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Oral Surgery > L3 - Complex Exodontia (8/20) > Flashcards

L3 - Complex Exodontia (8/20) Flashcards

1
Q

describe flap base and whyh

A

base of flap must be BROADER than the free margin

  • has to preserve the blood supply
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2
Q

size of flap

A

must be adequate size
*flap extends TWO TEETH ANTERIOR AND ONE TOOTH POSTERIOR to the surgical area

or vise versa

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3
Q

why need the size

A
  1. adequate visualization
  2. adequate access of instrumentatin
  3. large enough to retract without tension
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4
Q

type of flap

A

full thickness – mucoperiosteal

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5
Q

make incision where - general

A

over an intact bone

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6
Q

describe flap base

A

BROADER than the free gingival margin

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7
Q

go over canine eminence?

A

NEVER

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8
Q

how far away from bony defect

A

must be at least 6-8 mm away from a bony defect

do not want margin too close tot he bone we will be removing

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9
Q

desctibe the vertical releasing incisions *

A

should NOT cross the bony eminence

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10
Q

types of mucoperiosteal flaps

A
  1. envelop
    - tytpical
  2. three-cornered
  3. four-cornered
    - type of flap used to cover a large hole
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11
Q

indications for SURGICAL extractions

- long list

A
  1. surgeon perceives a possible need for excessive force to extract a tooth
  2. when closed technique has failed
  3. patient with heavy dense bone
  4. short clinical crowns secondary to bruxism
  5. hypercementosis
  6. widely divergent
  7. close proximity to sinus
  8. teeth with extensive caries
  9. severe attrition
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12
Q

check what before surgical extraction is an option **

A

LOOK AT X-RAYS

-

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13
Q

when will you know a tooth will need surgical extraction?

A

after taking the time to examine the X-rays

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14
Q

is it okay to come over the bone with the forceps?

A

YES

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15
Q

first force on a tooth?

A

APICAL

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16
Q

REMOVE BUCCAL CORTICAL PLATE?

A

you can

- NEED a finger rest

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17
Q

purchase point?

A

with bur – to get a point to grab onto

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18
Q

when have multi-rooted tooth?

general

A

you can take one root out at a time if you want

elevator in to separate the tooth and remove them

take the crown off?

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19
Q

*before you open up what must you do

A

look at x-rays and look at mouth and know your approach before hand

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20
Q

oroantral communications prevention

A

surgical removal

this is a sinus perforation

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21
Q

oroantral communications diagnosis

A
  1. examine tooth
  2. visualization
  3. nose-blowing
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22
Q

treatment of oroantral communications if less than 2mm

A

dont have to do anything about it really

- try to ensure a good blood clot

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23
Q

tx for oroantral communications if b/w 2-6 mm

A

pack the socket, and do a figure 8 suture

antibiotics, decongenstants, and sinus precautions like no smoking, nose blowing, sneezing, sucking out of a straw

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24
Q

tx for oroantral communications if b/w 2-6 mm

A

pack the socket, and do a figure 8 suture

antibiotics, decongenstants (dont use for awhile), and sinus precautions like no smoking, nose blowing, sneezing, sucking out of a straw

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25
Q

tx for oroantral communications if greater than 7

A

consider flap closure

- buccal or palatal finger

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26
Q

most common injury to adjacent tooth

A

fracture of existing restoration

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27
Q

common injuries to adjacent teeth

A

fracture of existing restoration

fracture of an adjacent carious tooth

luxating an adjacent tooth
- using elevator as a scoop instead of using it the other way

extracting the wrong teeth

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28
Q

how to prevent taking out the wrong tooth

A

THE TIME OUT METHOD

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29
Q

most common complications with tooth being extracted

A

root fracture - most common

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30
Q

root / tooth displacement

A

complications with tooth being extracted

  1. into max sinus
  2. into infratemporal space – maxillary third molar
  3. into the sublingual space
  4. into the submandibular space
  5. down the pharynx
  6. aspirated
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31
Q

where can maxillary molar be displaced to

A

the maxillary third molar

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32
Q

nerves that can be affected

A
  1. mental
  2. lingual
  3. long buccal
  4. nasopalaatine
    5 IAN
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33
Q

bite blocks for?

A

to alleiviate any post op discomfort in the TMJ

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34
Q

patients on coumadin INR?

A

CAN perform an extraction on a patient with an INR of 3.0 or less

(if 2.8 – single tooth go for it if very invasive then i would be tentative)

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35
Q

microfibular collagen uses

A

avitene

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36
Q

microfibular collagen uses

A

avitene

37
Q

describe dry socket

A
  1. pain 3-4 days post op
  2. bad taste
  3. headaches
  4. bad headache
  5. pain radiated to patients ear
38
Q

pain radiating to ear singifies

A

dry socket

39
Q

details about the vertical releasing incisions

A
  1. should NOT cross a bony eminence (like canine eminence)
  2. should NOT end at the facial aspect of the tooth
  3. should cross the free gingival margin at the line angle of the tooth (avoid cutting the papilla away)
40
Q

adequate radiogrpahs include?

