts of a suture needle?
Staged end
Body (shaft)
Point
How can peri-operative haemeostasis be achieved?
Use an LA with a vasoconstrictor
Rare - use artery forceps
Diathermy - cauterise blood vessels
Bone wax
How can post-operative haemostasis be achieved?
Pressure
LA infiltration
Diathermy
Surgical
Sutures
What nerves can be damaged in third molar removal?
Lingual
Inferior alveolar
Mylohyoid
Buccal
When is the lingual nerve at risk?
Incision of flap
Raising of buccal and lingual flaps
Retraction of flap
Bone removal
Extraction with forceps
What are the complications of lower third molar removal?
Pain
Swelling
Bruising
Trismus
Paraesthesia/anaesthesia lip/tongue
