Complicated Exodontia

Question 1

Delivery of tooth requiring reflection of flap, removal of bone and/or delivery in multiple pieces

Answer 1

Surgical Extraction

Question 2

Flap Design Parameters

Answer 2

-Base broader than free margin

Question 3

Where should flap incisions be made

Answer 3

• Over intact bone

- Should not rest over osseous defect

Question 4

• Soft tissue reflection without tearing
• Oblique–base is broader than apex
• Cross gingival margin at line angle
• Incision over intact bone, but not on osseous prominence

Answer 4

Vertical (oblique) releasing incision

Question 5

Which type of flap:

• Sulcular in dentate patient; crestal in edentulous area
• Most Common

Answer 5

Envelope Flap

Question 6

Which type of flap:

-Single vertical (oblique) release at gingival line angle

Answer 6

Three Cornered Flap

Question 7

Which type of flap:

• Two vertical releasing incisions
• Very Rare

Answer 7

Four Cornered Flap

Question 8

Which type of flap:

-limited use to periapical surgery

Answer 8

Semi-lunar Flap

Question 9

Which type of flap:

-Limited use for access to bony palate for torus removal

Answer 9

“Y” incision Flap

Question 10

What are the 3 steps of Flap Development

Answer 10

• Incision (firm, with scalpel contacting bone)
• Reflection (Sharp end of periosteal elevator between periosteum & bone; Elevate along a broad front)
• Retraction (Protect soft tissue)

Question 11

How to properly suture

Answer 11

Grab from buccal or palatal, wrap around twice (knot should be flat against touching tissue)

Question 12

Force used to remove root fragments & tips

Answer 12

Gently “tease” or “wiggle” out of socket

DO NOT use blunt apical forces

Question 13

Technique for Open Extraction of Single-Rooted Tooth

Answer 13

1. Flap
2. Determine need for bone removal
3. Grasp a small margin of bone with forcep
4. Remove bone with bur or chisel
5. Apical purchase
6. Irrigate well under depth of flap

Question 14

Technique for Open Extraction of Multi-Rooted Tooth

Answer 14

1. Divide & Conquer
2. Identify Furcation
3. Fissue Bur (703 & 701) to section–divide tooth through pulpal floor into furcation
4. Avoid violation of sinus floor or lingual cortex
5. “Split” tooth–root from root with straight elevator
6. Convert multi-rooted tooth into several single rooted pieces
7. Elevate or luxate and deliver root segments

Question 15

What is used to remove buccal or interradicular bone

Answer 15

A Bur; never use excessive force

Question 16

Standards that must be met to leave a piece of root in a socket

Answer 16

• Small piece (<4mm)
• Deeply embedded in bone
• Not an infected tooth–not pulp ally nor periodically
• Not mobile

Question 17

Why would you leave a root tip in a socket

Answer 17

Risk of removal is greater than leaving it in place**

• Destroys bone
• Encroach & Damage vital structures
• Risk of displacement–e.g. sinus, sublingual, submandibular space

Question 18

Tx planning –> Sequencing –> Technique

These are the steps to:

Answer 18

Multiple Extractions

Question 19

Besides the maxillary and mandibular first theories, in which neither are superior to the other, what is one general commonality when performing multiple extractions

Answer 19

Generally pulled from Posterior to Anterior