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BDS III CPA PAST PAPERS SORTED BY TOPIC (2005 – 2019) > MINOR ORAL SURGERY (MOS) > Flashcards

MINOR ORAL SURGERY (MOS) Flashcards

1
Q
  1. Describe the histological changes after extraction (6) (Formative, 2017)
A
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2
Q
  1. Dr suggests extraction for 21 with perio endo lesion, what consideration for extraction?

(Summative, 2016)

A

 Local anaesthesia may not be effective in normal dosage because of the presence of pus in the periodontium, the pH is lower hence the ratio of unionised to ionised LA is significantly increased so the LA cannot pass into the nerve

 Need cut and drain the abscess

 Infraorbital block may be used hence possibility of hematoma on the lower eye

Anson: see page 169-171 for table (too big to include)

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3
Q
  1. (Summative, 2015)
    a. Please give 3 types of impaction. (3)
A

 Mesio-angular impaction

 Horizontal impaction
 Vertical impaction
 Disto-angular impaction

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4
Q

3b. 3 main concerns of flap design (3)

A

 Vascular supply
 Adequate access
 Anatomical structures e.g. lingual nerve, mental nerve

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5
Q

3c. Why soft tissue flap in Oral Surgery is called mucoperiosteal flap? (2)

A

 The flap includes the mucosa, submucosa and the periosteum. And it is a flap (LOL)

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6
Q

3d. 6 steps of minor oral surgery for removing impacted third molar after you have achieved anesthesia (6)

A

 Adequate access: incise and create a proper flap  Remove bone
 Section the tooth
 Remove the tooth particles using elevators

 Measures to aid haemostasis, put some haemostatic agents like collagen plugs/Gelfoam?

 Wound closure: suture the flap

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7
Q

3e. Draw flap designs: 3-sided flap for the extraction of 45, and standard flap for the extraction of an impacted 38 on the diagram on the next page (8) (but the given diagram of 38 is not impacted)

A
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8
Q

3f. List three methods of suturing? (3)

A

 See Zwahlen’s powerpoint

 Interrupted vertical mattress

 Interrupted horizontal mattress

 Triangular

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9
Q
  1. Tooth 48 is impacted. What factors contribute it the difficulty of its surgical removal?
A
  • Angulation
    • [Easiest] Vertical > mesioangular > distoangular > horizontal [Complicated]
  • Depth of impaction
    • Affect extent of bone removal and iatrogenic trauma
  • Root formation
    • Optimal time when root formed are 1/3 to 2/3 (less deeply impacted)
  • Root morphology
    • Number of root, taper, shape, curvature
  • Bone density
    • Less calcified in younger, more easy bone removal
  • Relationship to vital structures
    • IDN, LN, second molar
  • Size of follicle
    • Larger favourable
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10
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

a. What are the radiographic findings in reg ard to the patient’s chief complaints? (2)

A

 Displaced tooth in fascial space causing abscess formation?

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11
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

b. Why there is a limited mouth opening? (2)

A

 Pericoronitis –> infection spread to fascial plane (masseteric, buccal space) –> muscle spasm

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12
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

c. What are the views (axial/sagittal/coronal) of the CT scans shown? Where is the tooth?

A

 sagittal / coronal / axial

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13
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

d. List three anatomical structures that are in proximity to 28 in this case. (3)

A
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14
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

e. What kind of anaesthesia would you give to the patient for removal of 18, 28, 38 and 48? Why? (1)

A

 GA, involve multiple extraction on all quadrants

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15
Q
  • C/O: pain after extraction of upper left 2nd molar, request for extraction of the other 3rd molars
  • HPC:
  • MH: hypertension under medication
  • DH: previous dentist claimed 28 extracted, but didn’t show the extracted tooth (patient was very

dissatisfied with the dentist)

