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instrumentation and sutures Flashcards

1
Q

INCISING TISSUE tools

A
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2
Q

ELEVATING TISSUE tools

A

WOODSON NO. 1
MOLT NO. 9

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3
Q

name? used for?

A

WOODSON NO. 1
* For interdental papillas, attached gingiva,
crestal periodontal fibers

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4
Q

name/used for?

A

MOLT NO. 9
* Pointed end for interdental papilla
* Broad end for free alveolar mucosa elevation and flap retraction

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5
Q

TECHNIQUES FOR ELEVATING MUCOPERIOSTEUM

A

* Push stroke
* Most common technique used, especially when combined with rolling/lifting component

* Rolling/lifting
* Good for interdental papilla

* Pull stroke
* Not used too often as it tends to tear and shred periosteum

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6
Q

name/use

A
  • Seldin retractor
  • Great for tongue retraction, and flap retraction
  • Not used as a periosteal elevator (blunt ends)
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7
Q

NAME/USE

A
  • Minnesota retractor
  • Cheek, flap retractor
  • Workhorse of retractors in OMS
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8
Q

name/use

A
  • Wieder retractor, a.k.a. “Sweetheart” retractor
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9
Q

name/use

A
  • Hemostat: control hemmorhage
  • Crile, Kelly, Halstead (a.k.a. “mosquito”)
  • Straight or curved
  • Handle with locking device once vessel is clamped
  • Also used for removing granulation tissue or small root tips
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10
Q

name/use

A
  • Burnisher
  • Any flap instrument for compressing bone around a nutrient vessel, control hemmorhage
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11
Q

GRASPING TISSUE tools

A

ADSON FORCEPS
BROWN FORCEPS
allis forceps

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12
Q

name/use

A

ADSON FORCEPS
* Three teeth opposed
* Stabilize tissue while passing suture needle
* Not good for grasping needle
* Used on skin

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13
Q

name/use

A

BROWN FORCEPS
* Multiple serrated tips
* Grasping keratinized mucosal edges
* Good for grasping needle
* Not for skin or fine tissue

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14
Q

name/use

A
  • Allis tissue forceps
  • Grasping and manipulating large portions of tissue that are going to be removed from the body
  • I.E. epulis fissuratum, lesions, bone
  • Not for grasping tissue that will remain
  • Too much trauma from beaks
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15
Q

REMOVING BONE tools

A

Rongeurs
chisel and mallet
bone file
hand piece

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16
Q

Rongeurs

A
  • Most commonly used for alveoloplasties
  • Will crush/cut lips if not paying attention
  • A relatively atraumatic means of removing bone
  • Quick cut, does not create heat like a handpiece and bur
  • Types:
  • Side cutting
  • End cutting (Blumenthal Rongeurs)
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17
Q
  • Chisel and Mallet
A
  • Cleanest means of removing bone
  • Can create traumatic forces to TMJ/jaw without proper support
  • Mallet: occasionally with nylon face to decrease noise/trauma
  • Unibevel - bone removal
  • Bibevel - splitting teeth
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18
Q
  • Bone file
A
  • Used for final smoothing of small areas of sharpness
  • Pull stroke is the action stroke
  • Crosscut or parallel grooves
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19
Q
A

bone file

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20
Q
  • Handpiece:
A
  • MUST NOT EXHAUST AIR INTO OPERATIVE FIELD
  • Electric vs Nitrogen powered
  • Completely sterilizable
  • High speed and torque
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21
Q

AIR EMPHYSEMA

A
  • Air-driven handpiece during surgical extraction
  • Sudden edema
  • Crepitus to area
  • Possible for air embolus
  • Air forced through venous system
  • Possibly requires airway protection
  • ABX to prevent secondary infection
  • Resolves 3-7 days
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22
Q

burs to remove bone

A
  • Carbide
  • One time use, then throw away
  • # 6 or #8 for bone removal or grooves
  • # 702 or #703 for sectioning teeth/contouring alveolus/troughing
  • # 703 has larger radius versus #702
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23
Q

thermal considerations of handpiece

A
  • Surgical handpiece must be done under copious irrigation
  • Will generate heat and kill superficial bone
  • Thermal necrosis occurs at 47°C
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24
Q

REMOVING SOFT TISSUE FROM BONY DEFECTS tools

A
  • Curettes
  • Hemostats
  • Rongeurs
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25
Q

