Complicated Exodontia Flashcards
Delivery of tooth requiring reflection of flap, removal of bone and/or delivery in multiple pieces
Surgical Extraction
Flap Design Parameters
-Base broader than free margin
Where should flap incisions be made
- Over intact bone
- Should not rest over osseous defect
- 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
Vertical (oblique) releasing incision
Which type of flap:
- Sulcular in dentate patient; crestal in edentulous area
- Most Common
Envelope Flap
Which type of flap:
-Single vertical (oblique) release at gingival line angle
Three Cornered Flap
Which type of flap:
- Two vertical releasing incisions
- Very Rare
Four Cornered Flap
Which type of flap:
-limited use to periapical surgery
Semi-lunar Flap
Which type of flap:
-Limited use for access to bony palate for torus removal
“Y” incision Flap
What are the 3 steps of Flap Development
- Incision (firm, with scalpel contacting bone)
- Reflection (Sharp end of periosteal elevator between periosteum & bone; Elevate along a broad front)
- Retraction (Protect soft tissue)
How to properly suture
Grab from buccal or palatal, wrap around twice (knot should be flat against touching tissue)
Force used to remove root fragments & tips
Gently “tease” or “wiggle” out of socket
DO NOT use blunt apical forces
Technique for Open Extraction of Single-Rooted Tooth
- Flap
- Determine need for bone removal
- Grasp a small margin of bone with forcep
- Remove bone with bur or chisel
- Apical purchase
- Irrigate well under depth of flap
Technique for Open Extraction of Multi-Rooted Tooth
- Divide & Conquer
- Identify Furcation
- Fissue Bur (703 & 701) to section–divide tooth through pulpal floor into furcation
- Avoid violation of sinus floor or lingual cortex
- “Split” tooth–root from root with straight elevator
- Convert multi-rooted tooth into several single rooted pieces
- Elevate or luxate and deliver root segments
What is used to remove buccal or interradicular bone
A Bur; never use excessive force
Standards that must be met to leave a piece of root in a socket
- Small piece (<4mm)
- Deeply embedded in bone
- Not an infected tooth–not pulp ally nor periodically
- Not mobile
Why would you leave a root tip in a socket
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
Tx planning –> Sequencing –> Technique
These are the steps to:
Multiple Extractions
Besides the maxillary and mandibular first theories, in which neither are superior to the other, what is one general commonality when performing multiple extractions
Generally pulled from Posterior to Anterior
