fractured teeth and retained roots Flashcards
why do teeth fracture?
thick cortical bone root shape root number hypercementosis ankylosis caries alignment
dry socket/alveolar osteitis
blood clot forms inadequately/dislodged/broken down
will feel fine for 2-3 days then will get sore again
dry socket risk factors
smoking female OCP lower jaw further back in mouth
what are soft tissue elevators used for?
raise flaps
fickling forceps
used in GA to remove a throat pack - gauze put down throat to prevent aspiration
describing procedure to pt
if tooth needs sectioning, describe - will feel like having a filling - similar drill water, noise, pressure, vibration but no pain give pt an idea of what to expect - pressure, no pain - lift gum up - possible drilling - dissolving stitches
risks
possible damage to adjacent teeth pain swelling bruising jaw stiffness bleeding dry socket infection risk nerve damage
surgery general principles
maximal access with minimal trauma
bigger flaps heal just as quickly as smaller ones
- size of incision doesn’t affect healing time (just swelling)
wide-based incision - circulation
use scalpel in one firm continuous stroke
- sliding rather than sawing action - a jaggy cut will scar more
no sharp angles
adequate sized flap
minimise trauma to dental papillae
- incise and raise v carefully so don’t cause recession
flap reflection should be down to bone and done cleanly - full thickness flap
no crushing
keep tissue moist - STs damaged if too dry
ensure that flap margins and sutures will lie on sound bone - plan ahead
make sure wounds are not closed under tension
- will cause tissue blanching and necrosis
aim for healing by primary intention to minimise scarring
aims of ST retraction
access to operative field
protection of STs
flap design facilitates retraction
instruments for ST retraction
Howarth’s periosteal elevator
Bowlder-Henry rake retractor
care
what flaps can be done?
1 sided
2 sided
3 sided
crevicular and relieving incisions
relieving incision
much easier to push a flap away than to pull towards
avoid nerves
incision line needs to go beyond jct of attached and unattached mucosa to give yourself enough access
bone removal
buccal gutter alongside the tooth you are trying to remove
can occasionally drill a molar to split up its two roots then can remove each one separately
cortical bone doesn’t bleed much, cancellous bone bleeds lots
why shouldn’t you do lingual drilling?
dangerous - can slip and damage structures
tongue
what do you use for bone removal?
motorised electrical straight handpiece
40000 rpm, own water supply
debridement types
gently as otherwise will dislodge clot or damage a nerve
physical
irrigation
suction
physical debridement
bone file or handpiece to remove sharp bony edges
Mitchell’s trimmer or Victoria curette to remove ST debris
Mitchell’s trimmer
one side like a probe one side like a small excavator
Victoria curette
2 big excavation type ends
debridement - irrigation
sterile water/(saline) into socket and under flap
debridement - suction
aspirate under flap to remove debris
check socket for retained apices etc
aims of suturing
reposition tissues cover bone prevent wound breakdown achieve haemostasis encourage healing by primary intention
suturing order
stitch papillae back in place first - keeps flap where you want it so easier to place other sutures
suturing too tight?
will necroses and blanch as have cut off the blood supply
types of sutures
resorbable - monofilament e.g. monocryl - multifilament e.g. velosorb, vicryl rapide non-resorbable - monofilament e.g. prolene - multifilament e.g. mersilk
when might you use non-resorbable monofilament?
in trauma on skin side
smooth so minimises scarring
peri-op haemostasis
LA with vasoconstrictor
artery forceps
diathermy
bone wax
post-op haemostasis
pressure LA with vasoconstrictor diathermy Whitehead's varnish pack surgicel - cellulose - helps to form a clot sutures
