instrumentation and sutures Flashcards
1
Q
INCISING TISSUE tools
A
2
Q
ELEVATING TISSUE tools
A
WOODSON NO. 1
MOLT NO. 9
3
Q
name? used for?
A
WOODSON NO. 1
* For interdental papillas, attached gingiva,
crestal periodontal fibers
4
Q
name/used for?
A
MOLT NO. 9
* Pointed end for interdental papilla
* Broad end for free alveolar mucosa elevation and flap retraction
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
6
Q
name/use
A
- Seldin retractor
- Great for tongue retraction, and flap retraction
- Not used as a periosteal elevator (blunt ends)
7
Q
NAME/USE
A
- Minnesota retractor
- Cheek, flap retractor
- Workhorse of retractors in OMS
8
Q
name/use
A
- Wieder retractor, a.k.a. “Sweetheart” retractor
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
10
Q
name/use
A
- Burnisher
- Any flap instrument for compressing bone around a nutrient vessel, control hemmorhage
11
Q
GRASPING TISSUE tools
A
ADSON FORCEPS
BROWN FORCEPS
allis forceps
12
Q
name/use
A
ADSON FORCEPS
* Three teeth opposed
* Stabilize tissue while passing suture needle
* Not good for grasping needle
* Used on skin
13
Q
name/use
A
BROWN FORCEPS
* Multiple serrated tips
* Grasping keratinized mucosal edges
* Good for grasping needle
* Not for skin or fine tissue
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
15
Q
REMOVING BONE tools
A
Rongeurs
chisel and mallet
bone file
hand piece
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)
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
18
Q
- Bone file
A
- Used for final smoothing of small areas of sharpness
- Pull stroke is the action stroke
- Crosscut or parallel grooves
19
Q
A
bone file
20
Q
- Handpiece:
A
- MUST NOT EXHAUST AIR INTO OPERATIVE FIELD
- Electric vs Nitrogen powered
- Completely sterilizable
- High speed and torque
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
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
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
24
Q
REMOVING SOFT TISSUE FROM BONY DEFECTS tools
A
- Curettes
- Hemostats
- Rongeurs
25
SUTURING MUCOSA tool
* 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
26
CUTTING SUTURE/TISSUE tools
*** Iris scissors**
* **Tissue cutting only**, do not use for suture cutting
*** Dean angled scissors**
* **Tissue and suture cutting**
* Serrated
27
HOLDING MOUTH OPEN
*** Bite block**
* Passively placed
* Decreases stress on TMJs
*** Molt mouth prop**
* Ratcheting system to remain open
* Can severely damage TMJs and teeth
28
SUCTIONING
* Surgical suction
* Small orifice
* Some with wire stylet used to clean tip
29
what is this? what are the portions?
30
DENTAL ELEVATORS
* Uses:
* Luxate teeth, NOT to remove teeth
* Minimizes root fractures
* Requires a fulcrum point
31
DENTAL ELEVATORS
* Types:
* Straight
* Flag/Cryer
* Pick
32
DENTAL ELEVATORS
* Crane pick/Cogswell:
* Elevate roots or teeth applied to a purchase point
33
potts elevator
34
E92
dental elevator
* MAGIC STICK!! (E-92)
* Offset shank to aid in luxation force
35
Primary instrument for tooth delivery
forceps
36
EXTRACTION FORCEPS
max and man ones
37
* Maxillary Forceps
* Beaks parallel to handle
* Palm under handle
38
* Mandibular forceps
* Beaks almost perpendicular to handle
* Palm on top of handle
39
extraction forceps beak function
* Beaks adapt to root structure
* Beak aligned parallel to long axis of tooth
* Acts as a wedge to expand alveolar bone
40
maxillary forcep #150
* Universal!
* Single rooted vs multirooted
41
max forcep #1
Incisors and canines
42
max forcep #53
R and L, furcated molars
43
max forcep #88
R and L
44
max forcep 210S
single conical rooted molars
45
man forcep 151
* Universal
* Single and multi rooted
46
man forcep 13
* #13, Ash, aka Charlene
* Conical rooted teeth, turning motion effective
47
man forcep 23
* #23, Cowhorn, aka Michael Jordan
* Molars
* Beaks enter bifurcation
* Tooth is elevated by squeezing handles and using pumping motion
48
man forcep 17
molars
49
* What does ‘suture’ mean?
