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BDS3 Oral Surgery > Basic Surgical Technique > Flashcards

Basic Surgical Technique Flashcards

1
Q

Basic principles of Surgery

A
  • Risk assessment involving good planning and MH
  • Aseptic technique
  • Minimal trauma to hard and soft tissues
  • Surgeon should be performed efficiently
  • Plan stages before embarking on procedure
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2
Q

What are the stages of Surgery?

A
  • Anaesthesia
  • Access
  • Bone removal as necessary
  • Tooth division as necessary
  • Debridement
  • Suture
  • Achieve haemostasis
  • Post-operative instructions
  • Post-operative medication
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3
Q

What do you do if the procedure is out of your depth?

A
  • Refer
  • Know own limitations
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4
Q

How to gain surgical access?

A
  • Wide-based incision- circulation
  • 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 (otherwise will break open)
  • Aim for healing by primary intention to
    minimise scarring
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5
Q

How to lift muco-periosteal flap?

A
  • Lift mucosa and periosteum
  • Strip it back until you see bone
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6
Q

Why do we use Soft tissue retraction?

A
  • Access to operative field
  • Protection of soft tissues
  • Flap design facilitates retraction
  • Howarth’s periosteal elevator or rake retractor
  • Should be done with care
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7
Q

What is a 3 sided flap?

A
  • Mesial incision
  • Incision following buccal margin
  • Distal incision
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8
Q

What is an envelope flap?

A
  • AKA 2 sided flap
  • Buccal incision along abutment tooth and tooth extracting
  • Distal incision
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9
Q

What to do if you need to use bone removal in order to remove tooth?

A
  • Electrical straight handpiece with saline
    cooled bur
  • Air driven handpieces may lead to surgical
    emphysema ( can be life threatening )
  • Round or fissure tungsten carbide burs
  • Protection of soft tissues

Steps not done in every case but in some

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10
Q

What is surgical emphysema?

A
  • Can be life threatening as can cause sepsis
  • Presence of gas in subcutaneous soft tissues
  • Detected clinically by swelling of affected area and crepitus on palpation
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11
Q

Where do you remove bone if needed?

A
  • Create a gutter of buccal bone next to tooth
  • If it doesn’t come out then need to divide the tooth
  • Start with crown
  • Then divide roots
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12
Q

What are the principles of use for Elevators?

A
  • Mechanical advantage
  • Avoid excessive force
  • Support the instrument to avoid injury to the
    patient should the instrument slip
  • Ensure applied force is direct away from major
    structures eg. antrum, ID canal, mental nerve
  • 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. 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
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13
Q

What is the motion used for elevators?

A
  • Wheel and axle
  • Wedge
  • Lever
  • Used in combo with each other
  • Avoid excessive force
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14
Q

What are some uses of elevtaors?

A
  • 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
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15
Q

What are the points of application of elevevators?

A
  • Mesial
  • Buccal
  • Distal
  • Superior (upper teeth)
  • Mesial/buccal alternately
  • Inferior (lower teeth)
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16
Q

What are the 3 methods for Debridement?

A

Physical
– Bone file or handpiece to remove sharp bony edges
– Mitchell’s trimmer or Victoria curette to remove soft
tissue debris

Irrigation
– Sterile saline into socket and under flap

Suction
– Aspirate under flap to remove debris

17
Q

What are the aims of suturing?

A
  • Approximate tissue (get back tissue to where it was)
  • Compress blood vessels
  • Reposition tissues
    – Cover bone
    – Prevent wound breakdown
    – Achieve haemostasis
    – Encourage healing by primary intention
18
Q

What are some different types of Sutures?

A
  • Non-absorbable
  • Absorbable
  • Can be polyfilament or monofilament
19
Q

When are non-absorbable sutures used?

A
  • If extended retention periods are required
    – Must be removed postoperatively
    – Closure of OAF or exposure of canine tooth
20
Q

What are polyfilament sutures?

A

– Several filaments twisted together
– Easier to handle
– Prone to wicking
- Oral fluids and bacteria move along the length
of the suture and can results in infection

21
Q

When are absorbable sutures used?

A

– Holds tissue edges together temporarily
– If removal of suture not possible/desirable
– Vicryl-breakdown via absorption of water into
filaments causes polymer to degrade
– May mean review is not required (usually review needed though)

22
Q

What is a monofilament suture?

A

– Single strand
– Pass easily through tissue
– Resistant to bacterial colonisation

23
Q

What are some different suture needles?

A

Curved
– ½ round is half the circumference of a circle

Cross section
– Triangular
- Tip of triangle on inside-cutting
- Tip of triangle on outside-reverse cutting*
– Round
- Not used in oral surgery

3/8 circle and 1/2 circle most used in oral surgery

24
Q

How to hold a suturing needle?

A
  • Point is pointy bit that goes into tissue first
  • Body (shaft) is where held by tweezers
  • Swaged end is where thread attaches to needle
25
Q

What are the peri-operative points to achieve Haemostasis?

A
  • LA with vasocontrictor (put more in if struggling with haemostasis)
    – Artery forceps
    – Diathermy
    – Bone wax
26
Q

What are post-operative points to achieve Haemostasis?

A

– Pressure
– LA infiltration
– Diathermy
– WHVP (not used anymore)
– Surgicel (most common)
– Sutures

27
Q

Post op medications

A
  • Medications not given as often as trying to reduce antibiotic resistance
  • Don’t tend to prescribe analgesics due to low prices and patient can buy themselves
28
Q

Why do you need to be careful of Lingual nerve during oral surgery?

A
  • Nerve is above lingual plate in 15-18% cases
    It is at risk during
    – Incision of flap
    – Raising of buccal and lingual flaps
    – Retraction of flap
    – Bone removal
    – Extraction with forceps
29
Q

What nerves do you need to be careful of during removal of third molars?

A

– Lingual (more commonly affected)
– Inferior alveolar (more commonly affected)
– Mylohyoid
– Buccal

30
Q

What are some complications of lower third molars?

A
  • Pain
  • Swelling
  • Bruising
  • Trismus
  • Paraesthesia/anaesthesia-lip/tongue
    Factor these into consent process and get them to sign notes
31
Q

What analgesia is useful for third molar removal?

A

– Ibuprofen
– Cocodamol
– Paracetemol

  • Chlorohexidine can also be given
32
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
- Curettage, enucleation of cyst
- Removal of apical part of root which may have
infected lateral canals

33
Q

What are the different flap designs?

A

Semi-lunar
– Reduced access
– Only good for apical lesions
– Scarring
– Dysaesthesia
– Less gingival recession

Triangular

Rectangular

34
Q

What materials do you use for a retrograde seal?

A
  • Zinc Oxide/eugenol
35
Q

Qualities of Retrograde seal?

A

– Cheap
– Easy to use
– Radiopaque
– Bacteriostatic
– Sensitive to moisture
– May resorb
– Doesn’t promote cementogenesis

36
Q

What are the steps for removal of apex?

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

BDS3 Oral Surgery (6 decks)

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