  • FSH:
  • E/O: Submandibular node tender on palpation
  • I/O: suture noted on mucosa of 28 region
    • Impacted 18, 38, 48
    • From CT scans, 28 seen on the mesial side of the left mandibular ramus

f. With regard to Derek’s dissatisfaction about the extraction by the previous dentist, what additional procedures would you perform? (1)

A

 Show the patient the tooth you extracted

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16
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    a. Regarding to this patient’s chief complaint, what will you check when performing clinical examination? (5)
A
  • E/O:
    • TMJ, mouth opening
    • Muscles of mastication
    • Lymph nodes
    • Facial asymmetry
  • I/O:
    • Probing depth of 47, 48
    • Any caries
    • Any pus?
    • Swollen gingiva? Operculum?
    • Palpation of mucosa
    • Mobility
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17
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    b. Describe the radiographic finding s. State your provisional diagnosis and briefly describe the possible causes. (4)
A
  • Pericoronitis, with Ludwig’s angina
  • Abscess formation due to infection of surrounding soft tissue of partially erupted third molar
  • Spread of infection through the least resis tance pathway occur, to bilateral submandibular and sublingual spaces
  • Raise of mouth floor and tongue result in difficulty in swallowing and narrowing of airways compromise breathing and may have asphyxiation
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18
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    c. What are your treatment plans for this condition? What are the extrinsic and intrinsic obstacles in surgical removal of 48? How can you overcome those obstacles? (6)
A

 Surgical removal of 48 under LA
 Extrinsic obstacles: bone (texture and density), soft tissue, 47, ID n.
 Intrinsic obstacles: root, crown, PDL space, follicular size, winters depth

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19
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    d. What can you do to reduce the anxiety of the patient during surgical removal of 48? (2)
A

 Clear pre-surgical explanation to patient

 Sedation (nitrous oxide, benzodiazepine)

 General anaesthesia
 Atraumatic surgery

 Sufficient LA

20
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    e. What is ‘dry socket’? State the possible causes and predisposing factors to it. (6)
A
21
Q
  1. Large right facial swelling, increasing difficulty in swallowing and breathing. Periapical radiograph 48: horizontally impacted 48, widened PDL space, mesial angular bone loss, 47 distal root moderately resorbed, radiolucency seen around the crown of 48.
    f. What are the treatments for ‘dry socket’? (2)
A
22
Q

23/F, radiographer, self-referred to your clinic to ask for extraction of wisdom teeth.
History: pain at wisdom teeth region for several times
Pan: 18, 28 vertical, fully erupted, 38 horizontal impaction, 48 horizontal/mesio angular impaction

a. In response to patient’s complaint, what clinical examination and special investigation should be done? (2)

A

 Presence of local infection
 Signs and symptoms of fascial space infection (diffused swelling, difficult of swallowing, breath)

 Presence of systemic involvement like regional lymphadenopathy
 Occlusal relationship –> whether trauma on opposing soft tissue
 Caries in or resorption of 3rd molar and adjacent tooth
 Eruption status and orientation of 3rd molar
 Limited mouth opening
 Periodontal status (mobility)
 TMJ function
 Special investigation: CBCT whether infection spread to fascial spaces

23
Q

23/F, radiographer, self-referred to your clinic to ask for extraction of wisdom teeth.
History: pain at wisdom teeth region for several times
Pan: 18, 28 vertical, fully erupted, 38 horizontal impaction, 48 horizontal/mesio angular impaction

b. What is your diagnosis and treatment plan? (5)

A

 Pericoronitis
 Extraction of impacted wisdom teeth 38 & 48

24
Q

23/F, radiographer, self-referred to your clinic to ask for extraction of wisdom teeth.
History: pain at wisdom teeth region for several times
Pan: 18, 28 vertical, fully erupted, 38 horizontal impaction, 48 horizontal/mesio angular impaction

c. What type of anesthesia do you suggest and why? (2)

