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SP15 Oral Surgery > Complicated Exodontia > Flashcards

Complicated Exodontia Flashcards

1
Q

This is the delivery of the tooth requiring reflection of a flay, removal of bone and/or delivery of the tooth in multiple pieces

A

surgical extraction

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2
Q

What are the design parameters for soft tissue flaps

A

base broader than the margin

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3
Q

Where should the incision for soft tissue flaps be made

A

over intact bone

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4
Q

You can do this, if needed to avoid tearing involving soft tissue flaps

A

a releasing incision

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5
Q

The soft tissue flap margin should be where

A

NOT rest over an osseous defect; elevation over intact bone

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6
Q

True or False

a sharp incision heals better than tearing

A

True; so prevent tearing

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7
Q

This type of incision permits soft tissue reflection without tearing and should be over intact bone, but not an osseous prominence

A

vertical (oblique) releasing incision

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8
Q

What is meant by the vertical releasing incision is oblique

A

the base is broader than the apex

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9
Q

When making a vertical releasing incision, doing this helps with healing and suturing

A

crossing the gingival margin at the line angle of the tooth

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10
Q

This type of mucoperiosteal flap is sulcular in dentate patients and crestal in the edentulous area

A

envelope

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11
Q

This type of mucoperiosteal flap has a single vertical (oblique) release

A

three corner flap

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12
Q

This type of mucoperiosteal flap has two vertical releasing incisions

A

four cornered flap

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13
Q

This type of mucoperiosteal flap is limited in use besides the periapical surgery

A

semi-lunar

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14
Q

This type of mucoperiosteal flap has limited use besides access to bony palate for torus removal

A

“Y” incision

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15
Q

How should you make the incision

A

firm, with the scalpel blade contacting bone

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16
Q

How should you reflect the flap

A

with the sharp end of the periosteal elevator between the periosteum and bone
elevate along a broad front

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17
Q

What are the two principles of suturing

A

penetrate tissue with the needle perpendicular to tissue

follow curvature of needle as you pass through the tissue

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18
Q

Which direction should you suture

A

buccal to lingual

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19
Q

What are the four main indications for surgical extraction

A

avoiding need for excessive force
dense bone
exostosis
root morphology

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20
Q

What are three indications involving the patient that can indicate a surgical extraction

A

age - dense bone, ankylosis, atrophic PDL
genetic considerations - race
bruxism - dense bone

21
Q

What are six additional indications for surgical extractions

A 
endodontic therapy
deep caries
sinus proximity
compromised adjacent teeth
multiple extractions
impactions
22
Q

What are the six steps for an open extraction of a single rooted tooth

A
  1. flap
  2. determine need for bone removal
  3. grasp a small margin of bone with a forcep
  4. remove bone with a bur or chisel
  5. apical purchase
  6. irrigate well under the depth of the flap
23
Q

You should follow this when removing bone with a bur or chisel

A

the buccal trough

24
Q

What is the overall just of an open extraction of multi-rooted teeth

A

“divide and conquer”

idenitfy the furcation and divide the tooth through the plural floor into the furcation

25
Q

Which burs should be used to divide the tooth

A

fissure burs (701/703)

26
Q

Which structures should you avoid when dividing the tooth

A

violation of the sinus floor and lingual cortex

27
Q

When extracting multi-rooted teeth, how is the elevator used

A

to split teeth, root from root

elevate or luxate the different rooted segments

28
Q

Which maxillary root should you extract last

A

the palatal root, it tends to go into the sinus

29
Q

When removing roots fragments/tips, some roots will fracture due to what

A

due to unfavorable curvature

30
Q

This facilities delivery of the root fragments/tips

A

thorough mobilization prior to fracture

31
Q

True or False

You can remove bone to create space into which the root can be elevated

A

True

32
Q

What is the proper technique for using the root tip picks

A

push the fine tip apically to wedge root tip from socket or wedge the tip into PDL and “draw” vertical vector to remove root tip

33
Q

What kind of forces should be used to remove root fragments and tips

A

gently “tease” or “wiggle” out of socket

don’t use blunt apical force

34
Q

Which instrument do you use to remove buccal or radicular bone

A

a bur

35
Q

It is important to do this in order to engage the tooth with the forceps

A

create a space into which the root can be elevated or expose adequate tooth structure

36
Q

What are four instances in which it is okay to leave root tips

A

small pieces; <4mm
deeply embedded in bone
not an infected tooth
not mobile

37
Q

What are three questions to ask if attempting to recover the root tip will make things better or worse

A

destroy bone?
encroach or damage vital structures?
risk of displacement into the sinus, sublingual, or submandibular space

38
Q

What are five steps to take if leaving a root tip

A 
radiograph to confirm root presence
inform and counsel the patient
document in chart
refer if indicated
evaluate at recall appointments
39
Q

What are some instances when multiple extraction may occur

A

replacement; implant, bridge

pre-prostthetic; RPD/CD

40
Q

This theory regarding multiple extractions says this arch should be first because anesthetic is obtained first and has a shorter duration and so that debris do not fall into lower extraction sites

A

maxillary

41
Q

This theory regarding multiple extractions says that this arch should be first so that blood from the other does not drain into the field and so that the harder teeth are first

A

mandibular

42
Q

What is the sequence of multiple extractions

A

posterior to anterior

43
Q

True or False

When doing multiple extractions, you can extract all the teeth then go back for root tips

A

False, recover all the roots from one tooth before proceeding to the next

44
Q

What is the staging of the 1st molar and cuspid

A

there is dense bone over the 1st molar and cuspid so you may elect to mobilize the first molar and cuspid initially, then extract the adjacent teeth, then return to them

45
Q

It is important to preserve what

A

bone height and width

46
Q

If surgically approaching, attempt to maintain what

A

a 4-walled bony defect

47
Q

You can consider this for “socket preservation”

A

grafting

48
Q

it is important to maintain this contour

A

buccal plate

49
Q

Make sure that these are smooth

A

osseous processes

SP15 Oral Surgery (7 decks)

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