OS - tutorial 3 Flashcards
what does a sinus imply about the duration of infection?
chronic infection
a sinus is placed buccally, what does this tell you about the anatomy of the buccal roots of tooth 26?
short roots, close to buccal cortex
why wont antibiotics help a root treated tooth showing signs of infection (sinus)?
bacteria in the tooth itself
tooth no longer has vascular supply
antibiotics are systemic so wont reach it
antibiotics only kill bacteria that have infiltrated tissues (acute)
what forceps would you use for xla tooth 26?
upper left molar
how can you achieve anaesthesia if a lidocaine infiltration fails?
intraligamentary, intraosseous, intrapulpal
or
articaine
list compications of xla of upper molars?
OAC
crown fracture
root fracture
alveolar fracture
laceration of soft tissues
damage to adjacent teeth
displacement in to antrum
if a crown fractures off during xla, what determines it becoming surgical?
if tooth is below bone level
shape of roots - bulbous, convergent, divergent, very long
what flap design would be most suitable for tooth 26? and why?
3 sided
reduces complication of OAC as you can use flap to close
once a flap has been raised, where do you remove bone to remove a tooth?
remove bone for a point of application
always take buccal roots out first
what factors determine whether you need to section the furcation during SR of a tooth?
convergent, divergent, bulbous roots
when extracting tooth 26, the palatal root is pushed up in to antrum. how do you investigate this?
PA
if doesnt show, DPT
Why would you give antibiotics for OAC creation?
introduced contaminated tooth in to a sterile area - risk of sinusitis
high risk - whole root
low risk - apical third of root
if OAC not managed, what may happen?
it will either close spontaneously
or
epithelialise and cause oral antral fistula (permanent communication) = chronic sinusitis
what is the surgical treatment for OAC?
buccal advancement flap - excise periosteum to allow mucosa to stretch across
what does a temperature above 37.8 degrees imply?
pyrexia
how do you investigate pericoronitis?
half/ full DPT
what are the local management measures for pericoronitis?
irrigation with saline
assess possible traumatic aspects e.g., upper 8 may need grinded down
what antibiotics can be given for pericoronitis showing with systemic effects like trismus and pyrexia?
metronidazole 400mg 3xday for 5 days
what must be avoided when taking metronidazole?
drinking alcohol
what are the angles of impaction seen with 8s?
transverse - lingual or buccal positioned
aberrant - upside down
horizontal
vertical
mesioangular
distoangular
what order do you plan surgery for third molars?
- path of eruption
- extrinsic/ intrinsic obstacles
- required bone removal
- point of application
- flap design
what flap design is most often used for third molars?
3 sided flap (triangular)
what are the general principles of flap design?
flap wound should rest on bone
fewer sutures placed the better
how do you carry out bone removal?
bur in a surgical handpiece
when would you need to section teeth?
horizontally impacted teeth
distoangular impacted teeth
roots with different paths of removal
why do you use saline irrigation when drilling bone?
bur gets hot
what suture material is used to close the wound and where do you place sutures?
3/0 vicryl rapide
suture placed from buccal tissues to lingual tissues immediately distal to 7
how do you check for an OAC?
CBCT
What flap design would you use to close an OAC?
buccal advancement flap
What antibiotics can you prescribe for OAC?
penicillin
what analgesic would you recommend for OAC?
ephedrine drops
mucolytic inhalers
How can you reduce patients risk of MRONJ?
ensure you dont strip the periosteum during elevation as it has blood supply for healing
when would you review an MRONJ risk patient?
8 weeks after xla
until socket heals
what is the significance of prednisilone and MRONJ?
causes damage to the bones
what warnings would you give to pts before completing SR on the mandible?
numbness of lower lip due to post op swelling
what disorder is associated with supernumerary teeth?
cleidocranial dysostosis
what flap design would you use for removing teeth in the lingual area?
envelope
