EXAM II Surgical Exodontia Flashcards
what is a flap?
soft tissue outlined by surgical incisions
a flap should carry its own ___ supply
blood
flaps allow surgical access to ___
underlying tissues
can flaps be replaced into their original positions?
yes, and they are maintained with sutures
what is the significance of designing a flap with a base that is broader than the free margin?
it preserved adequate blood supply
what are some things that an appropriately sized flap can provide?
- good visualization
- adequate access for instruments
- able to place retractor on bone and hold without tension
do straight incisions heal faster or slower than torn tissue?
faster
with the envelope flap design, how many teeth should be anterior to the tooth being worked on? what about posterior? why?
2 anterior, 1 posterior
because you’re usually coming into the mouth from the anterior, having more teeth anterior helps provide better visualization
how many teeth need to be anterior and posterior to the tooth being worked on in a releasing incision?
1 anterior and 1 posterior
what are the components of a full thickness flap?
mucosa, submucosa, and periosteum
what is the purpose of a full thickness flap?
to access bone, therefore subperiosteal
___ is the primary tissue for bone healing
periosteum
what component of full thickness flaps make them bleed less?
the area between bone and periosteum is less vascular, so there is less bleeding
incisions must be ___mm away from the defect, and need to be over intact ___
- 6-8
- bone
what should you avoid when creating a flap?
local structures, like lingual and mental nerves
mandibular 3rd molar - stay on the external oblique ridge
apical area of bicuspids - mental nerve
are mandibular or maxillary flaps safer and rarely endanger any vital structures?
maxillary
- facial surface of maxillary alveolar process has no nerves or arteries to damage
what is the concern with palatal flaps?
blood supply from greater palatine and nasopalatine arteries - want to avoid these
when should releasing incisions be used?
only when necessary, for greater visualization
normally, a ___ releasing incision is enough, and is usually where?
single, anterior
releasing incisions should have a ___ angle, with the base ___ than the gingival margin
- oblique
- wider
why is it important not to cross bony prominences when making incisions?
tissue is very thin and can tear, causing necrosis
should an incision go through a papilla?
no, it should be anterior or posterior, but never through it
releasing incisions should cross the ___ at the ___, and should not be directly on ___ or ___
- free gingival margin at the line angle of the tooth
- facial aspect of the tooth or in the papilla
what are the 5 types of mucoperiosteal flaps?
- envelope flap
- vertical release
- edentulous envelope flap
- semi-lunar incision
- palatal Y incision
the ___ flap is a sulcus incision to crestal bone through the periosteum, is a ___ thickness flap, and is usually sufficient for most procedures
- envelope
- full
vertical releases can create ___-corner and ___-corner flaps
3- and 4-corner flaps
what does the vertical release provide that the envelope flap by itself doesn’t?
greater access with a shorter sulcus incision
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?
- 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)
what is a semi-lunar flap used for?
apical surgery (limited root access)
what is the palatal Y flap used for? where are the releasing incisions placed?
- tori removal
- releasing incisions anterior to cuspid at the junction of the greater palatine artery and nasopalatine artery
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.
- 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)
how should you reflect tissue on a 3-corner flap?
start at anterior papilla pushing apically, then reflect crestal mucosa moving posteriorly
what are some reasons you suture a flap?
- coapt wound margins
- control bleeding (hemostasis)
- cover the bone to avoid necrosis
when suturing a flap, why should you avoid tension on the flap?
to avoid retraction of wound edges, exposure of bone, and delayed healing
what are the two resorbability types of suture material?
digestion (enzymes) and hydrolysis
what are the two sources of suture material?
natural or synthetic
what are the two filament types of suture material, and what are the characteristics of each?
- unifilament (monofilament) - smooth surface, easy handling, reduces tissue trauma
- multifilament - easier to tie, attracts bacteria (braided) and can be a source of infection
what are common resorbable/natural sutures used in dentistry?
plain and chromic gut
what are common resorbable/synthetic sutures used in dentistry?
dexon, vicryl, PDS (polydioxanone)
what are common non-resorbable/natural sutures used in dentistry?
silk
what are common non-resorbable/synthetic sutures used in dentistry?
nylon, polypropylene (prolene), ethibond, mersiline
what is the basic suturing technique?
- 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
a prudently used ___ extraction technique may be more conservative and cause less operative morbidity compared with a ___ extraction
- open (surgical)
- closed
what is the technique for surgical extraction of single rooted teeth?
- provide adequate visualization: reflect flap
- determine need for bone removal
- try to reseat forceps
- grasp a bit of buccal bone over root and remove along with root
- try straight elevator pushing it down the PDL; protect elevator from slipping with finger rest
- surgical bone removal over area of tooth
describe bone removal over the area of a tooth
- 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
what should you do following tooth removal?
- smooth sharp bone edges
- debride and irrigate wound
- replace flap and palpate (repeat above if not smooth)
- suture
the surgical extraction of multirooted teeth is the same surgical technique used for single rooted teeth except what?
the tooth may be divided to convert multirooted tooth into 2 or 3 single rooted teeth
what is the surgical extraction technique if the crown is present?
want the crown to stay attached to one root, or split the crown and have it attached to both
what is the surgical extraction technique if the crown is missing?
just divide the roots and extract them
what are the steps of a surgical extraction of a mandibular molar?
- 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
what are two pointed elevators that can be used to elevate and remove roots?
crane pick and cryer elevator
what are some considerations prior to extracting maxillary molars?
- divergent roots, dilacerations
- proximitry to sinus
- severe caries
- bulbous roots/hypercementosis
- immediate implant placement
how should you extract a maxillary molar if the crown is intact?
- +/- 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
how should you extract a maxillary molar if the crown is not present?
- +/- flap
- split roots
- remove buccal root first so you can greater access to palatal root
what are some possible complications from a molar extraction?
- injury to IA, mental, or lingual nerves
- tooth/root into sinus
- oroantral fistula
- sinusitis
- tooth into infratemporal space
what are the 2 requirements for the removal of root tips?
excellent light and excellent suction (also irrigation)
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?
either
what are complications that can arise from the removal of root tips?
sinus, nerve, mylohyoid
describe the open (surgical) technique for the removal of root tips
- envelope flap +/- releasing incision
- two types:
- removal of buccal bone over root of tooth
- open window technique
when is it justifiable to leave a root tip?
- 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
what are considerations in treatment planning for multiple extractions?
- 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
should maxillary or mandibular teeth be extracted first? why
- 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
when extracting multiple teeth, should you start anterior and work posterior, or oppose? is there an exception?
- 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
what is the extraction sequence for FMX?
- maxillary posterior
- maxillary anterior
- maxillary canine
- mandibular posterior
- mandibular anterior
- mandibular canine
soft tissue reflections should not made on more than one ___ at a time
quadrant
when extracting teeth, all teeth in the quadrant should be luxated with a ___ and then extracted with ___
- elevator
- forceps
what should you do to the empty sockets after extraction?
compress them if you are not planning to place an implant
after repositioning soft tissue following extractions, what should you do?
- 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
