Minor Oral Surgery Technique - Fractured Teeth and Retained Roots

Question 1

Why do teeth fracture?

Answer 1

Thick cortical bone
Root shape
Root number
Hypercementosis
Ankylosis
Caries
Alignment

Question 2

What warnings should be given to patients?

Answer 2

Explain procedure
If tooth needs sectioning then describe
What to expect during surgery - pressure, no pain; lift the gum up, possible drilling; water from the drill; stitches
If adjacent teeth are close then warn of possible damage to these teeth

Question 3

What are the post operative complications?

Answer 3

Pain
Swelling
Bruising
Jaw stiffness
Bleeding
Dry socket
Infection (unusual)
Nerve damage risk (numbness) - can be temporary, permanent, altered

Question 4

Give examples of general surgical principles

Answer 4

Maximal access with minimal trauma
Bigger flaps heal just as quickly as small ones
Wide-based incision for better circulation
Use scalpel in one firm continuous stroke
No sharp angles
Adequate sized flap
Minimise trauma to dental papillae
Flap reflection should be down to bone and done cleanly
No crushing
Keep tissue moist
Ensure that flap margins and sutures will lie on sound bone
Make sure wounds are not closed under tension
Aim for healing by primary intention to minimise scarring

Question 5

Describe ideal soft tissue retraction

Answer 5

Access to operative field
Protection of soft tissues
Flap design facilitates retraction
Howarth’s periosteal elevator or Bowdler-Henry Retractor (Rake)
Should be done with care

Question 6

Describe physical debridement

Answer 6

Bone file or handpiece to remove sharp bony edges
Mitchell’s trimmer or Victoria curette to remove soft tissue debris

Question 7

Describe irrigation debridement

Answer 7

Sterile saline/water into socket and under flap

Question 8

Describe suction debridement

Answer 8

Aspirate under flap to remove debris
Check socket for retained apices etc

Question 9

What are the aims of suturing?

Answer 9

Approximate tissues and compress blood vessels to:
- reposition tissues
- cover bone
- prevent wound breakdown
- achieve haemostasis
- encourage healing by primary intention

Question 10

How is peri-operative haemostasis achieved?

Answer 10

LA with vasoconstrictor
Artery forceps
Diathermy
Bone wax

Question 11

How is post-operative haemostasis achieved?

Answer 11

Pressure
LA with vasoconstrictor
Diathermy
Whitehead’s Varnish Pack
Surgical
Sutures