SUTURING MUCOSA tool

A
  • Needle holder
  • 6” or 15 cm
  • Grasping surface on beak is crosshatched (prevent
    needle spinning)
  • As opposed to hemostats which are parallel
  • Needle prone to spin
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26
Q

CUTTING SUTURE/TISSUE tools

A

* Iris scissors
* Tissue cutting only, do not use for suture cutting

* Dean angled scissors
* Tissue and suture cutting
* Serrated

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27
Q

HOLDING MOUTH OPEN

A

* Bite block
* Passively placed
* Decreases stress on TMJs

* Molt mouth prop
* Ratcheting system to remain open
* Can severely damage TMJs and teeth

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28
Q

SUCTIONING

A
  • Surgical suction
  • Small orifice
  • Some with wire stylet used to clean tip
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29
Q

what is this? what are the portions?

A
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30
Q

DENTAL ELEVATORS
* Uses:

A
  • Luxate teeth, NOT to remove teeth
  • Minimizes root fractures
  • Requires a fulcrum point
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31
Q

DENTAL ELEVATORS
* Types:

A
  • Straight
  • Flag/Cryer
  • Pick
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32
Q

DENTAL ELEVATORS
* Crane pick/Cogswell:

A
  • Elevate roots or teeth applied to a purchase point
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33
Q
A

potts elevator

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34
Q

E92

A

dental elevator
* MAGIC STICK!! (E-92)
* Offset shank to aid in luxation force

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35
Q

Primary instrument for tooth delivery

A

forceps

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36
Q

EXTRACTION FORCEPS

A

max and man ones

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37
Q
  • Maxillary Forceps
A
  • Beaks parallel to handle
  • Palm under handle
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38
Q
  • Mandibular forceps
A
  • Beaks almost perpendicular to handle
  • Palm on top of handle
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39
Q

extraction forceps beak function

A
  • Beaks adapt to root structure
  • Beak aligned parallel to long axis of tooth
  • Acts as a wedge to expand alveolar bone
40
Q

maxillary forcep #150

A
  • Universal!
  • Single rooted vs multirooted
41
Q

max forcep #1

A

Incisors and canines

42
Q

max forcep #53

A

R and L, furcated molars

43
Q

max forcep #88

A

R and L

44
Q

max forcep 210S

A

single conical rooted molars

45
Q

man forcep 151

A
  • Universal
  • Single and multi rooted
46
Q

man forcep 13

A
  • # 13, Ash, aka Charlene
  • Conical rooted teeth, turning motion effective
47
Q

man forcep 23

A
  • # 23, Cowhorn, aka Michael Jordan
  • Molars
  • Beaks enter bifurcation
  • Tooth is elevated by squeezing handles and using pumping motion
48
Q

man forcep 17

A

molars

49
Q
  • What does ‘suture’ mean?
A
  • Any strand of material that is utilized to ligate blood vessels or approximate tissues
50
Q
  • Primary purpose of suturing
A
  • Position and secure surgical flaps to their anatomic position
  • Promote optimal healing
  • Hemostasis
51
Q

THE “IDEAL”SUTURE

A
  • Sterile
  • All-purpose: composed of material that can be used in any surgical procedure
  • Causes minimal tissue injury or tissue reaction: ie, nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic
  • Easy to handle
  • Holds securely when knotted: ie, no fraying or cutting
  • High tensile strength
  • Favorable absorption profile
  • Resistant to infection
    No suture material is “ideal”
52
Q

ESSENTIAL SUTURE CHARACTERISTICS

A
  • Sterility
  • Uniform diameter and size
  • Pliability for ease of handling and knot security
  • Uniform tensile strength by suture type and size
  • Freedom from irritants or impurities that would elicit tissue reaction
53
Q

TISSUE REACTION TO SUTURES
* Initial response (4-7 days)

A
  • Invokes inflammatory response
  • PMNL, mononuclear cells, fibroblasts
54
Q

TISSUE REACTION TO SUTURES
* After 4-7 days

A
  • Dependent on type of suture used
  • Plain gut elicits intense response with macrophages and PMNLs
  • Non-absorbable elicits less intense, relatively acellular response
55
Q

suture wicking

avoidance

A
  • All sutures passing through mucous membrane or skin provide a “wick” down which bacteria can gain access to underlying tissue

* How to avoid/limit wicking:
* Use monofilament material if possible
* Remove suture as early as possible

