Complicated Exodontia Flashcards
This is the delivery of the tooth requiring reflection of a flay, removal of bone and/or delivery of the tooth in multiple pieces
surgical extraction
What are the design parameters for soft tissue flaps
base broader than the margin
Where should the incision for soft tissue flaps be made
over intact bone
You can do this, if needed to avoid tearing involving soft tissue flaps
a releasing incision
The soft tissue flap margin should be where
NOT rest over an osseous defect; elevation over intact bone
True or False
a sharp incision heals better than tearing
True; so prevent tearing
This type of incision permits soft tissue reflection without tearing and should be over intact bone, but not an osseous prominence
vertical (oblique) releasing incision
What is meant by the vertical releasing incision is oblique
the base is broader than the apex
When making a vertical releasing incision, doing this helps with healing and suturing
crossing the gingival margin at the line angle of the tooth
This type of mucoperiosteal flap is sulcular in dentate patients and crestal in the edentulous area
envelope
This type of mucoperiosteal flap has a single vertical (oblique) release
three corner flap
This type of mucoperiosteal flap has two vertical releasing incisions
four cornered flap
This type of mucoperiosteal flap is limited in use besides the periapical surgery
semi-lunar
This type of mucoperiosteal flap has limited use besides access to bony palate for torus removal
“Y” incision
How should you make the incision
firm, with the scalpel blade contacting bone
How should you reflect the flap
with the sharp end of the periosteal elevator between the periosteum and bone
elevate along a broad front
What are the two principles of suturing
penetrate tissue with the needle perpendicular to tissue
follow curvature of needle as you pass through the tissue
Which direction should you suture
buccal to lingual
What are the four main indications for surgical extraction
avoiding need for excessive force
dense bone
exostosis
root morphology
What are three indications involving the patient that can indicate a surgical extraction
age - dense bone, ankylosis, atrophic PDL
genetic considerations - race
bruxism - dense bone
What are six additional indications for surgical extractions
endodontic therapy deep caries sinus proximity compromised adjacent teeth multiple extractions impactions
What are the six steps for an open extraction of a single rooted tooth
- flap
- determine need for bone removal
- grasp a small margin of bone with a forcep
- remove bone with a bur or chisel
- apical purchase
- irrigate well under the depth of the flap
You should follow this when removing bone with a bur or chisel
the buccal trough
What is the overall just of an open extraction of multi-rooted teeth
“divide and conquer”
idenitfy the furcation and divide the tooth through the plural floor into the furcation
Which burs should be used to divide the tooth
fissure burs (701/703)
Which structures should you avoid when dividing the tooth
violation of the sinus floor and lingual cortex
When extracting multi-rooted teeth, how is the elevator used
to split teeth, root from root
elevate or luxate the different rooted segments
Which maxillary root should you extract last
the palatal root, it tends to go into the sinus
When removing roots fragments/tips, some roots will fracture due to what
due to unfavorable curvature
This facilities delivery of the root fragments/tips
thorough mobilization prior to fracture
True or False
You can remove bone to create space into which the root can be elevated
True
What is the proper technique for using the root tip picks
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
What kind of forces should be used to remove root fragments and tips
gently “tease” or “wiggle” out of socket
don’t use blunt apical force
Which instrument do you use to remove buccal or radicular bone
a bur
It is important to do this in order to engage the tooth with the forceps
create a space into which the root can be elevated or expose adequate tooth structure
What are four instances in which it is okay to leave root tips
small pieces; <4mm
deeply embedded in bone
not an infected tooth
not mobile
What are three questions to ask if attempting to recover the root tip will make things better or worse
destroy bone?
encroach or damage vital structures?
risk of displacement into the sinus, sublingual, or submandibular space
What are five steps to take if leaving a root tip
radiograph to confirm root presence inform and counsel the patient document in chart refer if indicated evaluate at recall appointments
What are some instances when multiple extraction may occur
replacement; implant, bridge
pre-prostthetic; RPD/CD
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
maxillary
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
mandibular
What is the sequence of multiple extractions
posterior to anterior
True or False
When doing multiple extractions, you can extract all the teeth then go back for root tips
False, recover all the roots from one tooth before proceeding to the next
What is the staging of the 1st molar and cuspid
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
It is important to preserve what
bone height and width
If surgically approaching, attempt to maintain what
a 4-walled bony defect
You can consider this for “socket preservation”
grafting
it is important to maintain this contour
buccal plate
Make sure that these are smooth
osseous processes