* Any strand of material that is utilized to ligate blood vessels or approximate tissues
50
* Primary purpose of suturing
* Position and secure surgical flaps to their anatomic position
* Promote optimal healing
* Hemostasis
51
THE “IDEAL”SUTURE
* 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
ESSENTIAL SUTURE CHARACTERISTICS
* 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
TISSUE REACTION TO SUTURES
* Initial response (4-7 days)
* Invokes inflammatory response
* PMNL, mononuclear cells, fibroblasts
54
TISSUE REACTION TO SUTURES
* After 4-7 days
* Dependent on type of suture used
* Plain gut elicits intense response with macrophages and PMNLs
* Non-absorbable elicits less intense, relatively acellular response
55
suture wicking
| avoidance
* 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
* Suture removal:
* skin of head and neck
* intraoral sites
* body/extremities
* Suture removal:
* 3-5 days →skin of head and neck
* 5-7 days →intraoral sites
* 5-10 days →body/extremities
57
SUTURE TYPES
SUTURE TYPES
* According to structure: Monofilament vs multifilament
* According to behavior in tissue: Resorbable vs nonresorbable
* According to origin: Natural vs synthetic
58
MONOFILAMENT
* Suture made of single filament
* Less inflammatory response
* Less wicking
* Requires more ties to assure an adequate knot
59
BRAIDED
* Multifilament
* Greater inflammatory response
* Greater wicking
* Fewer ties for adequate knot
60
ABSORBABLE materials
* Plain Gut
* Chromic Gut
* Monocryl (Poliglecaprone 25)
* Vicryl (Polyglactin 910)
61
NON-ABSORBABLE materials
* Silk
* Nylon
* Prolene (Polypropylene)
* Steel
62
* Gut sutures were derived from?
* Gut sutures were derived from the submucosal layer of ovine (sheep) small intestine or the serosallayer of bovine (cow) small intestine
63
* Plain gut:
* Tissue treated with?
* Tensile strength maintained for?
* Absorption complete within?
* Tissue treated with aldehyde solution
* Tensile strength maintained for 7-10 days
* Absorption complete within 70 days
64
* Chromic gut:
* Treated with?
* Tensile strength maintained for?
* Absorption complete within?
* Treated with chromium salt
* Tensile strength maintained for 10-14 days
* Absorption complete within 90 days
65
absorbable gut sutures
* Tissue reaction is due to?
* Breakdown accomplished by?
* Do not place under?
* Used for?
* 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
* Monocryl (Poliglecaprone 25):
* made of?
* Tensile strength at 7 days, at 14 days, and at 21 days
* Absorption complete at?
* 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
* Vicryl (Polyglactin 910):
* made of?
* Tensile strength of at 14 days, at 21 days
* Absorption complete at?
* 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
Monocryl (Poliglecaprone 25) and Vicryl (Polyglactin 910):
* Absorbed by?
* Used for?
* Absorbed by hydrolysis – minimal tissue reaction
* Used: General soft tissue approximation
Not used where extended tissue approximation is required
69
Surgical silk:
non-absorbable
* Braided raw silk spun by silkworms (organic protein called fibroin)
* Sometimes coated with beeswax or silicone to ease handling/placement
70
absorbtion surgical silk
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
tensile strength of silk
remains at 1 yr
72
silk contrindications and uses
* 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
* Nylon forms
non-absorbable
* Monofilament (Ethilon) polyamide polymer
* Braided (Nurolon) coated with silicone
74
nylon tensile strength
* Progressive hydrolysis may result in loss of tensile strength (81% at 1 years, 72% at 2 years, 66% at 11 years)
75
nylon use
* Minimal tissue reaction, should not be used where permanent retention of tensile strength is required
76
nylon elasticity makes it useful for?
makes it useful in retention and skin closure
77
Prolene (Polypropylene):
non-absorbable
* Monofilament of isostatic crystalline stereoisomer of a liner propylene polymer (permitting little or no saturation)
78
prolene uses
* 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
prolene strength
* Not subject to degradation or weakening, and maintains tensile strength for up to 2 years
80
suture sizes
* Sutures were originally manufactured?
* #1?
* A #4 suture?
* The manufacturing techniques, derived at the beginning from?
* 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
SUTURE SIZES
* Size refers to?
* The more zeroes characterizing a suture size?
* The smaller the suture, tensile?
* 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
attatchement end of suture needle
* Swaged end permanently attached to material
* Eyed →need to thread suture material
83
chord length suture needle
* Straight line distance between the point of
the curved needle and swage
84
needle length of suture needle
* Distance between point to end along needle
85
radius of suture needle
Distance between center of the circle to
body of needle
86
diameter of suture needle
* Gauge or thickness of the needle
87
NEEDLE POINT forms
cutting
reversed cutting
taper
88
* Cutting needle point
* Needle body is triangular
* Sharpened cutting edge on inside
* Easy to tear through tissue if too forceful
89
* Reverse cutting needle point
* Needle body is triangular, inverted
* Less tear through
90
* Taper needle point
* Rounded needle body
* Limited tear through
91
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_______
* 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
SURGICAL KNOT
* 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
SIMPLE INTERRUPTED SUTURE
* Maintains?
* Requires more?
* holding power against stress?
* Maintains strength and tissue position if
one portion fails
* Requires more time and suture material
* Has minimal holding power against stress
94
HORIZONTAL MATTRESS SUTURE
* Tension?
* speed?
* Minimizes?
* Tension suture
* Rapid
* Minimizes number of sutures needed
* Less suture material used
95
FIGURE OF EIGHT SUTURE
* Tension?
* apposition?
* Good to ?
* Tension suture
* Brings tissue into good apposition
* Good to secure socket dressings
96
SIMPLE CONTINUOUS SUTURE
* Easy for?
* Involves?
* material use?
* tension-holding?
* failure if?
* 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
LOCKING CONTINUOUS SUTURE
* stability vs simple running?
* material use?
* partial failure/break?
* Greater tissue stability vs simple running
* Uses more suture material vs simple running
* More stable in the event of a partial failure or breakage
