Oral Surgery Flashcards
What are the indications for exodontics
Retained deciduous teeth
Interceptive orthodontics — extracting deciduous tooth that interferes with normal eruption of adult tooth
Severe periodontal disease +/-
Non-vital teeth or fractured crown with root exposure +/-
Teeth undergoing resorption
Malocclusion — interference
Supranumerary teeth +/-
Impacted teeth —> predispose to dentigerous cyst
Why do we do pre-extraction radiographs?
Assess teeth involved
Identify issues likely to complicate extraction
Eg
- dilaceration (curved root tip)
- hypercementation (expansion of apical portion of root tip)
What are the steps for a single rooted tooth extraction??
Severe epithelial attachment with #11/15c blade and enter peridontal spaced
Root elevator/luxator
— rotate elevator to stretch/tear periodontal ligament — hold for 10secs
— remove and work 360degrees around tooth
— work deeper until tooth becomes mobile
Ideally elevate until tooth luxated
Use extraction forceps with care
Radiograph to confirm compete removal
Debridement alveolus with excavator if necessary
Flush alveolus thoroughly
Compress sides with fingers to collapse alveolus
+/- suture gingiva (always in cats)
How does a multi-rooted tooth extraction differ from a single tooth extraction?
Sectioning of tooth at furcation of roots
— elevate and remove each root segment individually
What are the most common complications of extractions?
Root breakage
Displacement of root tips into nasal cavity or mandibular canal
Hemorrhage
Dehiscence and fistula formation
Iatrogenic jaw fracture
What do you do if there are retained root tips after extraction?
Usually should be removed
- try root tip elevator but careful not to push root tip into alveolar canal or nasal cavity
Use high speed bur to removed channel of bone around tooth root and then elevate remainder of root
Atomization
— ankylosed roots
—dental bur to drill out remaining root tip
(Not recommended anymore)
When is surgical extraction of a tooth indicated?
Where simple elevation is difficult — healthy root structures
- > canines
- > upper 4th premolar
- > upper 3rd premolar or 1st molar
- > lower 1st molar
Impacted (unerupted) teeth
Diseased teeth where major complications are a significant risk
What technique is used for surgical extraction of teeth?
Create a buccal (vestibular) mucoperiosteal flap
—> envelope flap +/- vertical incision
—> single pedicle flap
Carefully leave attached gingiva past mucogingival line
Removed lateral crest bone to exposure furcation (high speed cutting bur)
Alveloectomy to expose roots
Elevator passed through furcation to aid identifying where to section tooth
Section tooth through the furcation between the distal and mesial roots
Elevate each root separately and removed by elevation/extraction forceps
Examine root and radiograph
Smooth alveolar or lateral bone with bur
Debridement socket
Flush with chlorhex
Check and close flap with absorbable suture - simple interrupted or cruciate
How are canine teeth extracted?
Surgical unless very mobile (eg peridontal disease with periapical inflammation and extensive bone loss )
When making your incision into the gingiva to extract a canine tooth, where does your incision begin?
In diastema (not at edge of gingival sulcus like in other teeth)
Once gingiva is lifted
Dental bur is used to cut alveolar bone at rostral and caudal borders of tooth —at least 1/3-1/2 root length
How would you elevate the canine tooth rom the alveolus in surgical extraction?
Use elevator and engage rostrally and caudally in the incisions made into alveolar bone
The alveolar bone is very thin apically. If you tip the canine tooth up too far during extraction, which complication can you cause?
Oronasal fistula
What suture do you use for the gingiva?
Absorbable 3-0 or 5-0
With reverse cutting needle
T/F: gingiva should be apposed with tension
FALSE
Tension= failure
How far should sutures be placed in the gingiva?
2-4mm
What aftercare is done for patients with gingival flaps?
Broad spectrum antibiotics
Soft food (2weeks)
No chew toys or hard treats
What can cause a oronasal fistula?
Dental disease and extractions
Pressure necrosis from foreign body
Complication of surgery, radiation therapy, hyperthermia therapy
Trauma- electrical cord burns, bite wounds and gunshot wounds, blunt trauma to head
What additional complications do you see form electrical cord burns in cats?
Oronasal fistula
Pulmonary edema
Burns = what for tissue to declare itself
Clinical signs of a oronasal fistula?
Inciting cause
Nasal discharge
Sneezing
Aspiration pneumonia
What two techniques can be used to repair and oronasal fistula?
Two layer — continuity of nasal and oral mucosa is restored ( off set suture lines)
Single flap technique — position suture line of “supported tissue”
What are the indications for the single flap technique in closing an oronasal fistula?
Acute (nonhealed) fistula
Defects too large to allow two layer closure
Removing a small amount tissue around the fistula allows the suture line to be over “supported” tissue —> Recuses movement with respiration and allows airtight closure
When is the double flap technique indicated for oronasal fistula?
Congenital defects and chronic fistulas where the mucoperiostum has healed to nasal mucosa
—one flap taken from the palate and second buccal flap covers it
What are possible salvage procedures that can be done for oronasal fistulas?
Intraoral appliances
— acrylic appliances
— nasal septal buttons
Inadequate management of maxillary or mandibular jaw fractures can result in??
Malalignment and malocclusion and/or non-healing fractures
What area of the jaw in the cat has the highest rate of fracture?
Symphysis and ramus
In a jaw fracture.. what is the tension side of the bone?
Dental arcade
What are the possible techniques for stabilizing jaw fractures?
Muzzle Intraoral splints Interdental wiring (supplement intraoral splint) Interfragmentary wiring External fixators Bone plates Interarcade wiring/bonding Partial maxillectomy/mandibulectomy Intramedullary pins
How can you maintain anesthesia during oral procedures?
Intermandibular intubation
Pharyngotracheal intubation
Temporary tracheostomy
-these techniques avoid having to extubate and re-intubate during repair
You decide to stabilize a jaw fracture using muzzling. How tight should this muzzle be?
Tight enough where the patient is able to lap up water and blenderized diets but there should still be interlock between the canines
Symphyseal separation is a common fracture in cats.. how can you treat this?
Circummandibular cerclage wire-pass through skin and under oral mucosa/gingiva
(Avoid overtightenng —> lingual rotation of canines causing malocclusion)
Intraoral split (can be formed right in mouth)
Hard plate trauma can be caused by?
Blunt trauma
— HBC
—kicks
—high rise syndrome in cats (also check for pulmonary contusion)
Penetrating wounds
Gunshot wounds
Sticks and bones
How can hard palate trauma be treated?
Conservative management - if mucoperisotum intact
Suture
Acrylic splint between canine teeth and suture
Pin and figure of 8 wire + suture if above doesnt work
How is an intraoral splint placed?
Clean teeth
Place interdental wire to facilitate alignment and improve mechanical retention of resin/acrylic
Acid etch teeth
Extrude premixed acrylic and allow to cure
Shape appliance with bur to avoid interference with occlusion
Which is preferred or intraoral splinting, composite resin/acrylic OR acrylics ?
Composite resin/acrylic preferred because it has normothermic curing unlike acrylics which has exothermic curing
What is the primary complication to intraoral splints for jaw fractures?
Premature loosening and soft tissue irritation under splint
On recheck, your patient that has a fracture jaw repaired now has discolouration of one of the canine teeth.. what should you do?
Root canal or extraction of that tooth
How can you repair a jaw fracture if the animal does not have adequate dentition for intraoral splint?
External fixators
Multiple pins
Avoid tooth roots
Standard fixation bars
Acrylic in tubing
When is interarcade wiring /bonding indicated???
Complex fractures/unstable fractures
-> reestablishes occlusion and requires feeding tube
