Par 2 Flashcards
Incisions to be Avoided?
- canine prominences
- region of mental foramen
- palatal vessels/nerves
- incisive papilla
- bony lesions
- major frena
- lingual of MD (vertical)
An envelop flap extends __ tooth/teeth anterior & __ tooth/teeth posterior to area of surgery.
An envelop flap extends 2 teeth anterior & 1 tooth posterior to area of surgery.
If relaxing incision required it should extend __ tooth/teeth anterior and __ tooth/teeth posterior to area of surgery.
If relaxing incision required it should extend 1 tooth anterior and 1 tooth posterior to area of surgery.
T/F? Incisions heal from side to side.
TRUE. Incisions heal from side to side–not end to end.
Flaps should be at least __ mm away from bony defect.
Flaps should be at least 5 mm away from bony defect.
What are the mandibular anatomical structures to avoid?
- lingual n.
- facial a.
- mental n.
- long buccal n.
- buccal a.
What are the maxillary anatomical structures to avoid?
- greater palatine vessels & nn
- incisive papilla
- nasopalatine n.
*A panoramic film is good for ___ year(s).
A panoramic film is good for 1 year(s).
*In the maxilla, the anatomic structure of import in removing posterior teeth is ___; in the mandible ___.
In the maxilla, the anatomic structure of import in removing posterior teeth is maxillary sinus; in the mandible inferior alveolar nerve.
What are the indications for surgical removal of erupted teeth?
- Failure of forceps extraction
- Probability of root fracture
- Proximity of significant adjacent structures
- To preserve supporting alveolar bone
How would you do surgical removal of maxillary cuspids?
- envelope flap
- remove elongated triangle of facial bone
- forceps & elevators
How would you do surgical removal of maxillary molars?
- envelope flap
- remove buccal bone–expose bifurcation
- section buccal roots (Start at bifurcation)
- remove crown w/ palatal root
- remove buccal roots
OR. - envelope flap
- section crown from roots
- divide roots
- remove roots individually
How would you do surgical removal of mandibular molars?
- divide crown/roots B/L (go 3/4 to 7/8 up t the occlusal surface w/ bur–to protect going thru the tongue)
- remove mesial & distal crown-root segments w/ forceps
OR - remove crown
- divide roots
- remove roots individually
When using elevators, where do you start?
At the MB line angle
For most instances, what are the most difficult teeth to extract?
Cuspids & 1st molars (I’m assuming he meant maxillary??)
How small is a root tip that can be left behind?
< 4-5mm
*List 3 potential indications for surgical removal of erupted teeth.
- failure of forceps extraction
- probability of root fracture
- proximity of significant adjacent structures
- to preserve supporting alveolar bone
*List 1 instance when a tooth planned for extraction should NOT be removed using an open surgical technique.
- Soft tissue attachment
- Elevators
- Forceps
- Your “other” hand
- Cuspids & 1st molars
*List 4 indications for extraction.
Possible answers: non-restorable caries, endo therapy won’t help, severe periodontitis, effects of trauma, impacted or supernumerary, ortho or prosth, cracked, malposed, pre-radiation therapy, associated with pathological lesion, esthetics & economics
*List 4 contraindications for extraction.
Possible answers: ANUG, post-radiation therapy, ASA IV, severity of pericoronitis (if red and sore extract), acute infections, and malignant tumors (remove tumor first or simultaneously)
*Why do you extract maxillary teeth before mandibular teeth in same appointment?
Debris from maxillary extractions can fall into open sockets of mandibular teeth if mandibular teeth are extracted first.
When you are doing a mandibular extraction, what position are you in? How should the occlusal plane be in relation to the floor?
7 - 8 o’ clock; MD parallel to floor
When you are doing a maxillary extraction, what position are you in? How should the occlusal plane be in relation to the floor?
7 - 8 o’ clock; 45-60 degrees (occ plane to floor)
- T/F? A lever transforms a small movement and large force into a large movement and small force.
FALSE. A lever transforms a large movement & small force to a small movement & large force.
- Using right angled elevator to remove the remaining residual mesial root fragment from 18, the mechanical principle involved is…?
wheel & axle
*If the working end of instrument at right angle to handle, what principle is being used?
Wheel and axle (Cryer elevator)
*The first direction of force when extracting a tooth…?
apical
- The most frequently omitted step when extracting a difficult erupted tooth is…?
cutting a flap
What teeth are #17 & #23 for?
mandibular molars
What is the difference between #17 & #23 forceps?
