Oral Surgery Flashcards
Why is 48 required to be extracted?
Grossly carious, pulp exposed.
Not involved in the occlusion.
Unrestorable.
Give a radiograph report of 48 and adjacent structures.
Diagnostically acceptable
Justification- determine if close relationship of 48 to inferior alveolar canal and also crown/root morphology and surrounding structures.
48 crown is grossly carious, with only the buccal wall remaining.
Large crown with small roots.
Crown is wider than the roots.
Roots looked curved in on one another and potentially fused at the apex.
Slightly over-erupted.
No clinical signs of close relationship between inferior alveolar canal and the roots of 48.
Working distance is small.
Thick cortical bone and square set jaw.
Potential root resorption.
What did you discuss with the patient pre-op?
Pain
Bleeding
Bruising
Swelling
Numbness- either temporary or permanent
Tingling
Altered sensation
Damage to nerve
Damage to adjacent teeth
Dry socket
Infection
Surgical access
Sutures
Retained roots +/- further treatment
Jaw stiffness
Sensitivity of adjacent teeth
Why did you make the decision to raise a flap?
Tried with standard instruments- Coupland’s elevator and luxator but wasn’t getting much movement in the tooth beyond the initial movement.
Decided to raise a flap in order to remove bone and get a better application point for the elevator.
What factors radiographically and clinically made you think it would be a difficult extraction?
Clinically- not much of the clinical crown left to get a grip with forceps, tooth was already undermined with gross caries.
Radiographically- square set jaw, thick cortical bone, fused roots, curved roots slightly, working distance is low, large crown to root ratio.
What type of suture technique did you use to put the flap back?
Used velosorb multifilament resorbable sutures.
Used the horizontal mattress technique?
Struggling to get haemostasis, what did you do?
Direct pressure with gauze
Surgicel placement
What post-op instructions did you give the patient?
Expect pain after extraction- especially given that it turned surgical and has sutures.
- Take paracetamol as soon as you get home, do not exceed the daily dosage. Recommend to take 2x 500mg tablets every 4 hours.
Swelling- will reach its maximum level of swelling 3 days after extraction and then it will go down.
Bruising- usually will start at the extraction site and gravity will work its way down.
Bleeding
- We will make sure it has stopped bleeding before you leave today.
- If it starts bleeding again, roll a piece of gauze into a sausage shape and dampen it, bite on it for 30 minutes, then 1 hour and then call emergency contact number.
- No exercise, no smoking, no alcohol for 24 hours, no mouthwash or rinsing out for 24 hours.
- The next day rinse with warm salty mouth rinse 4 times per day- reduce the risk of infection.
- Brush teeth as normal but try avoid hitting the blood clot.
- Don’t touch it with your tongue or finger.
Sutures are restorable, so don’t need to come back to get them out, they will dissolve on their own within a couple weeks.
What did you use to numb the patient up?
1:80,000 parts adrenaline 2% lidocaine in IDB- 2.2ml.
1:100,000 parts adrenaline 4% articaine in long buccal- 2.2ml.
What instruments did you use to extract the tooth?
Initially luxator to sever the PDL and then a couplands elevator to elevate the tooth out the socket.
Decision was made to raise a 3-sided flap using a blade in a blade holder.
Minnesota used to retract, alongside a Howarth’s.
Bone removed using the round bur in an electric handpiece.
- want to make a narrow an deep buccal gutter.
Application point gained- Couplands used to elevate the tooth intact.
What type of sutures were placed?
Velosorb- reservable multifilament.
Why did you use velosorb sutures?
Resorbable- patient doesn’t need to come back.
What information were you getting from the OPT that you weren’t getting from the PA?
Working distance
Width of cortical bone
Full width of the inferior alveolar canal
Anatomy of the crown and roots
Describe the sequence of surgery for removal of 48.
Consent given- written and verbal.
Anaesthesia
Luxation
Elevation
Surgical access- flap raised
Bone removal
Elevation of tooth
Check tooth and socket
Debridement of socket- physical, irrigation and suction.
Sutures
Haemostasis
Post-op instructions
Why did you use articaine for the long buccal?
Has a higher % anaesthetic agent inside and has more adrenaline- so will also longer.
This is desirable in the mandible where the bone is thicker.
