Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Complex Adult Dentistry > Oral Surgery > Flashcards

Oral Surgery Flashcards

1
Q

What is exodontia?

A

Tooth extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the principles of exodontia?

A

Expansion of bony socket
Separation of attachment of PDL
Separation of gingival soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the average bone losses in the first 1-6 months post exodontia in mm?

A

Horizontal loss 3.8mm

Vertical height reduction 1.24mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which plate (buccal/lingual) exhibits the most resorption post exodontia?

A

Buccal plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the healing cascade post exodontia?

A

Clot formation fibrin mesh work. 24-48h
Epithelial migration over socket & clot becomes granular. 7 Days
granulation tissue become collagen &early bone. 20 Days
Bone marrow occupies socket replacing woven bone. 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is the clot formed post exodontia?

A

Haemorrhage
Bleeding
Platelet aggregation
Clot formation (platelets and leukocytes in fibrin gel).
2-3 days inflammatory cell clean site prior to new tissue formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a periotome?

A

Like a sharp flat plastic used to sever PDL

Not used in LDI (expensive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is a periotome used?

A

Long axis of blade Inserted into socket along medial and distal sides

Not used in facial plate because it’s thin and easily damaged

Wait 10-20 seconds with instrument in situ

Then used as a lever

Slow pressure otherwise tip will break

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are luxators?

A

Thin and sharp sever PDL
Effective
Bone preserving
Separate tooth and bone before extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is a luxator used?

A

Chops a size matching root diameter
Apply apical pressure
Gently rock to sever PDL
Vacuum broken remove tooth with forceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an elevator?

A

Rotate around a fulcrum to lever tooth out of socket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the three ways to use an elevator?

A

Lever
Wedge - similar to a luxator
Wheels and axel - between teeth and rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three types of elevator?

A

Couplands straight ones
Warwick James straight and left and right hockey stick

Cryers left and right and mega sharp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 5 pairs of sinuses in the maxilla?

A 
Frontal sinus 
Ethmoid sinus 
Sphenoid sinus 
Nasal cavity 
Maxillary sinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the average volume of the maxillary sinus?

A

10.5-18 cm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the ostium?

A

This is where the maxillary sinus drains into middle meatus of the nasal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are vascular canals in the sinus?

A

This are tuberositys wishing the bone lining the sinus where vessels run

Important when carrying out sinus surgery.

(Infra Osseous artery’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the four functions of the maxillary sinus?

A

Vocal resonance
Olfactory function (smell)
Warming & humidifying air
Decreasing the weight if the scull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is pneumatisation?

A

This is where the sinus drops down between roots.

This is poorly understood

This increases with age and tooth loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the schneiderian membrane?

A

This is the membrane that lines the maxillary sinus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the thickness of the schneiderian membrane and how does the alter with gender?

A

0.34-3.11mm

Males usually thicker

Related to biotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a septa?

A

These are thin bony projections between walls of the sinuses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the relevance of the maxillary sinus?

A

Exodontia
Endodontics
Implants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are complications involving the maxilla related to exodontia?

A

Oro-antral communication (OAC)
Oro-antral Fistula (OAF)
Displacement if teeth/roots
Maxillary tuberosity fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is an Oro-antral communication (OAC) ?

A

This is a non epithelialised passage between the oral cavity and the maxillary antrum which can be as a result of exodontia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is an oro-antral fistula (OAF)?

A

A pathological epithelial lined passage between the oral cavity and maxillary antrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is an OAF formed?

A

From an OAF that’s untreated, it’s a chronic version.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What cause an Oro-antral communication?

A 
Roots close to the sinus
Thin alveolar bone 
Peri apical pathology 
Root morphology
Lone standing molars 
Traumatic extractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the signs and symptoms of an OAC?

A

Signs - visible
-resonant

Symptoms- 
Bubbling into nose/mouth 
Discharge 
Congestion and pain 
Sinus symptoms 
Air escaping into mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What must you not do if a patient may have a suspected OAC?

A

Don’t get them to blow nose because if OAC isn’t present it may cause one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are signs and symptoms of a fistula?

A

Signs - soft tissue perforations
Prolapse of sinus lining
Discharge

Symptoms-
Bubbling
Air escaping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the options for an OAC (5options)?

A

If tiny, spontaneous healing may occur

Buccal advancement flap
Palatial advancement flap
Buccal fat pad
Playlet rich fibrin (PRF) membrane closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a buccal advancement flap?

A

This is where the buccal tissue is pulled over to close.

Works best in first attempt

Reduces sulcus depth (denture counter indication)

Tissue is thin so can perforate
Sharp bone must be removed first

Not good for large OAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a palatial advancement flap?