A
  • ID block and long buccal nerve block
  • Since sectioning of tooth and full thickness of mucoperiosteal flap involve the lingual gingivae, 3rd molar (supplied by IDN) and buccal gingivae (long buccal nerve)
  • Or GA?
    • Due to increased surgical difficulty and depth of impaction, which involve prolonged surgery and extensive bone removal
    • Infection make LA inefficient (but normally extract after resolution of infection except life threatening fascial space infection)
25
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

a. Regarding to this patient’s condition, what will you check when performing the clinical examination?(5)

A
26
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

b. Describe the radiographic findings. What is the provisional diagnosis? What are the possible causes? (4)

A
  • Radiopaque mass located inside right maxillary sinus
  • Fluid is filled in right maxillary sinus
  • Oroantral fistula
  • Iatrogenic
    • Root fracture during extraction, failure to retrieve while damage the membrane lining, allowing upward displacement into maxillary sinus
  • Infection
    • Pre extraction existing apical pathology already disrupt the membrane lining
27
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

c. What are your treatment plans for this patient? List any 2 surgical techniques involved (6)

A
  • General guideline
    • For small fistula (< 5 mm) spontaneously closure can be expected
    • Large perforation require surgical repair
  • Surgical
    • Caldwell Luc operation : intraoral access into maxillary sinus via fossa above maxillary premolar for continuous drainage and retrieval of retained root
    • Direct closure: debride socket and pack with Gelfoam, followed by buccal / palatal flap
  • Instructions to patient
    • Avoid smoking
    • Avoid using straws for drinking (produce negative pressure)
    • Sneezing should be with mouth open
  • Drug prescription
    • Decongestant
    • Antibiotics for app. 10 days
  • Create an access window at anterior antral wall to take out tooth fragment from the sinus, if the sinus opening is large, bone graft
  • If opening is small, close by epithelial repositioning
  • If opening is moderate (2-6mm), figure of 8 suture with gelfoam, follow sinus precautions, prescribe amox, cephalexin, or clindamycin for 5 days, decongestant nasal spray, refer if communication persists for longer than 2 weeks, refer if patient has previous history of chronic sinus disease
  • If sinus opening is large (>7mm), refer to OMFS. Raise buccal flap to take out the root fragment and close the oroantral fistula
  • Refer to OMFS, suction, Caldwell luc procedure, buccal advancement flap, palatal rotation flap, try to irrigate and flush out the tooth
  • For pericoronitis, extract upper first, let inflammation resolve, extract lower, irrigate, antibiotic
28
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

d. Patient seemed to be quite anxious about the surgical procedure. What can you do to reduce the anxiety of the patient during surgical treatment? (2)

A

 Oral Sedation* trazolan

 Adequate local anesthesia

 Consider GA
 Anxiolytic drug

 hypnosis
 communication, explain procedure

29
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

e. What is dry socket? State the possible causes and predisposing factors to it (6)

A
  • Alveolar osteitis. Delay wound healing not associated with an infection. “postoperative pain inside and around the extraction site, which increases in severity at any time between the first and third day after the extraction, accompanied by a partial or total disintegrated blood clot within the alveolar socket with or without halitosis”
  • Proposed risk factors:
    • Operator factor: lack of operator experience, trauma, bone fragments, flap design
    • Patient factor: poor OH, smoking, oral contraceptives, immunocompromised patients, DM, radiotherapy, AIDS, poor blood supply, impacted lower 8, age
    • Bacterial involvement
  • Causes: loss of blood clot due to fibrinolytic effect
30
Q

The patient comes for right submandibular swelling
C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing
Smoke 1 pack a day for many years.
Given: A pan, 3 CT scan photos (Axial, sagittal and coronal view provided, “aiming” at a radiopaque object in sinus. CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

f. What are the treatments for “dry socket”? (2)

A

 Irrigate socket with saline

 Socket should not be curetted

 Place gauze with iodoform, eugenol, benzocaine, balsam of peru, change dressing every other day for 3- 6 days, once pain decreases, dressing should not be replaced, delay wound healing

 BIPP (Bismuth iodoform paraffin paste)

 Cotton pellet with ZOE, (Amoxicillin), metronidazole/ doxycycline, lidocaine gel

 Rinse with CHX bid for 7 days

31
Q

Given: panoramic radiograph. Generalized horizontal bone loss Multiple missing teeth: 18, 16, 24, 25, 26, 27, 38, 31, 41, 42, 48 Periapical radiolucency, Furcation involvement, Tilting

a. How would uncontrolled diabetes type 2 affect the healing if 37 were to be extracted?

