Oral surgery

Question 1

what are some medical condition considerations for extractions

Answer 1

high blood pressure, angina, recent MI, cardiac defects, valve replacement, previous endocarditis, hypertrophic cardiomyopathy, liver and kidney disease, diabetes, epilepsy, haemophillia A&B

Question 2

what are some drugs that need to be considered before XLA

Answer 2

anticoagulant therapy, antiplatelet therapy, chemotherapy/radiotherapy, bisphosphonates

Question 3

what are some clinical considerations prior to XLA

Answer 3

medical history, location of the tooth, remaining coronal tooth structure, caries extension, adjacent tooth status, presence of extra oral swelling, adjacent anatomical structures, planned tooth replacement

Question 4

what are the characteristics of a envelope/sulcular flap

Answer 4

extended horizontal sulcular incision, requires minimum two teeth for good vision

Question 5

what are the advantages of a envelope/sulcular flap

Answer 5

no relieving incisions, easy re-approximation of the flap

Question 6

what are the disadvantages of a envelope/sulcular flap

Answer 6

can tear under pressure, difficult reflection, limited visualisation

Question 7

what are the indications for a envelope/sulcular flap

Answer 7

aesthetic region, minimally invasive periodontal surgical treatment

Question 8

what are the characteristics of a 2-sided flap

Answer 8

envelope with one relieving incision - mesial or distal for greater access, acts as a compromise between aesthetics and access

Question 9

what are the advantages of a 2-sided flap

Answer 9

better access compared to an envelope flap, adequate blood supply

Question 10

what are the disadvantages of a 2-sided flap

Answer 10

gingival recession, limited access to long roots

Question 11

what are the indications of a 2-sided flap

Answer 11

aesthetic zone where greater access is needed, minimal bone removal, third molar extractions, surgical XLAs, apicectomy, cyst removal

Question 12

what are the characteristics of a 3-sided flap

Answer 12

envelope with two relieving incisions, mesial and distal, provides optimal access and vision

Question 13

what are the advantages of a 3-sided flap

Answer 13

optimal access and vision, easy re-approximation of flap to its original position

Question 14

what are the disadvantages of a 3-sided flap

Answer 14

prone to gingival recession

Question 15

what are the indications of a 3-sided flap

Answer 15

third molar XLAs, apicectomy, cyst removal, impacted tooth exposure, bone graft, buccal advancement flap, apical respositioning flap, surgical procedures involving more than one tooth

Question 16

what are the characteristics of a smeilunar incision

Answer 16

incision made across the mucoperiosteum away from the gingival margin

Question 17

what are the advantages of a smeilunar incision

Answer 17

no gingival recession, PDL remains intact

Question 18

what are the disadvantages of a smeilunar incision

Answer 18

scarring, difficult to replace flap, limited access, prone to tearing, paraesthesia risk

Question 19

what are the indications of a smeilunar incision

Answer 19

apicectomy

Question 20

what are the principles of a flap design

Answer 20

• gain access with minimum trauma
• large flaps heal at the same rate as smaller flaps
• broader base to maintain blood supply
• for a full thickness mucoperiosteal flap, cut to bone using a firm continuous incision not feathered
• avoid sharp angles
• either include or exclude the papillae entirely
• do not crush the tissue
• keep moist with saline

Question 21

what are the elevator principles

Answer 21

• elevator tip is inserted between bone and tooth mesially
• do not lever off adjacent teeth
• avoid excess force
• do not apply force towards major anatomical structures
• support pts jaw and ridge
• use under direct vision only
• take care not to push into sinus

Question 22

what are resorbable sutures

Answer 22

suture material is absorbed by tissues, the patient doesn’t need to come back, used in areas where suture removal is difficult

Question 23

what are non-resorable sutures

Answer 23

tensile strength doesn’t reduce and it is not absorbed by tissues, requires the patient to return for suture removal, used in areas where a suture is required for a longer duration

Question 24

what are monofilaments

Answer 24

suture consists of a single strand, less filaments reduces the number of sources of possible infection

Question 25

what are polyfilament

Answer 25

suture consists of several strands twisted together, easier to handle, more filaments increases the number of sources of possible infection, fluid and bacteria may accumulate