A

This is where skin from the palate is rotated around to cover OAC

This has a good blood supply

More tissue with less tension

Thi her tissue and preserves sulcus depth

Granulating palate bone (sore) will regrow tissue to

Ensure that it is cut long enough so it will rotate and cover OAC otherwise it’s useless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a buccal fat pad?

A

This is taking tissue from the buccal fat pad to fill OAC

It’s used in conjunction with buccal advancement flap or palatial advancement flap

It’s for larger OAC’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What’s is playlet rich fibrin?

A

Patients blood is taken and centrifuged
Playlet rich fibrin with healing cells gel is removed and sutured in place

(Favoured option)

Not available on NHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is important about suturing over an OAC?

A

Has to be watertight otherwise it will break down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are treatment options for a displaced root?

A

Gentle suction
Leave
Refer for lateral window removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the 6 places a fractured tooth root be?

A 
Socket 
Mucoperiosteum 
Antrum
Swallowed 
Inhaled 
Suctioned
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is antral regime?

A

This is what’s used to care for an OAC after it’s been managed conservatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the 6 components of an antral regime?

A 
Analgesia 
No nose blowing 
Sneeze like a horse (let it out) 
No straws 
Decongestants 
Consider broad spectrum antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are tuberosity fractures?

A

Fracture of bone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How do you manage a tuberosity fracture?

A

If it’s attached and small leave it
Splint if moving
Refer

If significant bleeding out the bone back in get them to bite on gauze and emergency referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How do you know if it’s a dental sinus infection?

A

It’s almost always unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the dental causes of acutely odontogenic maxillary sinusitis?

A

Periapical infection
Periodontitis
Peri-implantitis
Post extraction infection

Trauma
Odontogenic cyst
Osteomyelitis
Displacement into sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What Bacteria cause non odontogenic acute sinusitis?

A

Predominantly aerobic bacteria

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhails
Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What bacteria cause odontogenic acute sinusitis?

A

Commonly anaerobes

Viridans streptococci
Fusobacterium
Prevotealla
Peptostreptoccus 
Porphyromonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What bacteria cause odontogenic chronic sinusitis?

A

Polymocrobrial, viridans streptococci and anaerobes

Similar to acute but reduced number of bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are signs and symptoms of sinusitis?

A

Pain and feeling unwell
Throbbing pain worse when leaning forward
Congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What happens if sinusitis spreads?

A

Orbital cellulitis
Cavernous sinus thrombosis
Meningitis
Inter-cranial abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the STOP Mnemonic?

A

Site (tissue present)?
Translucency/opaque?
Outline (margins)?
Previous imaging?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are some big red flags?

A

Loss of symmetry and tissue masses
Distorted anatomy and displaced teeth
Bone erosions
Teeth floating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What to do if odontogenic cause is excluded?

A

GP/ENT referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What to do if odontogenic cause is confirmed (acute &chronic)?

A

Acute

Antimocrobrial therapy
Early and aggressive
Analgesia
Decongestants - ephedrine nasal drops

Chronic

Eliminate source of infection
Antimicrobrials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What do I need to know about a sinus cyst?

A

Radio graphic changes (1/3 have mucosal thickening)

Radiological analysis
If in doubt CBCT
If it’s well circumscribed and asymptomatic it’s not likely to be sinister

Remember red flags

56
Q

If you suspect cancer what are some things you should ask?

A

Are you experiencing any unexplained weight loss
And vision disturbance
Any tiredness

57
Q

What are symptoms of neoplasia in a sinus?

A 
Neoplasia erode tissue and bone 
They may cause bleeding or nasal discharge 
Have radiological features 
Cause mobile teeth
Ocular symptoms and neorogical signs
58
Q

What is impaction?

A

Obstruction in the eruption pathway of

59
Q

What is the average eruption completion of the third molar?

A

Early 20s

60
Q

What are the three types of impaction of a third molar?

A

Partially covered by soft tissue
Completely covered by soft tissues
Completely covered by bone

61
Q

What are the four classifications if impaction?

A

Mesioangular - tilts mesialy
Horizontal - lies horizontally
Vertical - good path but won’t erupt
Distoangular - most difficult to treat

62
Q

What impaction classification is most common?

A

Vertical
Mesioangular
Horizontal
Distoangular

63
Q

What are the statistics about third molars?

A

Quarter of population have impacted ones
Higher in females
One of most common procedures on NHS
Most common OMFS procedure

64
Q

What are the most common issues with mesioangular impaction?

A

Pericoronitis
Caries
Perio
Distal caries in second molar

65
Q

What is a simptom and a sign?

A

Symptom - something patient notices
Pain swelling

Sign - observed by professional
Palpitation lumps
BOP

66
Q

What is pericoronitis

A

Partially erupted teeth with operculum covering it causes food packing and infection

67
Q

What is an operculum?

A

Flap of gingival tissue overlying 8s

68
Q

What are symptoms of pericoronitis ?

