Minor oral surgical techniques: Fractured teeth and retained roots Flashcards
Why do teeth fracture?
- Thick cortical bones
- Root shape
- Root number
- Hypercementosis
- Ankylosis
- Caries
- Alignment
What warnings do you need to inform patient before extracting tooth?
- Explain procedure to patient
- If tooth needs sectioning then describe
- Give patient idea of what to expect during procedure
- P, no pain
- Lift gum up
- Possible drilling (same one as used for fillings)
- Stitches
- If adjacent teeth are close by then would be sensible to warn of possible damage to these teeth
What post operative complications should you explain to patient?
- Pain
- Swelling
- Bruising
- Jaw stiffness
- Bleeding
- Dry socket (more common in lower)
- Infection (unusual)
- Nerve damage risk i.e. numbness (Temporary/ permanent/ altered)
- Use language patients understands
What are the general surgical principles?
- Maximal access with minimal trauma
- Bigger flaps heal just as quickly as smaller ones
- Wide-based incision - circulation for healing afterwards
- 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 so they don’t fall
- Make sure wounds are not closed under tension
- Aim for healing by primary intention to minimise scarring
How to achieve soft tissue retraction?
- Access to operative field
- Protection of soft tissues
- Flap design facilitates retraction
- Howarth’s periosteal elevator or Bowdler-Henry Retractor (Look like Rake at end)
- Should be done with care as has sharp edge so rest on bone not soft tissues
How to achieve debridement?
Physical
- Bone file or handpiece to remove sharp bony edges
- Mitchell’s trimmer or Victoria curette to remove soft tissue debris
- Don’t be too vigorous
Irrigation
- Sterile saline/water into socket and under flap
- Most important
Suction
- Aspirate under flap to remove debris
- Check socket for retained apices etc
What are the aims of Suturing?
- Reposition tissues
- Cover bone
- Prevent wound breakdown
- Achieve haemostasis
- Encourage healing by primary intention
- Compress blood vessels
What are the types of suturing?
Resorbable
- Monofilament
E.g. MONOCRYLTM (poliglecaprone 25)
- Multifilament
E.g. VICRYL RAPIDETM (polyglactin 910)
Non-Resorbable
- Monofilament
E.g. PROLENETM (polypropylene) - use this for skin
- Multifilament
E.g. MersilkTM (black silk)
How to achieve Haemostasis Peri-operative?
- LA with vasoconstrictor
- Artery forceps
- Diathermy
- Bone wax (some need to have it removed later as it doesn’t break down0
How to achieve Haemostasis Post-operative?
- Pressure
- LA with vasoconstrictor
- Diathermy
- Whitehead’s Varnish Pack (Iodoform, Gum Benzoin, Storax, Balsam Tolu, Ethyl Ether)
- Surgicel (help blood clot form)
- Sutures
What to do after extraction?
- Post-op instructions
- Post-op medication
How to take out lower 5 but you fractured crown via two step incision?
- Luxate and Elevate to mobilise and break PDL
- Be careful of mental foramen and mental nerve (use radiographs to see anatomy)
- When using a distal relieving incision you have to pull towards you (technically correct but harder to do)
- To use a mesial incision flap (go along 4 to avoid mental nerve)
- Use round bur and create a buccal gutter to give application point to elevators
- Elevate tooth
- Place flap back
- Place first stitch gingival margin distal of 5 you took out
- Then stitch mesial of 5 and both sides of the distal incision you created
- Useful but gives limited access as have to pull flaps down quite low to not tear the tissues
How can surgical emphysema arise?
- Drilling the roots of tooth using high speed
- Air released from turbine can cause air into tissues, swelling and surgical emphysema
- Use motorised oral surgery handpiece as spins at lower speed and less risk of surgical emphysema