56
Q
  • Suture removal:
  • skin of head and neck
  • intraoral sites
  • body/extremities
A
  • Suture removal:
  • 3-5 days →skin of head and neck
  • 5-7 days →intraoral sites
  • 5-10 days →body/extremities
57
Q

SUTURE TYPES

A

SUTURE TYPES
* According to structure: Monofilament vs multifilament
* According to behavior in tissue: Resorbable vs nonresorbable
* According to origin: Natural vs synthetic

58
Q

MONOFILAMENT

A
  • Suture made of single filament
  • Less inflammatory response
  • Less wicking
  • Requires more ties to assure an adequate knot
59
Q

BRAIDED

A
  • Multifilament
  • Greater inflammatory response
  • Greater wicking
  • Fewer ties for adequate knot
60
Q

ABSORBABLE materials

A
  • Plain Gut
  • Chromic Gut
  • Monocryl (Poliglecaprone 25)
  • Vicryl (Polyglactin 910)
61
Q

NON-ABSORBABLE materials

A
  • Silk
  • Nylon
  • Prolene (Polypropylene)
  • Steel
62
Q
  • Gut sutures were derived from?
A
  • Gut sutures were derived from the submucosal layer of ovine (sheep) small intestine or the serosallayer of bovine (cow) small intestine
63
Q
  • Plain gut:
  • Tissue treated with?
  • Tensile strength maintained for?
  • Absorption complete within?
A
  • Tissue treated with aldehyde solution
  • Tensile strength maintained for 7-10 days
  • Absorption complete within 70 days
64
Q
  • Chromic gut:
  • Treated with?
  • Tensile strength maintained for?
  • Absorption complete within?
A
  • Treated with chromium salt
  • Tensile strength maintained for 10-14 days
  • Absorption complete within 90 days
65
Q

absorbable gut sutures
* Tissue reaction is due to?
* Breakdown accomplished by?
* Do not place under?
* Used for?

A
  • Tissue reaction is due to non-collagenous material
  • Breakdown accomplished by proteolytic enzymatic digestive process
  • Do not place under stresses tissue where extended approximation is needed
  • Used: general soft tissue approximation
66
Q
  • Monocryl (Poliglecaprone 25):
  • made of?
  • Tensile strength at 7 days, at 14 days, and at 21 days
  • Absorption complete at?
A
  • Monofilament copolymer of glycolide and e-caprolactone
  • Tensile strength 50-60% at 7 days, 20-30% at 14 days, and lost at 21 days
  • Absorption complete at 91-119 days
67
Q
  • Vicryl (Polyglactin 910):
  • made of?
  • Tensile strength of at 14 days, at 21 days
  • Absorption complete at?
A
  • Braided multifilament coated with copolymer of lactide and glycolide
  • Tensile strength of 75% at 14 days, 50% at 21 days
  • Absorption complete at 56-90 days
68
Q

Monocryl (Poliglecaprone 25) and Vicryl (Polyglactin 910):
* Absorbed by?
* Used for?

A
  • Absorbed by hydrolysis – minimal tissue reaction
  • Used: General soft tissue approximation
    Not used where extended tissue approximation is required
69
Q

Surgical silk:

A

non-absorbable
* Braided raw silk spun by silkworms (organic protein called fibroin)
* Sometimes coated with beeswax or silicone to ease handling/placement

70
Q

absorbtion surgical silk

A

absorbed by proteolysis at 2 years, can cause acute tissue reaction, and eventual encapsulation by fibrous connective tissue
* Eventually pushed out by body if left in

71
Q

tensile strength of silk

A

remains at 1 yr

72
Q

silk contrindications and uses

A
  • Contraindicated in pts with silk sensitivities
  • Used: General soft tissue approximation (vermillion border – pts enjoy better as gut suture ends are sharp on tissue)
73
Q
  • Nylon forms
A

non-absorbable
* Monofilament (Ethilon) polyamide polymer
* Braided (Nurolon) coated with silicone

74
Q

nylon tensile strength

A
  • Progressive hydrolysis may result in loss of tensile strength (81% at 1 years, 72% at 2 years, 66% at 11 years)
75
Q

nylon use

A
  • Minimal tissue reaction, should not be used where permanent retention of tensile strength is required
76
Q

nylon elasticity makes it useful for?

