lecture 4

Question 1

delivery of the tooth requiring

• reflection of a flap
• removal of bone
• and/or delivery of the tooth in multiple pieces

Answer 1

surgical extraction

Question 2

if you need to remove the flap, bone,

After trying everything - then may need to open surgically -

_ is beginning of surgery

Answer 2

Elevation of the flap

Question 3

design parameters for soft tissue flaps:

_ broader than _
so blood supply allows inflow of arterial blood and outflow of venous blood

adequate size and visibility are key

Answer 3

base broader than free margin

we want to go a couple teeth mesial and couple teeth distal of tooth being extracted

Question 4

design parameters for soft tissue flaps:

incision over _

avoid injury to vital structures

_ incision, if needed to avoid tearing

Answer 4

incision over intact bone

vertical(oblique) releasing incision if needed to avoid tearing

sharp incision heals better than a tear

Question 5

vertical(oblique) releasing incision if needed to avoid tearing

• permits soft tissue reflection without tearing
• oblique - base is broader than apex
• cross gingival margin at the _ of the tooth

incision over intact bone, not over an osseous prominence or defect

Answer 5

cross gingival margin at the line angle of the tooth

Question 6

types of mucoperiosteal flaps:

Envelope:
_ in dentate patient

_ in edentulous area

Answer 6

sulcular in dentate patient

crestal in edentulous area - no teeth

Question 7

types of mucoperiosteal flaps:

_ flap, single/one vertical (oblique) release

Answer 7

three cornered flap

Question 8

types of mucoperiosteal flaps:

_ flap, two vertical releasing incisions

Answer 8

four cornered flap

Question 9

types of mucoperiosteal flaps:

_ flap - limited use for periapical surgery

Answer 9

semilunar

Question 10

types of mucoperiosteal flaps:

_ flap - limited use for access to bony palate for torus removal

Answer 10

Y incision

Question 11

developing the flap:

incision - firm, with scalpel blade contacting bone

• reflection - sharp end of periosteal elevator between periosteam and bone, elevate along a broad front
• retraction - to protect _

Answer 11

retraction to protect soft tissue

Start out with sharp end of periosteal elevator

Transition to the spoon end

Question 12

number _ blade is used to incise the gingival sulcus

Answer 12

15 blade

Question 13

principles of suturing

• penetrate tissue with needle _ to tissue
• follow curvature of needle as you pass it thru the tissue

Answer 13

perpendicular to tissue

we go from buccal to lingual or unattached to attached tissue

Question 14

indications for open/surgical extractions

Answer 14

avoiding need for excessive force

dense bone

exotosis

root morp - multirooted teeth, dilaceration, internal resorption

age (dense bone, anklyosis, atrophoc PDL)

genetic considerations - blacks stronger bone

bruxism - more difficult

endodontic therapy

deep caries

sinus proximity

comproised adjacent teeth

multiple extractions

impactions

Question 15

technique for open extraction of single-rooted tooth

1. flap
2. deteremine need for bone removal
3. grasp a small margin of bone with forceps
4. remove bone with bur
5. apical purchase
6. irrigate well under depth of flap

Answer 15

remove bone with bur or chisel
-make a buccal trough - not cutting tooth itself but bone

lingual cortex - soft tissue hard to heal over it

apical purchase - really broken off crown and root - pressure buccal bone for implant

apical hole in bone and push from it on the tip of root

Question 16

technique for open extraction of multi-rooted tooth

” _ and _”

identify furcation

fissure bur (703,701) to section = divide tooth thru pulpal floor into furcation

avoid violation of sinus floor, lingual cortex

Answer 16

divide and conquer

Release the flap and make a buccal trough
Right below the furcation - want the defect to be 4walled

“split” tooth - root from root with straight elevator

convert multi-rooted tooth into several single rooted pieces

For 3 or 14
Buccal trough first
MD
Then palatal - wants to sneak of in the sinus

elevate or luxate and deliver root segments

Question 17

removal of root fragments and tips:

some roots will fracture due to unfavorable curvature
-thorough _ of the root prior to fracture facilitates delivery

-remove bone to create space into which the root can be elevated

gently engaged elevator into PDL space

Answer 17

thorough mobilization

Question 18

what are the fragile elevators used for

Answer 18

sole use is as a wedge to remove root fragments/tips

push fine tip apically to wedge root tip from socket or wedge tip into PRL and “draw” vertical vector to displace root tip

gently tease/wiggle out of socket, do not use blunt apical force

NOT GOOD FOR PRYING - PRYING FORCES WILL BEND AND BREAK THESE INSTRUMENTS

Question 19

removal of bone for surgical extraction:

use bur to remove _ or _ bone

create a space into which the root can be elevated or expose adequate tooth structure to engage forceps

gently elevate the root

if not mobilized, remove more bone

never use excessive force

Answer 19

buccal or interradicular bone

Question 20

leaving root tips?

Answer 20

small piece, less than 4mm

deeply embedded in bone

not an infected tooth- not pulpally or periapically involved

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