Basic Surgical Technique

Question 1

What is the rough stages of oral surgery from start to finish?

Answer 1

• LA/GA [anaesthesia]
• access
• bone removal as necessary
• tooth division as necessary
• debridement
• suture
• achieve haemostasis
• post op instructions to pt
• post op meds to pt

Question 2

what is the goal when obtaining surgical access?

Answer 2

• maximal access with minimal trauma
• bigger flaps heal just as quickly as smaller ones
• preserve adjacent soft tissues
• use scalpel in one firm stroke, no sharp angles, helps have a clean incision and reduce unnecessary trauma

Question 3

how do you achieve bone removal and tooth division?

Answer 3

• electrical straight handpiece with saline cooled bur
• round or fissure tungsten carbide burs

[USING AIR DRIVEN HANDPIECES MAY LEAD TO SURGICAL EMPHYSEMA - introduction of gasses into soft tissues, swollen tissues]

Question 4

what are the uses of elevators in oral surgery?

Answer 4

• provide mechanical advantage
• to loosen teeth prior to using forceps
• extract teeth without using forceps
• removal of multiple root stumps or retained roots
• removal of root apices
• FUNCTIONS AS A LEVER

Question 5

what is debridement and what types do you get in oral surgery?

Answer 5

removal of unwanted tissue

Physical:
- bone file or handpiece to remove sharp bone edges

Irrigation:
- Sterile saline into socket and under flap

Suction:
- Aspirate under flap to remove debris

Question 6

what is the goal with suturing?

Answer 6

• to connect the tissues so that healing is promoted (primary intention)
• compress blood vessels, haemostasis
• cover bone

Question 7

what are the 2 main types of sutures and how do they function?

Answer 7

Absorbable:
- holds tissue edges together
- vicryl breakdown causes the polymer filaments to degreade

Non-absorbable:
- holds tissue edges together
- must be REMOVED post operatively once tissues healed

Question 8

what’s the difference between monofilament and polyfilament sutures?

Answer 8

polyfilament:
- several filaments twisted together
- easier to handle but PRONE to wicking (infection prone)

monofilament:
- single stranded
- easy glide through tissues
- resistant to infection

Question 9

what are the properties of suture needles?

Answer 9

curved (allows for good insertion and mobility)

triangular cross section and sharp

Question 10

how can haemostasis be achieved peri-operatively?

Answer 10

• LA with vasoconstrictor
• artery forceps
• diathermy
• bone wax

Question 11

how can haemostasis be achieved POST-OPERATIVELY?

Answer 11

• pressure
• la infiltration, vasoconstrictor helps
• sutures and surgicel
• diathermy

Question 12

what are some nerves that may interfere with removal of third molars?

Answer 12

• lingual, inferior alveolar (more common)
• mylohyoid, buccal