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BDS3 - Oral Surgery > Basic Surgical Technique > Flashcards

Basic Surgical Technique Flashcards

1
Q

What are the basic principles before a surgical extraction?

A

-Risk assessment
-Aseptic technique
-Minimal trauma to hard tissues
Consider: the patient and their medical history, informed discussion, benefits vs risks, minimise trauma to hard and soft tissues to reduce complications of bleeding etc.

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2
Q

What are the stages of oral surgery?

A

Consent, surgical pause, anaesthesia, access, bone removal if necessary, tooth division as necessary, debridement, suture, achieve haemostasis, post op instructions, post op medication and follow up.

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3
Q

Do big or small flaps heal faster?

A

They heal the same.

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4
Q

What membranes must you lift when lifting a mucoperiosteal flap?

A

Mucosa AND periosteum.

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5
Q

What are the steps in gaining surgical access.

A
  • Wide-based incision circulation/perfusion
  • Use scalpel in one 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 tissues 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 (more scarring with secondary intention).
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6
Q

What is primary intention wound healing?

A

Primary intention is the healing of a clean wound without tissue loss. In this process, wound edges are brought together, so that they are adjacent to each other (re-approximated). Wound closure is performed with sutures (stitches), staples, or adhesive tape or glue.

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7
Q

What are the two types of incision for wisdom tooth removal?

A

3 sided and envelope incisions.

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8
Q

What incisions do you make in a 3 sided incision?

A

Mesial, crevicular and distal relieving incision.

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9
Q

What incisions do you make in an envelope incision?

A

Distal and crevicular relieving incision (extending to the 7).

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10
Q

What instruments can we use for soft tissue retraction?

A

Ash
Bowdler henry rake retractor
Howarth’s periosteal elevator
Rake retractor.

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11
Q

Why do we use soft tissue retraction?

A

To improve access to operative field
Protection of soft tissues
Flap design facilitates retraction.

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12
Q

What might air driven hand pieces lead to?

A

Surgical emphysema.

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13
Q

What hand piece do we use for bone removal and tooth division?

A

Electrical straight hand piece with saline/sterile water cooled bur.

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14
Q

What bur do you use for bone removal and tooth division?

A

Round or fissure tungsten or carbide burs.

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15
Q

What technique do you use for removing a crown or root of a tooth,

A

Buccal gutter.

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16
Q

What are the principles of use of an elevator?

A
  • Mechanical advantage
  • Avoid excessive forse
  • Support the instrument to avoid injury to the patient should the instrument slip
  • 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 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 closed.
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17
Q

What are the uses of elevators?

A
  • 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 and root apices.
18
Q

What are the three basic actions of using elevators?

A

Wheel and axle (rotate wrist when elevating tooth)
Wedge
Lever.

19
Q

What are the mechanics of using an elevator that we use at undergrad level?

A

Mesial, buccal or maybe distal.

20
Q

What are the three stages of debridement?

A
  1. Physical- bone file or hand piece to remove sharp bony pieces. Use Mitchell’s trimmer or Victoria curette to remove soft tissue debris.
  2. Irrigation- sterile saline into socket and under flap.
  3. Suction- aspirate under flap to remove debris. Check socket for retained apices.
21
Q

What are the aims of suturing?

A
  • Reposition tissues
  • Cover bone
  • Prevent wound breakdown
  • Achieve haemostasis
  • Encourage healing by primary intention.
22
Q

What are the two types of sutures?

A

Non-absorbable

Absorbable.

23
Q

What are examples of non-absorbable sutures and what are they used for?

A

Mersilk, prolene and ethlon (nylon). Must be removed after a certain period of time. Used for oro-antral fistula or exposure of a canine tooth.

24
Q

What are examples of absorbable sutures and what are they used for?

A

They hold tissue edges together temporarily. If removal of suture not possible or desirable. Vicryl breakdown via absorption of water into filaments causes polymer to degrade. Vicryl rapide or velosorb fast.

25
Q

What are the two sizes of sutures?

A

Polyfilament (several filaments twisted together, easier to handle, prone to wicking (oral fluids and bacteria move along the length of the suture and can result in infection)

Monofilament (single strand, pass easily through tissue, resistant to bacterial colonisation).

26
Q

What are the two sizes of suture needles we use in the dental hospital?

A

3/8 circle or 1/2 circle.

27
Q

What are the two cross section shapes of suture needles?

A

Triangular (tip of triangle on inside (cutting), tip of triangle on outside (reverse cutting))
Round (tapered).

28
Q

Where do you hold a suture needle?

A

1/3 from the swaged end of the needle.

29
Q

Where can you place sutures for a 3 sided incision?

A
  • 1 distal and 2 mesial

- 1 distal, 1 mesial and 1 between the 7 and removed 8.

30
Q

Where would you place sutures for an envelope incision?

A

-1 between the 7 and removed 8 and 1 distal suture.

31
Q

How can you achieve haemostasis peri-operatively?

A

La with vasoconstrictor
Artery forceps
Diathermy
Bone wax (closes bleeding in the holes in bone).

32
Q

How can you achieve haemostasis post-operatively?

A 
Pressure
La infiltration
Diathermy (cauterising)
WHVP
Surgicel (oxidising cellulose)
Sutures.
33
Q

What 4 nerves can be damaged by removing third molars?

A

Lingual (lower)
Inferior alveolar (lower)
Mylohyoid
Buccal.

34
Q

What procedures risk the lingual nerve being damaged?

A 
Incision of flap
Raising of buccal and lingual flap
Retraction of flap
Bone removal
Extraction with forceps.
35
Q

What are some complications of removing a third molar tooth?

A 
Pain
Swelling
Bruising
Bleeding
Trismus
Infection
Dry socket
Paraesthesia (temporary or permanent).
36
Q

What is the sequence of excising a mucocele (sac of saliva in response to trauma)?

A

Stretch mucosa
LA infiltration
Create an elipse incision just under the mucosa
USe blunt dissection to remove the lump to avoid the nerve endings
Gradually pull out lump
Place 3 sutures (one at top, one in the middle and one at the bottom of the excision)
Send lump to lab.

37
Q

What is the sequence of an oro-antral fistula repair?

A

Take radiograph to see breach in maxillary sinus
Inject LA
Place distal and mesial relieving incisions
Score the mucoperiosteum to allow the flap t stretch to close the communication (no tension closure)
Suture.

38
Q

What are the aims of peri-radicular surgery?

A
  1. To establish a root seal at the apex of a tooth or at the point of perforation of a lateral perforation
  2. To remove existing infection.
39
Q

What are the three flap designs for peri-radicular surgery?

A

Semi-lunar
Triangular (2 sided)
Rectangular (3 sided).

40
Q

How can you prepare a root end during peri-radicular surgery?

A

Ultrasonic (cleans canal, creates 3mm prep within canal, removes contaminated root filling)
Bur (prep usually out with confines of canal).

41
Q

What chemicals do you use for a retrograde seal during peri-radicular surgery?

A

Amalgam, zinc oxide or MTA (mineral trioxide aggregate).

42
Q

What are the reasons for failure of a peri-radicular surgery?

A

Inadequate seal
Inadequate support
Split roots
Soft tissue defect over apex post op.

BDS3 - Oral Surgery (7 decks)

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