- # 23 can apply more pressure & can slip & lock into furcation; also if crown were to break, it’s more likely to fracture down the middle–can treat as 2 premolars, etc
- # 17 cannot lock into furcation
*Relaxing incision should be what distance from tooth being extracted?
1 tooth anterior and 1 tooth posterior to area of surgery, 5mm from tooth being extracted- ant segment
*Which elevator is used as a “wheel & axle”?
Cryer elevator
*T/F? When sectioning molar tooth for removal, start at occlusal and go towards bifurcation.
FALSE.
*Name three reasons/indications for leaving a root tip.
Possible answers: no more than 4-5mm in length, no periapical pathologic infection, must be deeply imbedded in bone and not loose, and danger/risk of removal must outweigh not removing tip
*Name three locations for a tooth to be pushed/misplaced during an extraction.
Possible answers: infratemporal fossa, maxillary sinus, submandibular space, inferior alveolar canal
*T/F? When removing max molar, section and remove palatal root separately and remove buccal roots with crown.
FALSE
*You have sectioned badly decayed #30 and removed the distal half of the tooth. There is no crown structure left. What elevator would be a good choice to use in a wheel and axle fashion to remove the mesial segment?
Cryer elevator
*T/F? Puncture wounds are treated via debridement, primary closure, and antibiotic therapy.
FALSE.
*What is the first line antibiotic for use in alveolar osteitis?
Antibiotics are not used for dry sockets.
A patient calls your office 24 hrs after dentoalveolar surgery complaining of pain. The most likely cause is…?
dry socket
Describe the alveolar bone surrounding the mandibular molars.
Variable; lingual often thinner!
What are the types of flaps?
- envelope
- flaps w/ vertical relaxing incisions
- curved flaps
- pedicle flaps
What are some possible causes to postoperative complications?
- poor access & visualization
- incorrect use of instruments
- poor technique
T/F? The mandible has greater potential for swelling, problems, and post-op pain.
TRUE.
In the lecture notes, what is stated as the treatment for puncture wounds?
Copious irrigation, antibiotics, & NO SUTURING!
How would you fix a 2-6mm sinus perforation? Over 7mm perforation?
2-6mm: clot promotion (Gelfoam?)
Over 7mm: reparative surgery (OMS?)
Can you ever leave a root fragment in the sinus?
Yes, if the fragment is small (2-3mm) & if the sinus and root tip are healthy.
What causes ecchymosis?
Caused by submucosal or subcutaneous oozing
- more common in elderly w/ inc’d capillary fragility
What causes trismus?
injection hematoma, hematoma in mm followed by fibrosis
What is the most common cause for subperiosteal infection?
inadequate flap debridement
What causes spicules/sequestra?
- loss of periosteal blood supply
- sharp unsupported bone
- uncontrolled force
What nerve does not regenerate?
lingual nerve
What is the most common tooth for dry sockets?
third molars
Are dry sockets more common in the maxilla or mandible?
More common in the mandible bc the mandible relies on one large vessel while the maxilla is highly vascularized.
What is the perfect patient for not getting dry sockets?
- male or non-menstruating women not on BC pills
- pre-op AB dose
- pre-op rinse & for several days post-op
- under 25 yrs old
- non-smoke/drinker
- no meds
- tetracycline in site
Bacteria in the oral cavity are largely…
aerobic gram + organisms
- Strep being the most common of them…
- others: Bacteriodes melaniogenicus, Candida
In the nasal cavity, the most prevalent bacteria in children is…? In adults…?
Children: H. influenzae
Adults: S. aureus
- others: aerobic gram + (mainly strep)
What is the main bacteria of the maxillofacial skin flora?
Staphylococcus epidermidis
- others: S. aureus from nose; Corynebacterium diphtheriae; Propionibacterium acnes
What is the bacterial flora below the clavicle like?
- S. epidermis
- C. diphtheriae
- Gram (-) aerobes, such as E. coli, Klebsiella, & Proteus
- Anaerobic enteric organisms such as Bacteriodes fragilus
What is the vaccine for Hep B?
Heptavax
T/F? HIV is likely to be transmitted via saliva.
FALSE
What is sepsis?
the breakdown of living tissue by the action of MO’s; usu accompanied by inflamm.
What are the conditions that make dry heat sterilization effective?
Dry heart at 285 F sterilizes in 3 hrs
What are the conditions that make moist heat sterilization effective?
Steam at 280 F sterilizes in 1.5 min
What are the conditions that make gas sterilization effective?
Ethylene oxide at 50 C in 3 hrs
- can destroy spores, but has toxicity to animal tissues