A
  • Advanced glycated end products cause altered microvascular structure, which decrease blood supply to injured regions
    • Decrease oxygenation –> Hypoxia (due to insufficient perfusion and angiogenesis)
    • Hypoxia amplify early inflammatory response, thus prolonging injury by increasing levels of oxygen radicals
    • Hyperglycemia can add to the oxidative stress when production of reactive oxygen species exceeds the antioxidant capacity
    • Interaction between AGEs and RAGEs (receptors of AGEs) also result in high levels of matrix metalloproteinase –> increased tissue destruction and inhibit normal repair
  • Dysregulated cellular functions
    • Impaired immune system, inhibit ion of chemotaxis, phagocytosis, dysfunction of fibroblast and epidermal cells –> inadequate bacterial clearance –> infection easily occur even in small wound
  • Neuropathy
    • Neural cells death due to decreased vasculature
    • Neuropeptides like nerve growth factors and substance P are relevant to wound healing, which promote cell chemotaxis, induce growth factor production, stimulate cell proliferation
    • Decreased neuropeptides is associated with neuropathy
    • Moreover, sensation can modulate immune response, with denervated skin exhibit reduced leukocyte infiltration
32
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

a. List 5 radiographic findings of the OPG.
b. What is the normal range of mouth opening?

A

 45 mm

33
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

c. What is the cause of tenderness of left masseter muscle?

A

 Spreading of infection to masseteric space, result in masseter muscle spasm

34
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

d. What is your diagnosis?

A

 Pericoronitis (with spreading to fascial space e.g. pterygomandibular space)

35
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

e. What are the risks of extraction?

A

 Spread of infection
 Damage adjacent vital structure due to inadequate access (trismus)

 IDN, LN deficit
 Or other possible complications (oroantral fistula, jaw fracture)
 Displace the tooth into facial spaces and sinuses
 Luxate adjacent tooth
 Dry socket
 Soft tissue trauma
 Bone fracture
 Tooth fragments left behind
 Post-operative haemorrhage

36
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

f. The socket is found to have no blood clot after 3 days. Name the condition.

A
37
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

g. How would you manage this condition?

A

 Explain to patient the pain is not due to retained root, and warn existence of pain for a week or more

 Irrigation with socket with saline or antiseptic like CHX

 Place resorbable dressing inside socket, replace after 24-48 hours and multiple replacement is required (no healing if using non-resorbable dressing)

 Prescribe short term analgesic

38
Q

Given: photo showing 38 inflamed mucosa, an OPG, and CT scan showing tooth in fascial space History: had an extraction lately, dentist hadn’t shown her the tooth, now painful

h. Would you prefer using LA or GA? Give your reasons.

A

 GA

 Localized infection make LA inefficient due to low pH

 LA may cause further spread of infection into deep fascial spaces

 Depth and angulation of 38 depends the surgical difficulty, excessive bone removal prefer GA

39
Q
  1. Hypertension. C/O: pain on the lower jaw and continued for a period of time and ceased. But recently pain experienced again and patient cannot fall asleep. Panoramic radiograph is provided. (Formative, 2011)
    a. Suggest treatment plan for the patient. If wisdom teeth are needed to be extracted, what are the internal and external obstacles? How will you overcome them?
A
  • Internal
    • Crown and root morphology, follicular space, depth and angulation of impaction
  • External
    • Bone, adjacent teeth, IDN, LN
  • Overcome by
    • Bone removal
    • Tooth sectioning
    • Pre operatively risk and difficulty assessment
40
Q

