Oral Surgery II - Kalamchi's Child Flashcards
What are the most commonly impacted teeth?
Followed by the…
*Mx and Mn for each
Mx and Mn 3rd molars
Mx canines, Mn premolars
T/F
It is necessary to remove all impacted teeth
False
The angulation of the Long Axis of the impacted 3rd molar is relative to what?
*clinical classification
2nd molar
The relationship of the impacted 3rd Molar to the __________ describes the Procedural Classifications
Occlusal Plane
*depth
5 types of impaction (of 3rd molar in relation to long axis of the 2nd molar)
Vertical
Horizontal
Mesio-angular
Disto-angular
Inverted/Ectopic
What is the most common type of 3rd Molar Impaction?
Mesio-angular
What is the 1st Radiographic choice for wisdom teeth diagnosis and removal absent associated pathology?
Panoramics
T/F
The ideal age to remove wisdom teeth is 16-18 y/o, when root is around 1/3 developed
True
Recurrent Pericornitis (swelling of gingival tissue around 3rd molar) is indication for what?
Wisdom teeth removal
3 Contraindications for the removal of Impacted Teeth:
Extremes of Age
Compromised Medical Health
Adjacent Structures imperiled
The infection of the soft tissue surrounding the crown of partially impacted tooth caused by normal oral flora
Pericornitis
When is it recommended to Surgically deal with Acute Pericoronitis?
If Abscessed
Bilateral, submandibular, sublilngual, submental space Abscess that must be treated aggressively:
What is important to consider with these cases?
Ludwig’s Angina (Mn Space Abscesses)
Airway compromise
Admit pt to hospital/observe airway
IV antibiotic
Analgesic
IV steroid
Incision/Drainage
What disease am I?
Ludwig’s Angina
Flap Design - Base _____ that free margin.
Suture _____ mm away from bony defect
broader
6-8 mm
T/F
Flaps can be cut Bucally or Lingually
False
*never Lingual!
After removal of Wisdom Teeth, what 4 effects are normal?
Pain
Swelling
Bleeding
Trismus
Swelling peaks ___ hrs after removal of wisdom teeth
48 hrs
Infection, prolonged numbness, iatrogenic injury, fractured mandible, oral antral fistula are all Uncommon complications of wisdom teeth removal
True
4 indications for removal of wisdom teeth:
Overcrowding
Caries
Associated pathology
Recurrent pericoronitic (acute/chronic)
In Fracture Management bone must be Closed to ___mm , otherwise will not heal
1 mm
3 types of Crown Fracture:
Ellis Class I - confined to enamel
Ellis Class II - enamel and dentin
Ellis Class III - enamel/dentin/pulp exposed
What type of Root Fracture has the best prognosis?
Tx is reduction and splint for ___ months
Apical 1/3
3
Tooth Concussion:
Tooth Subluxation:
hemorrhage/edema into PDL
PDL ruptured, tooth not displaced
Concussion/Suluxation Tx:
soft foods, maybe relieve occlusion
Extrusion, only ____ tissues retain tooth
Lateral Luxation, what is injured?
gingival
some apical fibers
Tx for Extrusion/Lateral Luxation:
Reduce/Splint 3-4 weeks
Intrusion extensively injures the PDL and ____ tissues
Tx for immature teeth:
Tx for Mature teeth:
pulpal
spontaneous re-eruption
ortho extrusion (2-3 weeks)
What’s happened to the tooth with Avulsion?
Tx?
tooth out
Reimplant/Splint 7-10 days
Alveolar Fracture:
Tx:
alveolar, PDL, pulpal injuries, often multiple teeth
Reduce/Splint 4-6 weeks
How long to immobilize Mobile Tooth:
Displaced:
Root Fracture:
Replanted tooth (mature):
Replanted tooth (immature):
3-4 weeks
3-4 weeks
2-4 months
7-10 days
3-4 weeks
What type of tooth injury has a survival rate of 100%
90%
50-90%
30-90%
10-50%
0-40%
Concussion
Subluxation
Extrusion
Lateral Luxation
Intrusion
Avulsion
Hemorrhage and edema in PDL:
100% survival rate
Concussion
PDL ruptured, tooth NOT displaced:
90% survival
Subluxation
PDL, neurovascular tissue damaged, only gingival tissue retains tooth:
50-90% survival
Extrusion
Apical PDL fibers compressed (some), PDL and pulpal tissues damaged:
30-90% survival
Lateral Luxation
Tooth knocked inward:
10-50% survival
Intrusion
Tooth out:
0-40% survival
Avulsion
3 types of Soft Tissue Injuries:
Abrasion
Contusion
Laceration
Best bone graft must have what 3 characteristics?
Osteocinductive
Osteoinductive
Osteogenic
What does it mean to be Osteoconductive?
Scaffolding
3 characteristics of Alloplastic material?
osteoconductive
low cost
no disease transmission risk
2 types of Alloplastic materials?
Hydroxylapatite
ceramics
What grafting material is osteoconductive only?
