Oral Surgery Techniques Flashcards
For a right handed operator where do you stand for extraction of right lower molars/premolars?
behind and to the patients right
For a right handed operator where do you stand for extraction of lower left teeth and all upper teeth?
in front and to the patients right
What should your non-dominant hand be doing during an extraction?
retracting the tissues
supporting the jaw and the alveolar bone (tooth supporting structures)
What movements can be used to elevate a tooth during an extraction? (3)
wheel and axle - rotation of the wrist - commonly used in cryers
lever -using a fulcrum
wedge - between PDL and the root
List the stages of carrying out a minor oral surgery procedure (13)
consent
surgical safety checklist
radiograph
anaesthesia
access - flap
possible bone removal
possible tooth division
debridement
suture
haemostasis
PO instructions
prescribe medication
follow up
What kind of consent is required for all oral surgery procedures (surgical and NS)?
Written (and verbal)
During minor oral surgery how do we gain access?
mucoperiosteal flaps
- mucosa and periosteum raised together.
In terms of the flap and soft tissues; What must we assess and ensure we do after creating the access flap? (5)
ensure that the flap is an adequate size - maintains circulation
ensure no sharp angles created in the tissues
ensure the flap is not crushed and kept moist during the procedure
minimise trauma to the papillae
What must we ensure after when closing the mucoperiosteal flap? (2)
That the margins of the flap are laid and sutured on sound bone
must not be closed under tension
What types of flaps can you lift?
1 sided - long crevicular incision
2 sided - crevicular incision with either a medial or distal relieving incision
3 sided is a crevicualr incision with a medial and distal
What is the risk of a distal relieving incision?
can damage the lingual nerve - if done in lower molars
What instruments do we use to retract soft tissues?
Rake retractor/ Bowdler-Hendry retractor
Howarth’s periosteal elevators
What instrument is used to carry out bone removal? (1)
What burs do we use? (2)
electrical straight handpiece
with a saline/sterile water cooled bur
fissure or round tungsten carbide bur
What instruments cannot be used to carry out bone removal?
air driven handpieces
Why can air driven handpieces not be used to carry out bone removal?
Can cause surgical emphysema - driving air/gas underneath the mucosa
What type of bone removal is carried out during a surgical extraction?
buccal guttering
How is the area managed before suturing (debridement and curettage)? (5)
use bone file/handpiece to remove sharp edges
remove soft tissue debris with Victoria curette
irrigate with saline
aspirate under the flab
check for retained apices
What instruments are used to deride soft tissue debris from a socket?
Mitchells trimmer
Victoria curette
List the types of suture material available.
non-absorbable
absorbable
monofilament
polyfilaments
Name examples of Non-absorbable suture materials
mersilk - polyfilament
prolene- monofilament
ethylon - monofilament
when are Non-absorbable suture materials used?
when wounds have to be supported for long periods of time
i.e. Closure of an OAF
Name examples of absorbable suture materials
Velosorb - polyfilament
when are Absorbable suture materials used? (2)
when sutures cannot be removed
when edges have to be held temporarily
How are absorbable sutures broken down?
hydrolysis
Name examples of monofilament suture materials
prolene
ethylon
Name examples of polyfilament suture materials
velosorb - absorbable
mersilk - non absorb
How are suturing needles categorised?
shape - 3/8 of a circle or 1/2 a circle
size and length
cross section - triangle/round
How do you achieve haemostasis during the surgery? (4)
LA + vasoconstrictor
diathermy
bone wax
artery forceps
How do you achieve haemostasis after the surgery? (4)
Pressure
LA infiltration
diathermy
surgicel pack and sutures
When are follow ups required fro patients? (3)
If complications are expected
if sutures have to be removed
if healing has to be monitored
Why do teeth fracture during extraction? (7)
poor extraction technique
thick cortical bone which Is hard to expand
there is an abnormal root shape
there are multiple roots
hypercementosis
ankylosis - fusion of root and bone
caries
What do we need to include in the consent conversation for oral surgery? (5)
what’s involved in the procedure - why, risks, benefits
options
who’s doing the procedure
expectations during
- pressure not pain
- sutures after
- drilling soudns
complications - perio and post
What technique do you use with the scalpel when carrying out the access incision?
one continuous stroke
Why should you avoid trauma to the papillae whilst carrying out the flap design?
Will cause recession
What are the benefits of using a one sided flap? (3)
less bruising
less swelling
less chance of damaging a nerve
Why is the border between the free and the attached gingivae important in flap design?
junction must be crossed in order to gain enough access
this area is very vascular = more bleeding, swelling and bruising
describe the flap design for the surgical removal of a premolar.
2 sided flap
- crevicular + M or D relieving incision
describe the flap design for the surgical removal of a 6 (molar).
1 sided crevicular flap from 7 to the 4
with semilunar access
describe the flap design for the surgical removal of an 8/wisdom tooth. (2)
2 sided flap
- crevicular + M/D relieving incision
3 sided flap
- crevicular + M and D relieving incisions
describe the flap design for the surgical removal of retained roots.
1 sided flap with semilunar access
