lecture 4 Flashcards
delivery of the tooth requiring
- reflection of a flap
- removal of bone
- and/or delivery of the tooth in multiple pieces
surgical extraction
if you need to remove the flap, bone,
After trying everything - then may need to open surgically -
_ is beginning of surgery
Elevation of the flap
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
base broader than free margin
we want to go a couple teeth mesial and couple teeth distal of tooth being extracted
design parameters for soft tissue flaps:
incision over _
avoid injury to vital structures
_ incision, if needed to avoid tearing
incision over intact bone
vertical(oblique) releasing incision if needed to avoid tearing
sharp incision heals better than a tear
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
cross gingival margin at the line angle of the tooth
types of mucoperiosteal flaps:
Envelope:
_ in dentate patient
_ in edentulous area
sulcular in dentate patient
crestal in edentulous area - no teeth
types of mucoperiosteal flaps:
_ flap, single/one vertical (oblique) release
three cornered flap
types of mucoperiosteal flaps:
_ flap, two vertical releasing incisions
four cornered flap
types of mucoperiosteal flaps:
_ flap - limited use for periapical surgery
semilunar
types of mucoperiosteal flaps:
_ flap - limited use for access to bony palate for torus removal
Y incision
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 _
retraction to protect soft tissue
Start out with sharp end of periosteal elevator
Transition to the spoon end
number _ blade is used to incise the gingival sulcus
15 blade
principles of suturing
- penetrate tissue with needle _ to tissue
- follow curvature of needle as you pass it thru the tissue
perpendicular to tissue
we go from buccal to lingual or unattached to attached tissue
indications for open/surgical extractions
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
technique for open extraction of single-rooted tooth
- flap
- deteremine need for bone removal
- grasp a small margin of bone with forceps
- remove bone with bur
- apical purchase
- irrigate well under depth of flap
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
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
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
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
thorough mobilization
what are the fragile elevators used for
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
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
buccal or interradicular bone
leaving root tips?
small piece, less than 4mm
deeply embedded in bone
not an infected tooth- not pulpally or periapically involved
not mobile