Alloplastic material
What type of material is Ostioconductive and Osteoinductive?
Allograft
Allografts are increased in expense why?
Bone from same species
What material is osteoconductive, osteoinductive, and osteogenic?
Autograft
What is the only Grafting source of osteogenic properties (osteoblasts)?
Autograft
autogeneous bone graft
Indications for Bone Grafting are loss of bone following traumatic injury, after extraction with alveolar atrophy, after resection of a Benign tumor, or pneumatized maxillary sinus for future implant placemnt
True
How long should you wait after a bone graft to place an implant?
4-6 months
What can fill the extraction socket and maintain bone height?
*helps stabilize marginal soft tissue at extraction site
Socket grafting
*extraction socket and site preservation
In Fracture Management you Reduce/Fix/Immobilize/Prevent infection
True
What is the most important preventable cause of early death after maxillofacial trauma?
Resp obstruction
What technique/sequence should be used to assure the airway is protected?
Chin thrust
Chin lift
Definitive airway
A Definitive Airway requires what?
tube in trachea
cuff inflated
What is the Gold Standard in the surgical airway?
Tracheostomy
Tracheostomy is used for ventilation in Lefort ____ fractures.
II and III
What is the edentulism rate for entire US?
65 and older?
10%
35%
The Alignment of the jaws is knows as ______ surgery
Orthognathic
T/F
In an Intraseptal Alveoplasty, Alveolar Width is lost
true
T/F
Always design flaps to preserve attached gingiva
True
The Rxn of the body to trauma from physical, chemical, or microbial means:
Inflammation
The accumulation of leukocytes, etc
Abscess
Spreading infection at the cellular level - needs to be taken care of immediately (ABx)
Cellulitis
Acute inflammation: Redness, Swelling, Heat, Pain and ______
loss of function
Chronic Inflammation is a prolonged process between what 2 processes?
Tissue destruction
Healing
The collection of fluid matl (pus) w/in a cavity lined by a wall:
Abscess
Spreading infection with poor localizing tendency
Cellulitis
The ability of an organism to spread throughout the tissue:
*and cause damage w/ toxins
Virulence
A large ____ produces a severe spreading lesion, and a small one leads to minor lesion
dose
Salmonella typhi contracted through…
Strep pneumo…
Staph aureus and Strep pyogenes…
ingestion
inhalation
direct contact
Cellulits is a _____ process
Abscess is a _____
Aerobic
anaerobic
% aerobic infections (cellulitis):
% anaerobic (abscess):
25%
75%
Acute pericornitis, should you do surgery?
defer UNLESS abscess has developed
T/F
the Pterygomandibular Space can be affected by the mandibular molar/premolar
True
The Masseteric Space is affected by what tooth?
Mn 3rd Molar
The Lateral pharyngeal space can deviate the _____
The Retropharyngeal space can cause _____
uvula
airway obstruction
Inflammation of the Bone Marrow:
Osteomyelitis
2 types of Osteomyelitis:
Acute-suppurative
Chronic-suppurative
Strep pneumo, H influenza, strep, staph aureus, etc… cause what?
Acute/Chronic sinusitis
4 situations in which use of ABx is not necessary:
Chronic well-localized abscess
Minor vestibular abscess
Dry socket
Chronic pericoronitis
When should swelling/pain be considered an infection?
3 days post op
Post op Ecchymosis is very common in the elderly
True
Antibiotics are not indicated for pts undergoing OS procedures unless…
2 scenarios
Active spreading infection
Medically compromised (immunodeficiency )
Acute infections do not develop in less the ____ days after extraction
2-3 days
300 mg Acetaminophen + 30 mg codeine
Tylenol III
325 mg Aceteminophen + 5 mg Hydrocodone
Norco
325 mg Acetaminophen + Oxycodone (2.5/5/7.5mg)
Percocet
*no proven value
Post Op Pain: Aspirin/Acetaminophen dose
Ibuprofen:
Codeine:
Propoxyphene:
Oxycodone:
Hydrocodone:
500-1000 mg
400 - 800 mg
30-60 mg
100 mg
5-10 mg
5-10 mg
Post op pain peaks when?
12 hrs
Pain decreases initially but increases 3-4 days in, unaccompanied by swelling, non-resopnsive to analgesics:
Dry Socket
Dry Socket - place dressing on it containing ______
eugenol
Post-op Trismus is more common in what procedure?
impacted Mn 3rd molars
Uninfected root tips less than ___ mm can be left in
2-3 mm
It is best to close Oral Antral communication as it occurs
True
The most common cause of IAN injury is what teeth roots in close proximity?
Wisdom
Seddon classification of nerve injury
Neuropraxia
Axonotmesis
Neurotmesis
T/F
extracting the wrong tooth is the 2nd most common insurance claim
true
Mn fractures are a recognized side effect of 3rd molar surgery
True
Dry socket happens mainly in the Mn and what demographic is at risk?
Females on oral contraceptives
Irrigation, CHX rinse, and ABx in extraction site all decrease Dry Socket incidence
True