Basic Surgical Technique Flashcards
basic principles
risk assessment - good planning & medical history
aseptic technique
minimal trauma to hard & soft tissues
stages of surgery
anaesthesia -> access -> bone removal as necessary -> tooth division as necessary -> debridement -> suture -> achieve haemostasis -> post op instruction + medication
surgical access
wide based incision - circulation
use scalpel in 1 firm continuous stroke
no sharp angles
adequate sized flap
flap reflection should be down to bone + done clearly
minimise trauma to dental papilla
no crushing
keep tissue moist
ensure flap margins & sutures will lie on sound bone
make sure wounds are not closed under tension
aim for healing by primary intention to minimise scarring
soft tissue retraction
access to operative field
protection of soft tissue
flap design to facilitate retraction
howarth’s periostea elevator used
bone removal and tooth division
electrical straight handpiece (no air) with saline cooled bur
air driven hand pieces can lead to surgical emphysema
round / fissure tungsten carbide burs
protection of soft tissues
principles of use of elevators
mechanical advantage
avoid excessive force
support instrument to avoid injury to ptx should it slip
ensure applied force is directed away from major structures i.e. antrum, ID canal, mental nerve
always use elevators under direct vision
never use adjacent tooth as a fulcrum unless it too is to be XLA
discard if blunt or bent
establish effective point of application
careful debridement after use to remove bone fragments
uses of elevators
provide point of application for forceps
loosen teeth prior to using forceps
xla of tooth without using forceps
removal of multiple root stumps
removal of retained roots
removal of root apices
3 basic actions
wheel & axle
wedge
lever
debridement
physical - bone file / handpiece to remove sharp bony edges, mitchell’s trimmer to remove soft tissue debris
irrigation - sterile saline into socket & under flap
suction - aspirate under flap to remove debris, check socket for retained apices etc
aims of suturing
reposition tissues
cover bone
prevent wound breakdown
achieve haemostasis
encourage healing by primary intention
non absorbable sutures
if extended retention periods are required
must be removed postoperatively
closure of OAF or exposure of canine tooth
polyfilament sutures
several filaments twisted together
easier to handle
prone to wicking - oral fluids / bacteria move along length of suture and can result in infection
absorbable sutures
holds tissue edges together temporarily
vicryl breakdown via absorption of water into filaments causing polymer to degrade
may mean review but not removal
monofilament sutures
single strand
pass easily through tissue
resistant to bacterial colonisation
2 types of suture needles
- curved
- cross section
peri operative haemostasis
LA with vasoconstrictor
artery forceps
diathermy
bone wax
post operative haemostasis
pressure
LA infiltration
diathermy
WHVP
surgicel
sutures
when is lingual nerve at risk
nerve is above lingual plate in 15-18% of cases
at risk:
incision of flap
raising of buccal and lingual flaps
retraction of flap
bone removal
extraction with forceps
when removing 3rd molars what can nerves can be damaged
lingual
inferior alveolar
mylohyoid
buccal
aims of periradicular surgery
establish a root seal at apex of tooth or at point of perforation of a lateral perforation
to remove existing infection e.g. curettage, enucleation of cyst, removal of apical part of root which may have infected lateral canals
options for flap design
semi-lunar -> reduced access, only good for apical lesions, scarring, dysesthesia, less gingival recession
triangular
rectangular
what is used for a retrograde seal in bone and why
zinc oxide-eugenol
- cheap & easy to use
- radiopaque
- bacteriostatic
- sensitive to moisture
- may resorb
- doesn’t promote cementogenesis
removal of apex
remove 3mm
minimal angle to allow visualisation
try to keep cut at right angles to root to minimise surface area
allow curettage
what is used for retrograde seal in apex and why
mineral trioxide aggregate
- moisture resistant
- promotes cementogenesis
- very good seal
however it is expensive, has long setting time & difficult to use
2 options for root end preparation
ultrasonic - cleans canal, creates 3mm prep within canal, removes contaminated root filling
bur - prep usually outwith confines of canal
wound closure after periradicular surgery
resorbable or non resorbable sutures 4.0
replace papillae first
then relieving incision
post periradicular op
standard post op instruction
review & ROS at 1week
post op radiograph between 1-6wks
further review 3-6mths
reasons why periradicular surgery fails
- inadequate seal; extra/bifid root, too little apex removed, seal of incorrect shape, lateral perforation problem, displacement of seal, lateral canals
- inadequate support; periodontal pockets, occlusal overload, excessive root resection
- split roots
- soft tissue defect over apex post op
