OSB1 Flashcards
Explain process of removing a tooth in MOS and the instruments used
-12 Blade to incise around gingival margin and medial relieving incision, full thickness to bone
-Rase flap with Ash number 9 molt periosteal elevator
-Rake retractor to retract
-Remove bone with surgical handpiece and Rosehead bur
-Section the roots with fissure bur in upward direction
-Couplands in furcation to ensure each roots can move individually and to elevate root
-Forceps to remove roots
-Debride socket using Mitchel’s trimmer, curettage and suction and saline. Remove sharp bone
-suture
Why bone is removed
-to reveal the tooth
-removes support for tooth
- creates application point for the elevator
- to access furcation in order to section the roots
Explain the suture process and instruments used
-30 vicryl resorbable (takes 2 weeks to resorb)
-Pass needle at 90 degrees angle at least 3mm from wound edge
-Pull through until little tail left on one side
-Surgeons knot to secure- 2 throws clockwise around needle holders, then 2 throws anti-clockwise, 1 throw clockwise.
-Too much tension causes necrosis, too loose prevents wound healing
- Relieving incision may also need closing but not always.
What is Mitchell’s trimmer used for. What is most Ash periosteal elevator used for. And the Howarths periostea elevator
- deriding socket after extraction
- raising full thickness mucoperiosteal flap
- initial raising of the flap
How to scrub up
-Open kit
-Put on mask
-Wash hands – using hibiscrub. Takes 2 minutes. Rinse with water with the water dripping from fingers to elbows. Hold hands above elbows. Dry with sterile towel from fingers to wrists, 1 for each hand
-Pick up corner of gown, place arms through sleeves, don’t push beyond cuffs. Colleague will fasten the back
-With hands still in cuff, pick up glove of opposing hand and put it on, over cuff of gown. Then put on other glove
The soft tissue layers you need to cut through
muscosa, submucosa, periosteum
How long does vicryl suture take to resorb
4-6 weeks (realistically 1-4 weeks)
Reasons for using elevators
-to provide an application point for forceps
-to loosen teeth prior to using forceps
-to dislodge a whole tooth from its socket
-to extract tooth roots
-dilate socket
Examples of when elevators should not be used
-When you cannot see root
-When a root fragment is close to antrum (incorrect force may result in displacing root into antrum)
- When a root fragment is in close proximity to a vital structure e.g the ID canal
List surgical principles (9)
-Pain free surgery (LA, behavioural management)
-Aspetic technique (sterile)
-Adequate access (flap)
-Minimal damage (to nerves, vessels, teeth, bone)
-Arrest of haemorrhage
-Debridement (removing necrotic, infected or foreign tissue. Saline irrigation)
-Wound closure (sutures)
-Drainage
-Prevention of infection (good technique, sterile, minimal damage, debride POI)
Peri and post operative ways of managing bleeding
1)Peri-operatively
*LA with vasoconstrictor
*resorbable suture
*Electrocautery e.g. bipolar/ chemical cautery e.g. silver nitrate sticks
*Haemostatic pack (SURGICEL/ GELITACEL)
Bone wax – useful for bony bleeds
2)Post-operatively
* Pressure
*Tranexamic acid
*Replace blood loss
*Further investigation of cause
*Other specialities
Principles of flap design
- Maximise access to surgical site
- Designed to aid healing (ensure adequate blood supply – wide base)
- Considers vital structures (mental and lingual nerves)
Advantage of a one sided and three sided flap. 1,2 or 3 most common
1= better blood supply
2=most common
3= better access
Aftercare instructions for normal XLA
-don’t rinse today but tomorrow for 3 days rinse with warm salt water after every meal
-no hot liquids or alcohol today
-no eating for 3 hours, soft diet for rest of day
-no smoking for 24 hours day
-no physical activity today
-brush as usual, be gentle in area
-if bleeds bite on gauze
-take usual pain meds
-get in contact if infection, excess pain, bleeding swelling, tenderness, fever, unpleasant smell
-wear denture as normal
What should be explained to patient before getting consent for XLA. Risks to let them know about
-Treatment: extraction of tooth under LA with or without cutting gum, bone removal, sutures
-Risks: pain, swelling, bleeding, bruising, dry socket, jaw stiffness, infection, OAC, root fracture, maxillary tuberosity fracture, temporary/ altered sensation to lip, side of tongue, cheek, chin. Damage to adjacent teeth
-Benefits: prevent infection. removes pain
-Alternative treatment: leave, root canal
