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Oral Surgery I > EXAM II Surgical Exodontia > Flashcards

EXAM II Surgical Exodontia Flashcards

1
Q

what is a flap?

A

soft tissue outlined by surgical incisions

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2
Q

a flap should carry its own ___ supply

A

blood

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3
Q

flaps allow surgical access to ___

A

underlying tissues

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4
Q

can flaps be replaced into their original positions?

A

yes, and they are maintained with sutures

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5
Q

what is the significance of designing a flap with a base that is broader than the free margin?

A

it preserved adequate blood supply

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6
Q

what are some things that an appropriately sized flap can provide?

A
  • good visualization
  • adequate access for instruments
  • able to place retractor on bone and hold without tension
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7
Q

do straight incisions heal faster or slower than torn tissue?

A

faster

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8
Q

with the envelope flap design, how many teeth should be anterior to the tooth being worked on? what about posterior? why?

A

2 anterior, 1 posterior

because you’re usually coming into the mouth from the anterior, having more teeth anterior helps provide better visualization

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9
Q

how many teeth need to be anterior and posterior to the tooth being worked on in a releasing incision?

A

1 anterior and 1 posterior

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10
Q

what are the components of a full thickness flap?

A

mucosa, submucosa, and periosteum

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11
Q

what is the purpose of a full thickness flap?

A

to access bone, therefore subperiosteal

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12
Q

___ is the primary tissue for bone healing

A

periosteum

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13
Q

what component of full thickness flaps make them bleed less?

A

the area between bone and periosteum is less vascular, so there is less bleeding

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14
Q

incisions must be ___mm away from the defect, and need to be over intact ___

A
  • 6-8
  • bone
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15
Q

what should you avoid when creating a flap?

A

local structures, like lingual and mental nerves

mandibular 3rd molar - stay on the external oblique ridge

apical area of bicuspids - mental nerve

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16
Q

are mandibular or maxillary flaps safer and rarely endanger any vital structures?

A

maxillary

  • facial surface of maxillary alveolar process has no nerves or arteries to damage
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17
Q

what is the concern with palatal flaps?

A

blood supply from greater palatine and nasopalatine arteries - want to avoid these

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18
Q

when should releasing incisions be used?

A

only when necessary, for greater visualization

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19
Q

normally, a ___ releasing incision is enough, and is usually where?

A

single, anterior

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20
Q

releasing incisions should have a ___ angle, with the base ___ than the gingival margin

A
  • oblique
  • wider
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21
Q

why is it important not to cross bony prominences when making incisions?

A

tissue is very thin and can tear, causing necrosis

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22
Q

should an incision go through a papilla?

A

no, it should be anterior or posterior, but never through it

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23
Q

releasing incisions should cross the ___ at the ___, and should not be directly on ___ or ___

A
  • free gingival margin at the line angle of the tooth
  • facial aspect of the tooth or in the papilla
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24
Q

what are the 5 types of mucoperiosteal flaps?

A
  • envelope flap
  • vertical release
  • edentulous envelope flap
  • semi-lunar incision
  • palatal Y incision
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25
Q

the ___ flap is a sulcus incision to crestal bone through the periosteum, is a ___ thickness flap, and is usually sufficient for most procedures

A
  • envelope
  • full
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26
Q

vertical releases can create ___-corner and ___-corner flaps

A

3- and 4-corner flaps

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27
Q

what does the vertical release provide that the envelope flap by itself doesn’t?

A

greater access with a shorter sulcus incision

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28
Q

edentulous envelopes are made through a scar at the ___. what should you be careful of in this area? how long is the edentulous envelope? where does it reflect?

A
  • crest of the ridge (no vital structures)
  • need to be careful of the mental nerve, which may have “migrated” towards the crest due to atrophy of the bone
  • can be as long as required
  • can reflect buccal or lingual (need to be careful of thin, fragile lingual tissues)
29
Q

what is a semi-lunar flap used for?

A

apical surgery (limited root access)

30
Q

what is the palatal Y flap used for? where are the releasing incisions placed?

A
  • tori removal
  • releasing incisions anterior to cuspid at the junction of the greater palatine artery and nasopalatine artery
31
Q

in developing a mucoperiosteal flap, you should use a no.___ blade with a ___ grasp. the sulcus incision is from ___ to ___. the blade should be at what angle toward the tooth? use a ___ to reflect the flap at the anterior papilla and move from front to back. use the flat end of a ___ to finish the reflection and to retract the flap initially, then use a ___ to hold the flap.

A
  • 15
  • pen
  • posterior to anterior
  • slight angle (dulle easily)
  • no. 9 molt periosteal elevator
  • elevator
  • retractor (rest it on bone to avoid tearing or trapping soft tissue)
32
Q

how should you reflect tissue on a 3-corner flap?

A

start at anterior papilla pushing apically, then reflect crestal mucosa moving posteriorly

33
Q

what are some reasons you suture a flap?

A
  • coapt wound margins
  • control bleeding (hemostasis)
  • cover the bone to avoid necrosis
34
Q

when suturing a flap, why should you avoid tension on the flap?

A

to avoid retraction of wound edges, exposure of bone, and delayed healing

35
Q

what are the two resorbability types of suture material?

A

digestion (enzymes) and hydrolysis

36
Q

what are the two sources of suture material?

A

natural or synthetic

37
Q

what are the two filament types of suture material, and what are the characteristics of each?

A
  • unifilament (monofilament) - smooth surface, easy handling, reduces tissue trauma
  • multifilament - easier to tie, attracts bacteria (braided) and can be a source of infection
38
Q

what are common resorbable/natural sutures used in dentistry?

