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BDS3 Oral Surgery > minor oral surgery techniques - fractured teeth and retained roots > Flashcards

minor oral surgery techniques - fractured teeth and retained roots Flashcards

1
Q

8 reasosn why teeth fracture

A
  • thick cortical bone
  • root shape
  • root number
  • hypercementosis
  • ankylosis
  • caries
  • alignment
  • poor technique
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2
Q

hypercemntosis

A

too much cementum

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3
Q

ankylosis

A

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
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4
Q

assessment pre extraction (3)

A

history

clinical evaluation

radiographic evaluation - check for unusual anatomy

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5
Q

pt warnings

(3 main aspects)

A

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
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6
Q

how to explain minor oral surgerical procedure in lay terms

A
  • 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
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7
Q

8 possible post operative complications

A
  • 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

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8
Q

1

A

safety plus syringe system

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9
Q

2

A

S shaped cheek retractor

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10
Q

3

A

mitchell trimmer

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11
Q

4

A

elevators

  • 3 couplands
  • 3 warwick james
  • 2 cryers
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12
Q

5

A

kilner needle holder - locks

part of suture equipment

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13
Q

6

A

flicking forceps

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14
Q

7

A

bowdler henry rake retractor

good for retraction

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15
Q

8

A

disposable suction and stillette

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16
Q

9

A

lack’s tongue depressor

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17
Q

13 general surgical prinicples

A
  • 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
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18
Q

reason for

maximal access with minimal trauma

A

don’t want to tear - more bleed, scar, sore

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19
Q

reason for

minimise trauma to dental papillae

A

trauma to dental papillae –> gingival recession

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20
Q

type of flap used in oral surgery

A

mucoperiosteal/MP/ full thickness flap

down to bone

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21
Q

reason for no crushing

A

bruise

swelling

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22
Q

reason for

wide based incision

A

circulation and healing

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23
Q

reason for keeping tissues moist

A

circulation and healing

24
Q

technique for using scalpel in incision

A

one firm continuous stroke

not sawing

25
Q

why ensure flap margins and sutures lie on sound bone

A

edges don’t rest in hole, want to rest on bone (not collapse on healing)

26
Q

reason for no sharp angles

A

blood supplly issue then necrosis

27
Q

why not close wounds under tension

A

compromise blood supply

28
Q

primary intention healing best

A

minimise scarring

in general intra oral scarring is rare - good healing capabilities of tissue

29
Q

soft tissue retraction why (2)

A
  • Access to operative field
  • Protection of soft tissues
    • Prevent bur catching on tissue
30
Q

tools for soft tissue retraction (2)

A

Howarth’s periosteal elevator

Bowdler-Henry Retractor (rake)

Ash

31
Q

role of ash and howards

A

raise and hold flap out the way - retraction

rest on bone not on soft tissue = damage

32
Q

mandibular anatomical consideration in flap design

A

mental foramen (between apices of 5 and 4)

33
Q

anterior flap consideration

A

frenum

34
Q

1 sided flap

A

crevicular incision only

35
Q

2 sided flap

A

crevicual incision

distal relieving incision

36
Q

how far does relieving incision need to go

A

beyond the junction of attached and unattached gingiva – needed for access, will get bleeding and swelling – warn pt

37
Q

what to do if more access needed once cut flap?

A

remove bone on buccal side

Guttering - buccal cortex of bone and buccal surface of root

do not drill root

38
Q

ideal place for sutures in this flap

A

1st stitch – distal papilla – taking stitch aim for middle of flap

2nd stitch – mesial papilla

3rd stitch- relieving incision

39
Q

general aim for first suture

A

taking stitch - aim for middle of flap, help regain anatomy

bring flap back in anatomical position so easier to place the other stitches

40
Q

flap design for lower 6 after decoronation

possible

A

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)

41
Q

3 types of debridement

A
  • physical
  • irrigation
  • suction
42
Q

debridement in oral surgery is

A

clean area

43
Q

physical debridement

A

bone file or handpiece to remove sharp bony edges

Mitchell’s trummer or Victoria curette to remove soft tissue debris

44
Q

irrigation debridement

A

sterilie saline/water into sockt and under flap

45
Q

suction debridement

A

aspirate under flap to remove debris

check socket for retained apices etc

46
Q

2 suturing roles

A

approximate tissues

compress blood vessels - not under tension

47
Q

why is the distal relieving incision cut after the papilla

A

so supported as resting on bone not on hole from drilling - more anatomical position than collapsing

48
Q

5 aims of suturing

A
  • Reposition tissues
  • Cover bone
  • Prevent wound breakdown
  • Achieve haemostasis
  • Encourage healing by primary intention
49
Q

4 types of sutures

A

resorable

  • monofilament
  • multifilament

non-resorable

  • monofilament
  • multifilament
50
Q

resorable monofilament suture

A

monocryltm (poligelecarprone 25) not used in dentistry

51
Q

resorbable multifilament

A

vicryl rapidetm (polyglactin 910)

52
Q

non-resorbable monofilament

A

prolenetm (polypropylene)

nylon, smooth, use in areas where skin prone to scarring (e.g. skin for lacerated lip)

53
Q

non-resorbably multifilament

A

mersilk TM (black silk)

not used much anymore in practice

54
Q

4 methods of peri-operative haemostasis

A
  • LA with vasoconstrictor
  • Artery forceps clip vessels
  • Diathermy burn vessels
  • Bone wax hard to use
55
Q

6 methods of post operative haemostasis

A
  • 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
56
Q

post op medications

A
  • Not routinely AB
  • Analgesia as painful when LA wears off
57
Q

importance of placing sutures on sound bone

A

if on hole - will collapse in and not heal well

imp for cyst lesions

BDS3 Oral Surgery (8 decks)

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