A 
Pain 
Halitosis 
Swelling 
Erythema 
Bad taste
69
Q

What happens when pericoronitis progresses?

A 
Tiramus
Purexia 
Lymphadenopathy 
Malaise 
Dysphagia
70
Q

What is trismus?

A

Limited mouth opening

71
Q

What is pyrexia?

A

Fever

72
Q

What is lymphadenopathy?

A

Swelling of lymph nodes and glands

73
Q

What is malaise?

A

General unwellness

74
Q

What is Dysphagia?

A

Difficulty swallowing

75
Q

Where can swellings appear?

A

Submandibular
Sublingual
Buccal space

76
Q

What are issues with submandibular and sublingual swellings?

A

If they are bilateral then this can obstruct the airway

77
Q

What symptoms can mimic pericoronitis?

A

Quinsy
Peritonsilar abscess
Tonsillitis

(Non are our issue)

78
Q

How do we treat pericoronitis?

A

If no systemic involvement
Irrigate with warm saline give pt syringe to take home
Take paracetamol ibuprofen etc

Don’t use chlorohexadone given anaphylaxis systemically found from treating dry sockets.

79
Q

What are the treatment options for pericoronitis with systemic involvement?

A

Metronidazole 400mg 3 times a day three days (anaerobic)

Amoxicillin 500mg 3 times a day for 3 days

80
Q

What happens if pericoronitis does not improve with antibiotics?

A

Removal of molar tooth

May have wrong antibiotic
May have non compliant patient

81
Q

What are the indications for third molar removal?

A

Any good reason

Including caries in the 7

82
Q

Is there any evidence with third molars and crowding?

A

These don’t cause crowding

83
Q

What impact successful surgery?

A

Social and medical history

84
Q

What impact does high bMI have on third molar surgery?

A

Worse healing
Short necks
Small mouths

85
Q

What is different for ginger people?

A

Bleed more

Require more analgesia because of lower pain tolerance

86
Q

What radiographs are indicated for third molars?

A

Periapicals and OPTs CBCT

87
Q

What is the CBCT indication?

A

OPT doesn’t give enough info

Might change treatment plan

88
Q

What nerves can be affected when thinking about third molars?

A

Lingual nerve
Mylohyoid nerve
Inferior alveolar nerve
Long buccal nerve

89
Q

What are the indications that suggest a risky third molar surgery?

A 
Superimposed IAN
Diversion of INA at apex 
Darkening of root where INA crosses it 
Interruption of white lines of canal
Darkening of roots associated with widening canal
Juxta apical area
90
Q

What are the indications for tooth roots & how does this make the extraction?

A 
Underdeveloped roots 
Conical roots - favourable 
Roots with widened PDL - favourable 
Splayed roots - challenging might leave roots in. 
Relationship to second molar
91
Q

What are the indications around bone and age in third molar surgery?

A

18 and younger bone very soft less needs to be removed, less dens so will cut and expand better. Better healing.

35 and over much more dense not as flexible more bone removal required worse healing

92
Q

What are the predictors of difficulty for third molar removal?

A

Alveolar bone level
Tooth position
Application depth
Doing of elevation

93
Q

Are there any neurological issues with treating maxillary third molars?

A

No

94
Q

What sedation options are there for third molar removal?

A

LA
LA&IV/Inhilation sedation
LA&GA

95
Q

What are the warnings to all patients undergoing any kind of oral surgery?

A 
Pain 
Swelling 
Bleeding 
Bruising 
Infection 
Dry socket 
Difficulty opening 
Damage to adjacent teeth
96
Q

What do you need to warn patients about with third molar surgery?

A

Damage to chorda timpani supplying slight taste
IA Nerve
lingual nerve

So lower lip, skin of the chin, side of the tongue, gingivae of lower teeth, lower teeth and taste

This can be pins and needles, pain or complete loss of sensation temporarily or permanently

Will be bruised, time off work and swelling rarely leading to hospitalisation

97
Q

When is the lingual nerve at risk

A

Anything too lingual when carrying out a procedure

Or kebabing when suturing

98
Q

What happens to the long buccal nerve in third molar surgery?

A

Gets sacrificed only supplies small amount of buccal tissue

99
Q

What is risk of maxillary third molar surgery?

A

Fractured tuberosity
OAC
Damage to adjacent teeth

100
Q

What is critical for third molar exodontia?

A

Good anaesthesia

101
Q

What anaesthetics and nerves would you numb before molar extraction?

A

Lower - lidocaine IA block
Articaine long buccal nerve

Upper -
Articaine buccal and palatial

102
Q

What is an operculectomy?

A

Removes soft tissue flap over third molar

103
Q

What is the periosteum?

A

Part of bone containing cells for remodelling

104
Q

What pre-op meds could be given to a straight forward third molar case?

A

Ibuprofen

105
Q

What is given post op after third molar removal?