A

plain and chromic gut

39
Q

what are common resorbable/synthetic sutures used in dentistry?

A

dexon, vicryl, PDS (polydioxanone)

40
Q

what are common non-resorbable/natural sutures used in dentistry?

A

silk

41
Q

what are common non-resorbable/synthetic sutures used in dentistry?

A

nylon, polypropylene (prolene), ethibond, mersiline

42
Q

what is the basic suturing technique?

A
  • needle pass at right angle to mucosa
  • pass through papilla, 3-4mm bite; don’t suture across an empty socket
  • pass through mobile flap first (buccal), pick up needle and pass thorugh fixed mucosa (lingual)
  • don’t tie too tightly - approximate wound edges
43
Q

a prudently used ___ extraction technique may be more conservative and cause less operative morbidity compared with a ___ extraction

A
  • open (surgical)
  • closed
44
Q

what is the technique for surgical extraction of single rooted teeth?

A
  • provide adequate visualization: reflect flap
  • determine need for bone removal
    1. try to reseat forceps
    2. grasp a bit of buccal bone over root and remove along with root
    3. try straight elevator pushing it down the PDL; protect elevator from slipping with finger rest
    4. surgical bone removal over area of tooth
45
Q

describe bone removal over the area of a tooth

A
  • crestal bone
  • bone over root surface (width of root and 1/2-2/3 length of the root) and remove with straight elevator forceps
  • purchase point made in root at most apical portion deep enough for tip of elevator
46
Q

what should you do following tooth removal?

A
  • smooth sharp bone edges
  • debride and irrigate wound
  • replace flap and palpate (repeat above if not smooth)
  • suture
47
Q

the surgical extraction of multirooted teeth is the same surgical technique used for single rooted teeth except what?

A

the tooth may be divided to convert multirooted tooth into 2 or 3 single rooted teeth

48
Q

what is the surgical extraction technique if the crown is present?

A

want the crown to stay attached to one root, or split the crown and have it attached to both

49
Q

what is the surgical extraction technique if the crown is missing?

A

just divide the roots and extract them

50
Q

what are the steps of a surgical extraction of a mandibular molar?

A
  • envelope flap, direct visualization
  • remove crestal bone around the neck of the tooth
  • tooth sectioned buccolingually (mesial and distal halves)
  • luxate with straight elevators
  • remove with lower forceps or elevators
51
Q

what are two pointed elevators that can be used to elevate and remove roots?

A

crane pick and cryer elevator

52
Q

what are some considerations prior to extracting maxillary molars?

A
  • divergent roots, dilacerations
  • proximitry to sinus
  • severe caries
  • bulbous roots/hypercementosis
  • immediate implant placement
53
Q

how should you extract a maxillary molar if the crown is intact?

A
  • +/- flap
  • divide tooth into thirds through the furcations, keep crown on the palatal root if possible
  • section off other roots
  • remove palatal root first to get greater access to other roots
54
Q

how should you extract a maxillary molar if the crown is not present?

A
  • +/- flap
  • split roots
  • remove buccal root first so you can greater access to palatal root
55
Q

what are some possible complications from a molar extraction?

A
  • injury to IA, mental, or lingual nerves
  • tooth/root into sinus
  • oroantral fistula
  • sinusitis
  • tooth into infratemporal space
56
Q

what are the 2 requirements for the removal of root tips?

A

excellent light and excellent suction (also irrigation)

57
Q

if the apical 1/3 of a root is fractured, which extraction technique should you use (closed or open)? what does closed and open refer to?

A

either

58
Q

what are complications that can arise from the removal of root tips?

A

sinus, nerve, mylohyoid

59
Q

describe the open (surgical) technique for the removal of root tips

A
  • envelope flap +/- releasing incision
  • two types:
    • removal of buccal bone over root of tooth
    • open window technique
60
Q

when is it justifiable to leave a root tip?

A
  • root must be small, 5mm or less
  • root tip deeply embedded in bone, not superficial
  • tooth is not infected
  • risks of surgery are greater than benefit
61
Q

what are considerations in treatment planning for multiple extractions?

A
  • full or removable partial dentures, immediate dentures, interim dentures
  • implant restoration, socket grafting, immediate placement of implant
  • soft tissue surgery, tuberosity reduction, alveoloplast, undercuts or exostoses
  • surgical guide for implants
62
Q

should maxillary or mandibular teeth be extracted first? why

A
  • maxillary
  • LA has a more rapid onset and disappearance
  • during extraction, amalgam, fixed crowns, bone chips, etc. can fall into empty sockets of the mandible
63
Q

when extracting multiple teeth, should you start anterior and work posterior, or oppose? is there an exception?

A
  • opposite - start posterior and work toward the anterior
  • exception is that you always want to extract the canine last because it has the longest root and is sometimes difficult to remove; having adjacent teeth removed allows the socket to expand easier
64
Q

what is the extraction sequence for FMX?

A
  • maxillary posterior
  • maxillary anterior
  • maxillary canine
  • mandibular posterior
  • mandibular anterior
  • mandibular canine
65
Q

soft tissue reflections should not made on more than one ___ at a time

A

quadrant

66
Q

when extracting teeth, all teeth in the quadrant should be luxated with a ___ and then extracted with ___

A
  • elevator
  • forceps
67
Q

what should you do to the empty sockets after extraction?

A

compress them if you are not planning to place an implant

68
Q

after repositioning soft tissue following extractions, what should you do?

A
  • palpate the ridge for bone irregularities/spicules, alveoloplasty as needed, area irrigated, soft tissue redundancy removed/trimmed
  • suture with no overlap of soft tissue; interrupted or continuous sutures with removal in 1 week if needed

Oral Surgery I (13 decks)

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