Oral Surgery 1 Flashcards
Why study radiographs before extraction
Lone molars Deep caries/fracture Weird roots Lesion under tooth Crown
In the standing extraction position, where should the mandible/maxilla be located
Maxillary arch level with surgeon’s elbow or below
Mandible parallel to floor
Instead of pulling the tooth, what do you do
Push
Rock
Rotate
3 types of elevators
Wedge
Lever
Wheel and axle
2 purposes of elevators
- Loosen teeth, create space
2. Remove parts of tooth or root (primary mechanism for 3rd molar)
A straight elevator does what to the tooth
Pushes DOESN’T SCOOP
Primary use of cryer elevators
Removing residual roots of multi-rooted teeth
How to use forceps
- Seat forceps by applying force apically
- B, L, or rotational force to expand alveolus to release tooth
- Minimal traditional force
8 steps to extraction
- Anesthesia (profound)
- Soft tissue release
- Elevate tooth
- Adapt forceps to tooth
- Lunate with forceps
- Remove tooth from socket
- Examine socket for soft tissue/granulation (curette)
- Gauze over socket and compress with occlusal forces
150 and 151 forceps remove what
Any, universal
Cow horn 23 removes what
Mandibular molar
What removes max anterior and premolars
1
150
Max canines are removed with what
1
150
Max 1st premolar is extracted with
1
150
Max 1/2nd molars are extracted with
150
53 R/L
88 R/L
Mandibular incisors/canine/premolars forceps
151
Ash
Surgical extraction
Removal of tooth with:
Flap
Removal of bone
Tooth in multiple pieces
When doing a flap, you should cross the gingival margin when
At the line angle of the tooth
5 types of mucoperiosteal flaps
Envelope Three cornered Four cornered Semi-lunar Y incision
Indications for open extraction
When you need to be more careful
- sinus proximity
- avoid excessive force
- ankylosis
- dense bone
Weird morphology
- roots
- exostosis
When can you leave a root tip
Small piece <4mm Deeply embedded Not infected Not mobile Risk of removal> leaving it Inform and counsel pt. Document Refer if needed
Impacted vs unerupted
I: failure to fully erupt within expected time
U: tooth not having perforated oral mucosa
T/F all unerupted teeth are impacted
FALSE
Formation of 3rd molars
Crown?
50% of root?
Average?
Crown - 14
50% of root - 16
Av. - 20
Winter’s classification
Based on inclination of impacted tooth to long axis of 2nd molar
M-angular
D-angular
Horizontal
Vertical
Therapeutic vs prophylactic indication for 3rd molar removal
T: treat active process/disease
P: prevent future disease
Indications for removal of third molars
Pericoronitis Caries Pathological resorption Pathology Eruption pain Crowding Post-ortho Orthographic surgery In line of a mand. Fracture Perio Lack of att. Ging
Why is it hard to pull 3rd molars in old people
Highly calcified bone, less flexible Slower recoop Mand. Fracture easier Non resolving Pins and needles Osteomyelitis and infection easier
Order of which teeth get extracted the most
Man 3rd > max 3rd > max canine > man PM > Man canine > max PM > max CI > Max LI > man 2nd molar
Peak pain occurs _
12 hrs after surgery
The first analgesic should be taken _
Before local wears off
Long acting local anesthetic to use before discharge
Marciano
Don’t prescribe more than _ worth of pain meds
3 days
Two options for meds post surgical extraction
10 of:
Tramadol 50 mg
Norco 5 mg/325 mg (hydrocodone/acetaminophen)
Peak swelling post surgery
36-48 hrs
T/F post op infection diagnosis can be made over the phone
FALSE
4 stages of wound healing cascade and main cell of each
Hemostasis - platelet
Acute inflammation - granulocytes
Proliferation - monocyte/macphage
Remodeling - fibroblast
What happens in the 4 stages of wound healing
Hemo - stop bleeding
Inflammation - stabilize clot, signal to cells to clean up wound
Proliferation - collagen and caps form on fibrin, provisional matrix where bone can form
Remodeling - woven bone replaces collagen, then mature bone
Normal healing timeline
1: mild-mod discomfort
3: socket healed over
4-6: lamina dura to resorbed radiographically
Things that mess up healing time (6)
Bad hygiene Bony pathology Smoking Radiation Anti-resorptive drugs Suppression of host defenses
BRASSB
Dry socket:
Loss, lysis, or breakdown of the blood clot prior to its maturation into granulation tissue
Things that increase risk for dry socket
Mandibular tooth
Smoking
Oral contraceptive
Pericoronitis
Osteomyelitis:
Bone infection. Medical and surgical issue, can lead to significant morbidity
