fractured teeth and retained roots Flashcards

1
Q

why do teeth fracture?

A
thick cortical bone
root shape
root number
hypercementosis
ankylosis
caries
alignment
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2
Q

dry socket/alveolar osteitis

A

blood clot forms inadequately/dislodged/broken down

will feel fine for 2-3 days then will get sore again

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3
Q

dry socket risk factors

A
smoking
female
OCP
lower jaw
further back in mouth
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4
Q

what are soft tissue elevators used for?

A

raise flaps

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5
Q

fickling forceps

A

used in GA to remove a throat pack - gauze put down throat to prevent aspiration

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6
Q

describing procedure to pt

A
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
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7
Q

risks

A
possible damage to adjacent teeth
pain
swelling
bruising
jaw stiffness
bleeding
dry socket
infection
risk nerve damage
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8
Q

surgery general principles

A

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

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9
Q

aims of ST retraction

A

access to operative field
protection of STs
flap design facilitates retraction

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10
Q

instruments for ST retraction

A

Howarth’s periosteal elevator
Bowlder-Henry rake retractor
care

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11
Q

what flaps can be done?

A

1 sided
2 sided
3 sided
crevicular and relieving incisions

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12
Q

relieving incision

A

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

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13
Q

bone removal

A

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

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14
Q

why shouldn’t you do lingual drilling?

A

dangerous - can slip and damage structures

tongue

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15
Q

what do you use for bone removal?

A

motorised electrical straight handpiece

40000 rpm, own water supply

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16
Q

debridement types

A

gently as otherwise will dislodge clot or damage a nerve
physical
irrigation
suction

17
Q

physical debridement

A

bone file or handpiece to remove sharp bony edges

Mitchell’s trimmer or Victoria curette to remove ST debris

18
Q

Mitchell’s trimmer

A

one side like a probe one side like a small excavator

19
Q

Victoria curette

A

2 big excavation type ends

20
Q

debridement - irrigation

A

sterile water/(saline) into socket and under flap

21
Q

debridement - suction

A

aspirate under flap to remove debris

check socket for retained apices etc

22
Q

aims of suturing

A
reposition tissues
cover bone
prevent wound breakdown
achieve haemostasis
encourage healing by primary intention
23
Q

suturing order

A

stitch papillae back in place first - keeps flap where you want it so easier to place other sutures

24
Q

suturing too tight?

A

will necroses and blanch as have cut off the blood supply

25
Q

types of sutures

A
resorbable
 - monofilament e.g. monocryl
 - multifilament e.g. velosorb, vicryl rapide
non-resorbable
 - monofilament e.g. prolene
 - multifilament e.g. mersilk
26
Q

when might you use non-resorbable monofilament?

A

in trauma on skin side

smooth so minimises scarring

27
Q

peri-op haemostasis

A

LA with vasoconstrictor
artery forceps
diathermy
bone wax

28
Q

post-op haemostasis

A
pressure
LA with vasoconstrictor
diathermy
Whitehead's varnish pack
surgicel - cellulose - helps to form a clot
sutures