A

Ibuprofen and paracetamol

106
Q

What can be given in addition for complex third molar surgeries?

A

Steroids dexamethasone

107
Q

What are the indications for air generating turbines in surgery?

A

No air at all can cause surgical emphysema which is medical negligence

Non air generating rotors

108
Q

What is a coronectomy?

A

Removing just the crown of the tooth when the molars are high risk

109
Q

What happens if roots move in coronectomy?

A

Roots have to be removed as well.

110
Q

What is an apicectomy/root end surgery

A

Removing the apex of a tooth

111
Q

What is a hemisection

A

This is premolarisation of a tooth- cutting it in half

112
Q

What is decompression

A

When there is a large anterior lesion and a surgical drain is put in to encourage healing before apicectomy

113
Q

What is special about MTA

A

Osteoinductive and very biocompatible

114
Q

What are the indexation for endodontic surgery

A

To eliminate/reduce infection when’re this isn’t possible non surgically

115
Q

How is endodontic surgery carried out?

A 
Raise a flap
Remove bone to reach apex
Clear granulation tissue
Remove apical 3mm roots at 90 degree angle 
Remove 3mm GP and fill with MTA 
Done
116
Q

What are counter indications that need to be considered in endo surgery

A 
Tooth 
Supporting bone 
Flap design 
Crowns 
Veneers 
Issues of recession 
Depth of sulcus 
Size and site of lesion
117
Q

3 types of flap design

A

Standard rectangular- includes papilla
Sub marginal - 3mm from gingival margin saves papilla and negates recession
Papilla base - leaves papilla but it to the gingival margin let’s you see more but negates recession abit more.

118
Q

What factors affect endodontic surgery outcome

A 
Age 
Sex 
Health 
Tooth location
Clinical signs and symptoms 
Lesion size 
Bone loss
Coronal restoration 
Resurgerey
Level of resection
Root filling material 
Haemostatic agent 
Bone grafting
119
Q

Why do root canals fail

A

Presence of bacteria in the root canal. Or biofilm outside if the canal.

120
Q

How do you do an endodontic retreat don’t restorability assessment

A

Make sure no cracks
Good amount of dentine
This will only be found out when restoration removed so make pt aware

121
Q

What could be suggested by a halo or J shaped bone los pattern surrounding a whole root on a radiograph.

A

Root fracture

122
Q

What can surgical endo be carried out?

A

After endo non surgical retreat meant and failure because this improves endo surgery outcome

123
Q

How is GP removed

A

Hand files one large mass
Use of rotary instruments
Braiding technique-push 2-3 files down around GP and twist to pull out like a claw
Solvent as last resort

124
Q

What files are used to remove GP

A

Headstrom files engage and help pull it out

125
Q

What are solvents used to remove root filling.

A

Endosolv - will dissolve rubber dam, one drip needed

126
Q

What mechanised rotary instruments are available for specific retreatment of a root canal

A

Pro taper D1-3
Very stiff and can easily extrude a canal

Reciprocating files :
Wave one gold - middle and apical third removal
Reciproc file good for whole removal

127
Q

What are the two types of healing

A

Primary - like a cut where there is no tissue loss etc

Secondary - tissue lost distance between margins heal is with a scar

128
Q

What are the four stages of healing

A

Haemostasis
Inflammatory phase
Proliferation phase
Remodelling phase

129
Q

What happens in the inflammatory phase of healing

A

Cellularisation
Vascularisation
Vasodilation

(Redness heat swelling)

130
Q

What happens in proliferation phase

A

Fibrin strands form structure
Fibroblasts lay ground substance and tropocollagen

Capillary formation and collagen formation

131
Q

What happens in the Re-modelling phase

A

Collagen fibres destroyed and replaced with better orientated collagen fibres
Wound strength increases
Vascularity and erythema decreases
Wound contracts

132
Q

What are considerations that need to be made relating to factors that influence healing

A

Foreign material
Necrotic tissue
Ischaemia
Wound tension

133
Q

Which does necrotic tissue impact healing

A

Acts as a barrier to ingrowth of reparative cells and can feed the bacteria

134
Q

How does ischaemia impact healing

A 
Reduction in blood supply 
Tissue necrosis 
Reduction in delivery of antibiotics 
Antibodies 
Nutrients
135
Q

Patient factors that influence healing

A 
Age 
Heart disease 
Diabetics 
Anticoagulants 
Steroids 
Bisphosphonates 
Immunosuppressants
BMI (airway, access, medical)
136
Q

What are the key surgical primciples

A

Adequate access
Adequate light
Surgical field free of excess blood / saliva

137
Q

What are key principles of preservative surgery

A 
Sufficient access 
Preserve vital structures 
Protect soft tissue 
Preserve blood supply 
Closure on sound bone

Complex Adult Dentistry (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions