L103. Minor Oral Surgery Techniques

Question 1

What factors make a tooth more likely to fracture during oral surgery?

Answer 1

• Thick cortical bone;
• Root shape;
• Root number;
• Hypercementosis;
• Ankylosis (fusion of root and bone);
• Caries;
• Alignment.

Question 2

What post-operative complications must you make a patient aware of before oral surgery?

Answer 2

• Pain;
• Swelling;
• Bruising;
• Jaw stiffness;
• Bleeding;
• Dry socket;
• Infection (unusual);
• Risk of nerve damage (e.g. numbness).

Question 3

List some general surgical principles:

Answer 3

• Maximal access with minimal trauma;
• Wide-based incision (circulation);
• Use scalpel in one, firm continuous stroke;
• No sharp angles;
• Adequate sized flap;
• Minimise trauma to dental papillae;
• Flap reflection should be down to bone and done cleanly (full thickness/ mucoperiosteal flap);
• No crushing;
• Keep tissue moist;
• Ensure that flap margins and sutures will lie on sound bone;
• Make sure wounds are not closed under tension (would compromise blood supply);
• Aim for healing by primary intention to minimise scarring.

Question 4

When creating a flap for surgical extraction of a 5, what anatomical structures should you be aware of?

Answer 4

• Mental foramen and nerve;
• IAN canal (this curves slightly forward);
• Phrenum (should be out of the way in a dentulous patient)

Question 5

When creating a flap for surgical extraction of a wisdom, what anatomical structures should you be aware of?

Answer 5

• IAN (although deep in the bone here);

- Lingual nerve (if you go too lingually).

Question 6

Where is the mental foramen usually located?

Answer 6

Between the apices of 4s and 5s

Question 7

What types of incision would you make to raise a flap when extracting a premolar?

Answer 7

• Crevicular (within gingival crevice), could do one long one for one-sided flap;
• Distal relieving (to avoid mental foramen).

Question 8

What is a two-sided flap?

Answer 8

A flap raised from two incisions e.g. distal-crevicular flap

Question 9

What is guttering?

Answer 9

Remove of bone to create more access (usually buccally)

Question 10

When suturing a two-sided flap, where would you place your first suture? (mesial papilla, distal papilla or crevicular flap)

Answer 10

Distal papilla (acts as a tacking suture in the middle - holds flap back in anatomical position)

Question 11

What techniques can you use to debride an area?

Answer 11

• Physical (bone file/ handpiece/ curette etc.);
• Irrigation (sterila saline/ water into socket/ under flap);
• Suction (aspirate under flap).

Question 12

What are the aims of suturing?

Answer 12

• Reposition tissues;
• Cover bone;
• Prevent wound breakdown;
• Achieve homeostasis;
• Encourage healing by primary intention.

Question 13

What are the two types of sutures and the two subgroups within these?

Answer 13

• Resorbable and Non-resorbable;

- Monofilament and Multifilament subgroups.

Question 14

Give an example of a resorbable, monofilament suture?

Answer 14

Monocryl

Question 15

Give an example of a resorbable, multifilament suture?

Answer 15

Vicryl rapide

Question 16

Give an example of a non-resorbable, monofilament suture?

Answer 16

Prolene

Question 17

Give an example of a non-resorbable, multifilament suture?

Answer 17

Mersilk (black silk)