minor oral surgery techniques - fractured teeth and retained roots Flashcards
8 reasosn why teeth fracture
- thick cortical bone
- root shape
- root number
- hypercementosis
- ankylosis
- caries
- alignment
- poor technique
hypercemntosis
too much cementum
ankylosis
fusion between root of tooth and PDL - direct contact between tooth and bone
- fracture bone
- hard to distinguidh between bone and tooth - issue when drilling out
assessment pre extraction (3)
history
clinical evaluation
radiographic evaluation - check for unusual anatomy
pt warnings
(3 main aspects)
Explain procedure to patient – need consent – written (best)
- If tooth needs sectioning, describe
- Give the patient an idea of what to expect during the procedure
- Explain minor surgical procedure (lay terms)
- If adjacent teeth are close by then is would be sensible to warn of possible damage to these teeth esp if filling in it that is risk of displacement
how to explain minor oral surgerical procedure in lay terms
- Pressure, no pain
- Lift the gum up – like lifting a blind
- Possible drilling (same drill as the one used for fillings)
- Water from drill
- Stitches – mainly resorbable now, takes time 1-3 weeks
8 possible post operative complications
- Pain
- Swelling
- Bruising
- Jaw stiffness esp in lower jaw
- Bleeding
- Dry socket more common in lower jaw and posteriors
- Infection (unusual)
- Nerve damage risk (i.e. numbness)
- Temporary, permanent, altered
Use language the patient understands
1
safety plus syringe system
2
S shaped cheek retractor
3
mitchell trimmer
4
elevators
- 3 couplands
- 3 warwick james
- 2 cryers
5
kilner needle holder - locks
part of suture equipment
6
flicking forceps
7
bowdler henry rake retractor
good for retraction
8
disposable suction and stillette
9
lack’s tongue depressor
13 general surgical prinicples
- maximal access with minimla trauma
- minimise trauma to dental papillae
- flap reflection should be down to bone and done clearly
- bigger flaps heal just as quicklly as smaller ones
- no crushing
- wide based incision
- keep tissues moist
- use scalpel in one firm continuous stroke
- ensure that flap margins and sutures will lie on sound bone
- no sharp angles
- make sure wounds are not closed under tension
- adequate sized flap
- aim for healing by primary intention to minimise scarring
reason for
maximal access with minimal trauma
don’t want to tear - more bleed, scar, sore
reason for
minimise trauma to dental papillae
trauma to dental papillae –> gingival recession
type of flap used in oral surgery
mucoperiosteal/MP/ full thickness flap
down to bone
reason for no crushing
bruise
swelling
reason for
wide based incision
circulation and healing
reason for keeping tissues moist
circulation and healing
technique for using scalpel in incision
one firm continuous stroke
not sawing
why ensure flap margins and sutures lie on sound bone
edges don’t rest in hole, want to rest on bone (not collapse on healing)
reason for no sharp angles
blood supplly issue then necrosis
why not close wounds under tension
compromise blood supply
primary intention healing best
minimise scarring
in general intra oral scarring is rare - good healing capabilities of tissue
soft tissue retraction why (2)
- Access to operative field
- Protection of soft tissues
- Prevent bur catching on tissue
tools for soft tissue retraction (2)
Howarth’s periosteal elevator
Bowdler-Henry Retractor (rake)
Ash
role of ash and howards
raise and hold flap out the way - retraction
rest on bone not on soft tissue = damage
mandibular anatomical consideration in flap design
mental foramen (between apices of 5 and 4)
anterior flap consideration
frenum
1 sided flap
crevicular incision only
2 sided flap
crevicual incision
distal relieving incision
how far does relieving incision need to go
beyond the junction of attached and unattached gingiva – needed for access, will get bleeding and swelling – warn pt
what to do if more access needed once cut flap?
remove bone on buccal side
Guttering - buccal cortex of bone and buccal surface of root
do not drill root
ideal place for sutures in this flap
1st stitch – distal papilla – taking stitch aim for middle of flap
2nd stitch – mesial papilla
3rd stitch- relieving incision
general aim for first suture
taking stitch - aim for middle of flap, help regain anatomy
bring flap back in anatomical position so easier to place the other stitches
flap design for lower 6 after decoronation
possible
1 sided flap – needs to be long crevicular incision (limited access)
No relieving incision – less bleeding, bruising and lower nerve risk
Get semilunar access
Can separate into 2 roots (can be done without raising flap sometimes)
3 types of debridement
- physical
- irrigation
- suction
debridement in oral surgery is
clean area
physical debridement
bone file or handpiece to remove sharp bony edges
Mitchell’s trummer or Victoria curette to remove soft tissue debris
irrigation debridement
sterilie saline/water into sockt and under flap
suction debridement
aspirate under flap to remove debris
check socket for retained apices etc
2 suturing roles
approximate tissues
compress blood vessels - not under tension
why is the distal relieving incision cut after the papilla
so supported as resting on bone not on hole from drilling - more anatomical position than collapsing
5 aims of suturing
- Reposition tissues
- Cover bone
- Prevent wound breakdown
- Achieve haemostasis
- Encourage healing by primary intention
4 types of sutures
resorable
- monofilament
- multifilament
non-resorable
- monofilament
- multifilament
resorable monofilament suture
monocryltm (poligelecarprone 25) not used in dentistry
resorbable multifilament
vicryl rapidetm (polyglactin 910)
non-resorbable monofilament
prolenetm (polypropylene)
nylon, smooth, use in areas where skin prone to scarring (e.g. skin for lacerated lip)
non-resorbably multifilament
mersilk TM (black silk)
not used much anymore in practice
4 methods of peri-operative haemostasis
- LA with vasoconstrictor
- Artery forceps clip vessels
- Diathermy burn vessels
- Bone wax hard to use
6 methods of post operative haemostasis
- Pressure bite on something
- LA with vasoconstrictor
- Diathermy
- Whitehead’s Varnish Pack
- Iodoform, Gum Benzoin, Storax, Balsam Tolu, Ethyl Ether
- Surgicel
- help blood clot form inside the pocket
- Sutures
post op medications
- Not routinely AB
- Analgesia as painful when LA wears off
importance of placing sutures on sound bone
if on hole - will collapse in and not heal well
imp for cyst lesions
