Minor oral surgery techniques Flashcards
Patient warnings
- explain procedure to pt
- if tooth needs sectioning, describe
- give the pt an idea of what to expect during the procedure in lay terms (pressure, no pain, lift the gum up, possible drilling, water from the drill, stitches)
- if adjacent teeth are close warn of possible damage to these teeth
- post operative complications
what are the post operative complications
- pain
- swelling
- bruising
- jaw stiffness
- bleeding
- dry socket
- infection (unusual)
- nerve damage (temporary, permanent, altered)
general surgical principles
- maximal access with minimal trauma
- bigger flaps heal just as quickly as smaller ones
- wide-based incision (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
how do you achieve soft tissue retraction
- access to operative field
- protection of soft tissues
- flap design facilitates retraction
- Howarth’s periosteal elevator or Bowdler-Henry Retractor (rake)
- done with care
what is a two sided flap
Cervicular incision and distal releiving incision
what structure do we need to think about before making incision
mental foramen
what does a 2 sided flap look like
where do we suture in a 2 sided flap
how many sides is this flap
1 sided flap
why do we make the distal relieving incision against bone rather than on papilla
If made distal incision before papilla it could collapse into the hole
So this way it is resting on healthy bone
Flap needs to be wider than the size of defect youre going to create
how is debridement done
- physical
- bone file or handpiece to remove sharp bony edges
- Mitchell’s trimmer or Victoria curette to remove soft tissue debris
- irrigation
- sterile salive/water into socket and under flap
- suction
- aspirate under flap to remove debris
- check socket for retained apices etc
how is suturing done
- approximate tissues
- compress blood vessels
- aims
- reposition tissues
- cover bone
- prevent wound breakdown
- achieve haemostasis
- encourage healing by primary intention
what are the aims of suturing
- reposition tissues
- cover bone
- prevent wound breakdown
- achieve haemostasis
- encourage healing by primary intention
what different types of sutures are there
- resorbable
- monofilament e.g. MONOCRYL
- mulifilament e.g. VICRYL RAPIDE
- non-resorbable
- monofilament e.g. PROLENE
- multifilament e.g. Mersilk
How to achieve haemostasis peri-operatively
- LA with vasoconstrictor
- artery forceps
- diathermy
- bone wax
how to achieve haemostasis post-operatively
- pressure
- LA with vasoconstrictor
- diathermy
- whitehead’s varnish pack
- surgicel
- sutures
what different flap designs are there
- semi-lunar (reduced access,only good for apical lesions, scarring, dysaesthesia, less gingvial retention)
- triangular (2-sided)
- rectangular (3-sided)
why is imporant to not do the distal relieveing incision on an 8 too lingual
could injure the lingual nerve
where should our distal relieveing incision be on an 8
follow the external oblique ridge
what are the stages of surgery
- consent
- surgical pause/safety checklist
- anaesthesia
- access
- bone removal as necessary
- tooth division as necessary
- debridement/wound
- management
- suture
- achieve haemostasis
- post-operative instructions
- post-operative medication
- follow-up
what’s important to ensure with surgical access
- wide-based incision-circulation/perfusion
- use scalpel in one firm continuous stroke
- no sharp angles
- adequate sized flap
- flap reflection should be down to bone and done cleanly
- minimise trauma to dental papillae
- no crushing
- keep tissues moist
- ensure that flap margins and sutures will like on sound bone
- make sure wounds are not closed under tension
- aim for healing by primary intention to minimize scarring
Principles of elevator use
- mechanical advantage
- avoid excessive force
- support the instrument to avoid injury to the patient should the instrument slip
- ensure applied force is direct away from major structures e.g. antrum, ID canal, mental nerve
- always use in direct vision
- never use an adjacent tooth as a fulcrum unless it too is to be extracted
- keep elevators sharp and in good shape. Discard if blunt or bent
- Establish an effective and logical point of application
- careful debridemnt after the use of elevators to remove any bone fragments that have been created
Uses of elevators
- To provide a point of application for forceps
- To extract a tooth without the use of forceps
- Removal of retained roots
- To loosen teeth prior to using forceps
- Removal of multiple rot stumps
- Removal of root apices
what are the different cross sections of suture needles
- triangular
- 3 cutting sides
- the main cutting side is on the inside curve of the needle and that can lead to the suture passing through the tissues nice and easy.
Concern is you can tear through sutures when tieying off so some people use reverse cutting
- round
- cutting is on the point, the rest is just about dilation and stretching of the tissue, tends to be used for more fryable tisesues
how to hold a suture needle
1/3 from the swaged end
what are the main different types of suturing
- Interrupted
- Horizontal mattress
- Continuous suture
- Vertical mattress suture
suturing for a 3 sided flap
what 4 nerves can be damaged during removeal of 3rd molars
- lingual
- inferior alveolar
- mylohyoid
- buccal
where is the lingual nerve in relation to the 3rd molar
above lingual plate in 15-18% of cases