A

makes it useful in retention and skin closure

77
Q

Prolene (Polypropylene):

A

non-absorbable
* Monofilament of isostatic crystalline stereoisomer of a liner propylene polymer (permitting little or no saturation)

78
Q

prolene uses

A
  • Does not adhere to tissues and is useful as a “pull-through” suture (subcuticular closure)
  • Minimal tissue reaction
  • Used: high tension areas (fascia), contaminated wounds, skin closures
79
Q

prolene strength

A
  • Not subject to degradation or weakening, and maintains tensile strength for up to 2 years
80
Q

suture sizes
* Sutures were originally manufactured?
* #1?
* A #4 suture?
* The manufacturing techniques, derived at the beginning from?

A
  • Sutures were originally manufactured ranging in size from #1 to #6
  • # 1 being the smallest
  • A #4 suture would be roughly the diameter of a tennis racquet string.
  • The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters.
81
Q

SUTURE SIZES
* Size refers to?
* The more zeroes characterizing a suture size?
* The smaller the suture, tensile?

A
  • Size refers to the diameter of the suture strand and is denoted as zeroes.
  • The more zeroes characterizing a suture size, the smaller the resultant strand diameter
  • 4-0 or 0000 is larger than 5-0 or 00000
  • The smaller the suture, the less tensile strength of the strand.
82
Q

attatchement end of suture needle

A
  • Swaged end permanently attached to material
  • Eyed →need to thread suture material
83
Q

chord length suture needle

A
  • Straight line distance between the point of
    the curved needle and swage
84
Q

needle length of suture needle

A
  • Distance between point to end along needle
85
Q

radius of suture needle

A

Distance between center of the circle to
body of needle

86
Q

diameter of suture needle

A
  • Gauge or thickness of the needle
87
Q

NEEDLE POINT forms

A

cutting
reversed cutting
taper

88
Q
  • Cutting needle point
A
  • Needle body is triangular
  • Sharpened cutting edge on inside
  • Easy to tear through tissue if too forceful
89
Q
  • Reverse cutting needle point
A
  • Needle body is triangular, inverted
  • Less tear through
90
Q
  • Taper needle point
A
  • Rounded needle body
  • Limited tear through
91
Q

SUTURING TECHNIQUE
* Grasp needle with holder below?
* how tight?
* Insert needle x° to tissue?
* how to continue to pass through tissue?
* grasp needle point with instrument?
* Pass through______ tissue first, then though ______ tissue
* Grasp tissue_______

A
  • Grasp needle with holder below the swage
  • Ratchet one to two “clicks”
  • Insert needle 90° to tissue
  • Turn wrist to continue to pass through tissue
  • Attempt to not grasp needle point with instrument: Will dull tip and tear through tissue with continued use
  • Pass through loose tissue first, then though stable tissue
  • Grasp tissue gently (do not crush wound edges)
92
Q

SURGICAL KNOT

A
  • First throw is forward and a “double”
  • Second throw or Reverse throw is single and “squares” the knot
  • Finish with another squared knot:
  • Single forward throw and single reverse throw
93
Q

SIMPLE INTERRUPTED SUTURE
* Maintains?
* Requires more?
* holding power against stress?

A
  • Maintains strength and tissue position if
    one portion fails
  • Requires more time and suture material
  • Has minimal holding power against stress
94
Q

HORIZONTAL MATTRESS SUTURE
* Tension?
* speed?
* Minimizes?

A
  • Tension suture
  • Rapid
  • Minimizes number of sutures needed
  • Less suture material used
95
Q

FIGURE OF EIGHT SUTURE
* Tension?
* apposition?
* Good to ?

A
  • Tension suture
  • Brings tissue into good apposition
  • Good to secure socket dressings
96
Q

SIMPLE CONTINUOUS SUTURE
* Easy for?
* Involves?
* material use?
* tension-holding?
* failure if?

A
  • Easy for linear long span wounds
  • I.e. alveoloplasty full thickness mucoperiosteal flap approximation
  • Involves one diagonal pass and one perpendicular pass
  • Uses less material vs multiple interrupted
  • Provides minimal tension-holding
  • Prone to failure if one portion fails
97
Q

LOCKING CONTINUOUS SUTURE
* stability vs simple running?
* material use?
* partial failure/break?

A
  • Greater tissue stability vs simple running
  • Uses more suture material vs simple running
  • More stable in the event of a partial failure or breakage

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