A
  1. root apexes
  2. morphology

adjacent structure like

  • sinus
  • IAN
41
Q

Three conditions must be met for a tooth / root fragment to be left in the alveolar process

A
  1. The root fragment must be small <4-5 mm
    1. The root must be deeply embedded
    2. The tooth involved must NOT be infected
      No radiolucency present
42
Q

in order For a surgeon to leave a previously described root fragment in place

A

The risk of removal must be greater than the benefit

43
Q

Three examples of when the risk of removal would be greater than the benefit

A
  • Large amounts of bone must be removed
    • The root tip is close to vital structures
      There is a high liklihood the root tip may be displaced
44
Q

If a root tip is left in place what must occur

A
  1. Patient must be informed
  2. radiographic documentation is obtained
  3. the decision to leave the root tip must be well documented in pt. chart
  4. the patient should be placed on a periodic recall schedule
  5. the patient should be instructed to contact you if they develop any symptoms
45
Q

multiple extractions sequencing and why

A

maxillary before mandibular

  • aneshetic considerations
  • wound contamination (debris)

posterior before anterior
- the 1st molar and canine teeth are removed last

46
Q

teeth that are removed last

A

1st molar and canine

47
Q

main components / tools to control bleeding

A
  1. gauze packs
  2. patient told to expect oozing for 12-24 hours

AVOID

  • smoking
  • spitting
  • sucking through straw
  • strenuous exercise
48
Q

pt. told to expect oozing for?

A

12 -24 hours

49
Q

most pain can be managed with

A

mild analgesics

50
Q

peak pain usually occurs when?

A

12 hrs. post-operative

pain rarely persist longer than 2 days

51
Q

diet in post-op

A

high calori liquid diet

soft diet

adequate hydration

cool foods

52
Q

when can patient rinse

A

post -op day 2

53
Q

brushing on day of surgery

A

AWAY from the extraction site

54
Q

max edema/ swelling will occur?

A

24-48 hours post-op

55
Q

how to control edema

A
  1. elevate head
  2. ice packs (20 on 20 off) for the 1st 24 hours
  3. 3rd post-op day heat may e applied
56
Q

when can you apply heat

A

3rd day

57
Q

for infection control consider…

A

consider antibiotics

58
Q

trismus details

A

patients MUST be told that this may occur

  • most commonly caused by multiple injections

heat packs may be helpful

59
Q

ecchymosis

onset?

A

bruising / not dangerous

  • usually seen in older patients
  • onset usually in 2-4 day post-op
  • can last 7-10 days
60
Q

radiographically needs to show what on roots

A

apex

morphology

*adjacent structures need to see sinus and IAN

61
Q

Cardinal rules of surgery

A
  1. adequate visualization
    - light, retraction, and suction
  2. unimpeded pathway for removal
  3. controlled force (finesse, NOT force)
  4. aseptic technique
  5. atraumatic handling of tissues
  6. adequate hemostasis
62
Q

adequate visualization

A

light

retraction

suction

63
Q

Post-op instruction headlines

A
  1. activity
  2. diet
  3. pain control
  4. wound care
64
Q

soft tissue injuries include

A
  1. tearing of flaps (most common)
  2. puncture injury
  3. abrasions
65
Q

tearing of flaps

A

most common soft tissue injury – most common injury is to the mucoperiosteal flap

due to

  • poor design
  • excessive retraction force
66
Q

reasons for puncture injury

A

inadequate finger rest

67
Q

reasons for abrasions

A
  1. re-tractors can cause

rotary instruments

68
Q

main injuries to osseous structures

A
  1. bone fracture
  2. management of fractures
  3. tuberosity fractures
69
Q

main cause of bone fracture during extraction?

most common areas?

A

excessive force – common in the maxillary canine and maxillary molar area
- fracture of the maxillary tuberosity

70
Q

excessive force use common in?

A

the maxillary canine region and maxillary molar area

71
Q

prevention of bone fracture

A

age
poor morphology
thickness of buccocortical plate

72
Q

if bone is removed with tooth? if bone remains attached?

A

if it is removed completely with the tooth– do not attempt to replace it – no blood supply

if bone is still attacahed to periosteum- there is a high probability that the bone will heal

73
Q

management of tuberosity fractures

A

splint tooth and return 6-8 weeks for surgical extraction

remove crown and wait for healing (6-8 weeks)

74
Q

tx for dry socket

A
  1. irrigation
  2. placement of a medicated dressing
  3. change dressing every day or every other day for 3-6 days
75
Q

common etiology causing oro-antral communications

A
  1. removal of maxillary molars and pre-molars
76
Q

risk factors for oro-antral communications

A
  1. divergent roots

2. no bone separating roots from sinus

77
Q

sequelae of oroantral communications (what can follow)

A
  1. fistula formation

2. sinusitis

78
Q

best method for diagnosing oro-antral communications

A

nose-blowing test (best method)

79
Q

Control of pain

- Mild analgesics usually work well T/F

A

True

80
Q

most common post -op pain meds used

A

tylenol
tylenol with codeine

NSAIDs

Vicodin

Percocet

81
Q

give first dose of meds when?

A

before the anesthetic wares off

82
Q

armentarium to control bleeding post - op

A
  1. pressure
  2. collagen plug
  3. microfibular collagen (Avitene)
  4. gelfoam
  5. collagen tape
  6. surgical
  7. topical thrombin
  8. bone wax
83
Q

wound dehiscence aka

A

exposure of bone

84
Q

main signs of dry socket

A
  1. pain radiating to ear
  2. bad smell
  3. bad taste
  4. exposure of bone
  5. PAIN STARTS 3-4 DAYS POST OP***
85
Q

bite blocks especially important with?

A

taking out mandibular teeth and limited the medial movement of the jaw

  • place on contra-lateral side
86
Q

medications that can increase risk of post-op prolonged bleeding

A

he 5 A’s

  1. ASA / aspirin
  2. anticoagulants
  3. antibiotics
  4. anti-cancer drugs
  5. alcohol
87
Q

put tooth back in to control bleeding

A

yes - can be used as a means to stop bleeding

88
Q

dry socket is complication of

A

delayed healing and infection

Oral Surgery (26 decks)

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