Basic Surgical Techniques Flashcards
What are the 3 basic principles for carrying out oral surgery?
- risk assessment
- aseptic technique
- minimal trauma to hard and soft tissues
In risk assessment for minor oral surgery, what should you consider?
- Need good planning
- Consider local anatomical structures (maxillary sinus, inferior alveolar canal etc.)
- Take a good medical history (looking for bleeding probs etc.)
- The benefits of the surgery must outweigh the risks
Can we have a completely aseptic technique in oral surgery?
No because the mouth contains so many micro-organisms but should do our best not to introduce any new organisms
Why do we want minimal trauma to hard and soft tissues?
leads to less post-operative pain, bruising, bleeding and complications
What kind of environment is desired for minor oral surgery?
A theatre environment is not required but there should be good cross-infection control (good PPE, surgical gowns and caps worn).
Why is radiological assessment so important in minor oral surgery?
- essential for safe surgery
- It helps you to assess the risk of a procedure e.g., seeing where the roots of wisdom teeth are in relation to the inferior alveolar nerve or assessing how close a root is to the maxillary antrum.
What are the stages fo surgery?
- -consent
- -surgical pause/safety checklist
- -anaesthesia
- -access
- Bone removal as necessary
- Tooth division as necessary
- Debridement/Wound Management
- Suture
- Achieve haemostasis
- Post-operative instructions
- Post-operative medication
- Follow-up
Explain the kind of consent needed for oral surgery?
- valid consent
- must have written consent where treatment involved consious sedation or GA (GDC standards)
-In GDH written consent for all oral surgery procedures
If getting written consent, what must you ensure?
That the written form is explained to the patient.
Otherwise, the signature means nothing
What is the surgical pause/safety checklist?
-a pause before anything happens to check the right patient is being treated, the procedure is considered and planned sufficiently
What is the most commonly used access flap?
A muco-periosteal flap
What is a muco-periostal flap?
- where you lift both the mucosa and vascular periosteum lying over the bone
- Dont want to leave the periosteum attached to the bone
You want to achieve maximum access with minimal trauma. How wide should you flap be? Why?
Opt for a wider flap to allow good access and visualisation
A wider flap headls just as quickly as a shoter one
If creating flaps in the anterior region, what do you want to consider?
- post op aesthetics
- scarring and recession
What are the 10 things you should consider when thinking about sirgical access?
- Wide-based incision
- Use scalpel in one firm continuous stroke
- No sharp angles
- Adequately 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
Why is a wide-based incision desireable?
-ensures there is still good circulation/perfusion in the flap and prevents necrosis of tissues
Why do you want to use the scalpel in one firm continuous stroke?
To minimise damage to underlying soft tissues
Why do you not want to close wounds under tension?
- likely the wound will break down
- less perfusion
- possible necrosis
Why do you want to aim for healing by primary intention?
Less scarring
What is the difference between primary and secondary intention healing?
- Primary intention is when the edges of a surgical incision are closed together with sutures/staples etc.
- Secondary intention is when a wound is left open to heal by granulation (proliferation) and remodelling
What is the most common type of surgical flap used for a wisdom tooth extraction?
a 3-sided flap
Where do you want your dital relieving incision to be for in a wisdom tooth removal and why?
More buccally placed in order to avoid damaging the lingual nerve
What is the most common retractor used for soft tissue retraction?
Howarths rake retractors (reflect light in too)
Why do we retract soft tissue?
Allows access and vision to operative field
Protects the soft tissues (dont want it getting caught in stuff)
What kind of handpiece is used for bone division and tooth removale in oral surgery?
An electrical straight handpiece with saline or sterlie water-cooled bur
Why do you not want to use an air-driven handpiece?
Can lead to surgical emphysema
What is surgical emphysema?
When air/gas is driven under the skin or mucosa - can cause things like eye damage and infections
When using elevators, what direction do you want the force applies?
Want the force directed away from any major structures (atrum, ID canal, mental nerve)
Note: dont want to displace the root into the antrum
Should you ever use the adjacent tooth as a fulcrum?
NO - unless it too is to be extracted
What are the possible uses of elevators?
- To provide a point of application for forceps
- To extract a tooth without the use of forceps
- Removal of retained roots
- To loosen teeth prior to using forceps
- Removal of multiple root stumps
- Removal of root apices
What are the 3 basic actions that can be used when using an elevator?
- wheel and axe
- wedge
- lever
Describe the wheel and axle movement.
- Primarily involves rotating the wrist when elevating the tooth to allow the point of the instrument to engage into the tooth while the opposite end sits on the bone and elevate wrist
Why do you want to avoid using a lever action?
Can fracture the underlying bone
When using elevators you want to avoid what kind of force?
Excessive force
What are the possible points of application of elevators?
- Mesial
- Buccal
- Distal
- Superior (upper teeth)
- Inferior (lower teeth
- Mesial/buccal alternately
What is debridement and curettage good for?
wound management and involves removal of dead tissue
What are the 3 different ways you can debride a wound?
- physical debridement
- irrigation
- suction
Describe physical debridement.
- Use a bone file or handpiece to remove any sharp bony edges
- Use of a Mitchell’s trimmer or Victoria curette to remove soft tissue debris
Describe irrigation in terms of wound debridement.
Use of sterile saline into socket and under flap to get rid of any debris
How would you use suction to aid debridement?
- Aspirate under the flap to remove debris
- Check socket for retained apices etc
What are the aims of suturing?
-want to approximate the tissues and compress the blod vessels to help with haemostasis
- Reposition tissues
- Cover bone
- Prevent wound breakdown
- Achieve haemostais
- Encourage healing by primary intention
What are the 2 different ways in which sutures can be classified?
- absorbable or non-absorbable
- monofilament or polyfilament
When are non-absorbable sutures used?
- if extended retention periods are required
- oral-antral fistulas or exposure of canine tooth
(they will need to be removed)
What are some examples of non-absorbable sutures?
- Prolene, Mersilk and Ethilon
Describe absorbable sutures and how they degrade. (when are they used)
- Holds tissue edges together temporarily
- Used if suture removal is not possible/desirable
- Vicryl-breakdown absorption of water into filaments causes polymer to degrade
Note: means that no review required unless there is a problem
What is an exmaple of an absorbable suture?
Velosob Fast
Describe monofilament sutures and their properties. (4)
- Single strand
- Pass easily through tissues
- Resistant to bacterial colonisation
- Tend to be the non-absorbable sutures
Describe polyfilament sutures and their properties. (4/5)
- Several filaments twisted together
- Easier to handle
- Prone to wicking
- Oral fluids and bacteria move along the lenth of the suture and can results in infection
- However, isnt common
- Tend to be the absorbable sutures
In cross sectiom ,suture needles are either what?
round (tapered) or triangular
Note: triangular corss section can be cutting needles or reverse cutting needles (look at notes)
What questions should you consider in the surgical appointment?
- What flap would you take and why?
- Where would you remove bone
- How would you elevate the root?
- What would you do next?
- Would you suture the wound and how?
- What post op instructions would you give?
- Would you give post op medications?
- Not done commonly
Why do teeth sometimes fracture during extractions?
- poor technique
- thick corticol bone (when expanding pocket more likely to fracture the tooth than the bone)
- root shape
- root number (more roots and divergent more likely)
- hypercementosis
- ankylosis
- caries (especially cervical)
- Alignment
Why don’t you want sharp angles in a flap nad suturing?
More likely to end up with necrosis
