Complicated Exodontia

Question 1

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

Answer 1

surgical extraction

Question 2

What are the design parameters for soft tissue flaps

Answer 2

base broader than the margin

Question 3

Where should the incision for soft tissue flaps be made

Answer 3

over intact bone

Question 4

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

Answer 4

a releasing incision

Question 5

The soft tissue flap margin should be where

Answer 5

NOT rest over an osseous defect; elevation over intact bone

Question 6

True or False

a sharp incision heals better than tearing

Answer 6

True; so prevent tearing

Question 7

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

Answer 7

vertical (oblique) releasing incision

Question 8

What is meant by the vertical releasing incision is oblique

Answer 8

the base is broader than the apex

Question 9

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

Answer 9

crossing the gingival margin at the line angle of the tooth

Question 10

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

Answer 10

envelope

Question 11

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

Answer 11

three corner flap

Question 12

This type of mucoperiosteal flap has two vertical releasing incisions

Answer 12

four cornered flap

Question 13

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

Answer 13

semi-lunar

Question 14

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

Answer 14

“Y” incision

Question 15

How should you make the incision

Answer 15

firm, with the scalpel blade contacting bone

Question 16

How should you reflect the flap

Answer 16

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

Question 17

What are the two principles of suturing

Answer 17

penetrate tissue with the needle perpendicular to tissue

follow curvature of needle as you pass through the tissue

Question 18

Which direction should you suture

Answer 18

buccal to lingual

Question 19

What are the four main indications for surgical extraction

Answer 19

avoiding need for excessive force
dense bone
exostosis
root morphology

Question 20

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

Answer 20

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

Question 21

What are six additional indications for surgical extractions

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

the buccal trough

Question 24

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

Answer 24

“divide and conquer”

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

Question 25

Which burs should be used to divide the tooth

Answer 25

fissure burs (701/703)

Question 26

Which structures should you avoid when dividing the tooth

Answer 26

violation of the sinus floor and lingual cortex

Question 27

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

Answer 27

to split teeth, root from root | elevate or luxate the different rooted segments

Question 28

Which maxillary root should you extract last

Answer 28

the palatal root, it tends to go into the sinus

Question 29

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

Answer 29

due to unfavorable curvature

Question 30

This facilities delivery of the root fragments/tips

Answer 30

thorough mobilization prior to fracture

Question 31

True or False | You can remove bone to create space into which the root can be elevated

Answer 31

True

Question 32

What is the proper technique for using the root tip picks

Answer 32

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

Question 33

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

Answer 33

gently "tease" or "wiggle" out of socket | don't use blunt apical force

Question 34

Which instrument do you use to remove buccal or radicular bone

Answer 34

a bur

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

What are five steps to take if leaving a root tip

Answer 38

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

Question 39

What are some instances when multiple extraction may occur

Answer 39

replacement; implant, bridge | pre-prostthetic; RPD/CD

Question 40

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

Answer 40

maxillary

Question 41

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

Answer 41

mandibular

Question 42

What is the sequence of multiple extractions

Answer 42

posterior to anterior

Question 43

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

Answer 43

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

Question 44

What is the staging of the 1st molar and cuspid

Answer 44

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

Question 45

It is important to preserve what

Answer 45

bone height and width

Question 46

If surgically approaching, attempt to maintain what

Answer 46

a 4-walled bony defect

Question 47

You can consider this for "socket preservation"

Answer 47

grafting

Question 48

it is important to maintain this contour

Answer 48

buccal plate

Question 49

Make sure that these are smooth

Answer 49

osseous processes