OS - Given PAN with no lower teeth, a few upper teeth and 14-12 is a bridge, 13 pontic. Complain of pain.
I/O: 14 and 12 carious, TTP; 12 has gingival swelling with pus exudation.
MH: On antihypertensive medication, allergy to “acetaminophen”, gastric pain

FSH: Heavy smoker (10 a day), social drinker

a. Describe how you would perform anesthesia and why (3)

A

 Anterior superior alveolar nerve block

 Important to locate infraorbital foramen via palpation, needle advance parallel to long axis of tooth until

it contact bone of infraorbital foramen

 Since local infiltration in 12 with pus is not effective

 Limit the use of adrenaline containing LA and aspirate prior to injection

41
Q

OS - Given PAN with no lower teeth, a few upper teeth and 14-12 is a bridge, 13 pontic. Complain of pain.
I/O: 14 and 12 carious, TTP; 12 has gingival swelling with pus exudation.
MH: On antihypertensive medication, allergy to “acetaminophen”, gastric pain

FSH: Heavy smoker (10 a day), social drinker

b. Outline the procedures for extraction using a sterile method, list what instruments you will use (4)

A
42
Q

OS - Given PAN with no lower teeth, a few upper teeth and 14-12 is a bridge, 13 pontic. Complain of pain.
I/O: 14 and 12 carious, TTP; 12 has gingival swelling with pus exudation.
MH: On antihypertensive medication, allergy to “acetaminophen”, gastric pain

FSH: Heavy smoker (10 a day), social drinker

c. Bone fracture noticed after extraction, what is the management (3)

A

 Take radiograph
 If small, take out the fractured bone
 If large, keep the bone attached to periosteum -> compression

 Refer to OMFS

43
Q

OS - Given PAN with no lower teeth, a few upper teeth and 14-12 is a bridge, 13 pontic. Complain of pain.
I/O: 14 and 12 carious, TTP; 12 has gingival swelling with pus exudation.
MH: On antihypertensive medication, allergy to “acetaminophen”, gastric pain

FSH: Heavy smoker (10 a day), social drinker

d. What analgesic you would give (2)

A

 NSAID may not be suitable

 Paracetamol 500 – 1000 mg, QID, no strict duration

44
Q

Information given:
70-year-old woman with DM
Pain on lower left molar region.
PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.
Clinical findings: Vertical fracture of 37 extending to root

a. What instruments will you use to extract lower molars? What is the motion? (3)

A
  • Separation of soft tissue attachment surrounding the tooth
    • Straight desmotomes > for maxillary anterior teeth
    • Curved desmotomes > for rest of maxillary and all mandibular teeth
  • Extraction forceps (straight forceps, upper premolar forceps, maxillary left and right molar forceps, Bayonet extraction forceps, lower root forceps, lower permanent molar forceps)
  • Expansion of socket
    • Apical pressure first, followed by buccal and lingual movement (more lingually since there is external oblique ridge)
    • While for signal and conical root initial rotational movement facilitate loosening
    • Final withdrawal movement is in outward occlusal direction (tractional force), avoid traumatizing opposing teeth
45
Q

Information given:
70-year-old woman with DM
Pain on lower left molar region.
PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.
Clinical findings: Vertical fracture of 37 extending to root

b. During extraction, you find that the lingual plate has been fractured. What will be the precaution for to further carry out the procedure? (3)

A

 Depends on bony plate is displaced or not

 Non-displaced → observation and soft diet is enough

 Displaced → open reduction and internal fixation with screw or plate, maxillomandibular fixation with

arch bar

 Explain to patient for possible malocclusion, loss of vitality of adjacent teeth, infection, nerve deficit -

Return in 1 week for review and follow up

BDS III CPA PAST PAPERS SORTED BY TOPIC (2005 – 2019) (62 decks)

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