Midterm Flashcards
What are some indications for extractions?
Caries (unrestorable), pulpal necrosis, periodontal disease, ortho reasons, malpositioned teeth, fractured teeth, preprosthetic, impacted, supernumerary, pathology, pre radiation, prior to medical procedures, teeth in the line of fracture, financial considerations.
What are some systemic contraindications for extractions?
Uncontrolled diabetes, leukemia, lymphoma, immunosuppressed patients, unstable cardiac disease, pregnancy (first and third trimesters), severe bleeding diathesis (hemophilia, platelet function disorders, anticoagulant use), anti-resorptive drug use, anti-angiogenic agents.
What are some local factors that are contraindications for extractions?
Radiation history, teeth associate with a tumor, pericoronitis, unable to properly anesthetize the tooth, anxiety, severe infection.
What are the near absolute contraindications?
Radiation, tooth within a tumor, pregnancy (1st and 3rd), uncontrollable bleeding diathesis.
When doing a radiographic assessment, what do you first look at?
The adequacy of the film. Does it include the entire tooth and PA region. Does it show vital adjacent structures (IA, sinus), readable quality, recent.
How recent should radiographs be for extractions?
Within a year unless active changes have been occurring.
What are some of the vital and adjacent structures that you should keep a look out for?
Sinus, IA, mental nerve, tuberosity, nose.
What are the restrictions for articaine/septocaine?
DON’T USE IT FOR BLOCKS
What are the three levels of IV sedation?
Moderate sedation, deep sedation, general anesthesia.
What types of machines are extraction instruments?
Wedges, levers, wheel and axle.
What type of instrument is used as a wheel and axel?
Cryer or root pick
What are the basic steps for closed extraction?
Separate the soft tissues (release PDL and papilla) Luxate the tooth (start using elevators as apically as possible, use the wedge, wheel and axle and lever aspects of instruments) Seat and position forceps (apically as possible, wedge it in, watching adjacent structures) Luxate the tooth with the forceps (buccal, lingual and rotational forces)
Full thickness mucoperiosteal flaps vs. partial thickness flaps
Full=mucosa, submucosa, periosteum.
Partial=mucosa and submucosa only.
Should the base or free edge be wider?
Base! So there is no part with out blood supply.
How does a soft tissue incision heal?
Across the incision, not along the length.
Where is the Y incision used?
On the palate to access a palatal torus.
How far should the incision extend?
1-2 teeth on either side of the surgical area.
What is used to elevate the flap and how?
Periosteal elevator. Pointed aspect to trace the incision and release the papilla. Elevate initial free edge, then use the round end, with sharp edge adjacent to the bone, to sweep back and forth.
What is used to keep the flap reflected?
Minnesota retractor.
What is the function of sutures?
Approximate wound margins. Aid in hemostasis. Hold soft tissue over bone. Maintain socket clot or dressing.
What are some of the suture techniques?
Single interrupted, running continuous, running locking, figure of eight. Horizontal or vertical mattress.
What direction are MN molars divided in? MX molars?
MN are buccal/lingual. MX are all roots into separate structures. Key is to section through the furcations.
Should you use apical pressure with root tips?
NO!
What are the indications for leaving a root tip?
Small (less than 4 mm), deeply embedded in the bone, no infection, risk of surgery is greater than the benefit.
What are the indications for a biopsy.
Persistent for more than 2 weeks and not responding to treatment within 2 weeks. Radiographic changes, hyperkeratotic changes, persistent swellings. Interfering with function. ulcerations, malignant characteristics.
What body parts should be included in the head and neck exam?
Neck, TMJ, oral cavity and oropharynx.
What type of technique is fine needle aspiration and what is it used for?
Cytology. Various head and neck lesions such as neck masses and parotid and other salivary gland tumors.
What is brush biopsy used for?
Another cytology method. Has a role in monitoring pts with chronic mucosal changes and can serve as a trigger for traditional biopsy. Can’t stage or grade the lesion due to lack of architecture
What are the light techniques?
Emit wavelengths that claim to highlight lesions with dysplasia. Used in the cervix. Potential use for screening and monitoring. Role really needs to be defined.
What type of lesions are incisional biopsies used for?
Large! Greater than 1 cm. Mucosal and deep intraosseous lesions.
Requirements for incisional biopsy.
Location is guided by diff. diag. Multiple samples may be needed depending on characteristics of lesion. Must include entire depth. The more narrow and deep (to end of lesion) the better. May need to be oriented for further treatment.
Excisional biopsy
Removes entire lesion with a perimeter of normal tissue. Can be the definitive treatment of the lesion. Used on smaller lesions and in locations that doesn’t disfigure the pt.
Why would you want to orient the margins of the specimen?
Guide you in cases which require a margin of normal tissue to definitively treat. (Malignant and recurring)
What type of incisions are easily closed?
Incisions.
What principle is used to place sutures?
Halving the lesion.
Formalin
Routine histologic examination. Fixative. Kills bacteria.
Michels
Simple salt. Only 5 days. Doesn’t kill pathogens and maintains pH. Can’t used formalin after. Used for immunofluorescence.
Why should a lesion be aspirated prior to biopsy?
Guide the location. If blood is aspirated, don’t do shit. Could lose a lot of biopsy.
What guides the decision of what type of biopsy?
Differential diagnosis, size and location of lesion.
Nodule
small rounded lump
Papule
Smaller than a nodule
Plaque
Patch
Pustule
Contain pus
Vesicle
Contain fluid
Bullae
Big blister
Ulcer
Open sore
Erosion
the superficial destruction of a surface area of tissue (as mucous membrane) by inflammation, ulceration, or trauma
Pt. Follow up
7-10 days for looking at surgical site and reviewing path results. Outlines definitive treatment.
What guides the differential diagnosis?
History obtained from pt!
Contraindications for 3rd molar removal?
Extremes of age, compromised medical status, risk of damage to adjacent structures, hx of radiation.
What are the angulations of impacted 3rds?
- Mesioangular (43)
- Horizontal-severe mesioangular (3)
- Vertical (38)
- Distoangular (6)
Pell and Gregory Classification
Based on the amount of bone from the anterior ramus covering the impacted tooth and the relationship to the occlusal plane.
Class 1: Entire MD distance is in front of the ramus.
Class 2: 1/2 is in front of the ramus.
Class 3: Tooth located completely within the ramus.
Class A: Even with occlusal plane.
Class B: Between the occlusal plane and cervical line.
Class C: Below the cervical line.
What is the relationship of overlying tissue used for?
ADA for description of the tooth. Not used to identify difficulty of tooth removal.
What is the classification scheme for overlying tissues?
Erupted
Soft tissue impaction
Partial bony impaction (less than 75% is covered)
Complete bony (More than 75% is covered.
When is the optimal time to extract a tooth?
When root is 1/3-2/3 formed.
MX Impaction variations
Vertical, distoangular, mesioangular. Listed in order of difficulty.
Pell and Gregory for MX?
A B and C are similar to MN.
What vital adjacent structures are there around MN 3rd molars.
Lingual nerve (temp .4-1.5% perm 0-.5%0, IA (temp 1-5%, perm 0-.9%).
Location of lingual nerve
10-15% of the time lies superior to the lingual crest. 2.5 mm below superior crest and 2.5 mm medial to crest.
Radiographic predictors of nerve position
Root darkening, deflection and interruption of the canal. Narrowing ofthe canal. Splitting of root apex.
