complicated exodontia

Question 1

flap

Answer 1

1 )section of soft tissue
2) outlined by a surgical incision
3) carries its own blood supply
4) allows surgical access to underlying tissues
5) can be replaced in its original position
6) can be maintained with sutures

Question 2

envelope flap

Answer 2

1) non releasing

Question 3

three corner flap

Answer 3

1) one releasing incision forward
2) one non releasing behind
3) dangerous, do not do without faculty supervision
- vascular and nerve anatomy

Question 4

full thickness mucoperiosteal flaps

Answer 4

1) envelope flaps are most useful in dentoalveolar surgery
2) two papilla forward and one back in posterior
3) one forward and back in the anterior

Question 5

avoid injury

Answer 5

1) never make a flap over soft tissue
- ONLY when there is bone underneath
- tap with a probe to make bleeding points
2) 3rd molar region has the danger zone
- lingual nerve is there and lots of vasculature
3) vertical incisions in palate
- avoid the greater palatine artery

Question 6

sulcular incision

Answer 6

1) envelope flap
2) edentulous patients require supracrestal incision for optimum closure
3) fibrous keratinized tissue is difficult to reflect

Question 7

three corner flap

Answer 7

1) one vertical releasing incision for improved apical access
- caution with verticals!

Question 8

four cornered flap

Answer 8

1) two vertical releases
2) apical aspect must be wider than the occlusal to maintain blood supply

Question 9

developing a flap

Answer 9

1) #15 blade
2) make the incision drawing the blade toward the operator
3) use one smoot stroke and contact the bone for the incision
4) no button holing
5) tilt blade 30 degrees out from line angle
6) #9 molt begin with the sharp end then go to the broad end

Question 10

suturing

Answer 10

1) hold the flap in position and approximate wound edges
2) hold soft tissue flap over bone
3) maintain material in the extraction socket
- figure 8
4) half a centimeter from papilla

Question 11

open extractions

Answer 11

1) surgical extraction IF
- removal of bone
- section of teeth
2) may be more conservative
3) may cause less operative morbidity

Question 12

indications for open extraction

Answer 12

1) fractured teeth
2) endo teeth
- atrophy of PDL and are ankylosed
3) dilacerated root
4) root fragment with no evidence of bone loss
5) hypercementosis or bulbous root
6) carious destruction of coronal aspect of tooth
7) no evidence of bone loss in mature alveolar bone

Question 13

techniques

Answer 13

1) application for forceps to tooth not bone
2) forceps, elevators, ronjeurs
3) molt to hold flap in place
4) decision can be made regarding removing bone

Question 14

multi rooted teeth open extraction

Answer 14

1) divide section teeth
- do not cut more than 50% in mandibular
- maxillary sectioned in T or Y, crown attached to palatal root is edeal
2 )remove bone
3) if no movement
- divide again
- remove more bone
4) movements
- luxate
- elevate
- cut off crown
- section
- deliver three roots

Question 15

cyer/ east and west elevators

Answer 15

1) not on basic tray
2) used with wheel and axle force
3) helpful for large mandibular molar roots after sectioning
4) use #9 molt for flap retraction
5) can use in closed technique

Question 16

remove root tips

Answer 16

1) uses root tip elevators on closed technique

Question 17

justification for leaving root fragments

Answer 17

1) small fragment enclosed by bone
2) must not be infected
3) must not have a radiolucency around the apex
4) risk of injury to vital structures outweigh benefits of removal

Question 18

treatment planning multiple extractions

Answer 18

1) review of medical history and objective findings indicate the number of extractions
2) immediate denture treatment plan
- removal of posterior teeth first
- posterior stop is left to maintain VDO
- dentures are delivered at extraction of anterior teeth
3) treatment plan by quadrant
4) at dental school, avoid bilateral IA blocks attempting extractions in two quadrants

Question 19

wound healing

Answer 19

1) early vasoconstriction, later vasodilation
2) swelling peaks at 4-5 days