Pre-Surgical Assessment & Instrumentations Flashcards
Major Concern about extraction is…
- Degree of surgical difficulty
- Problem related to patient management
What is the difference between an uncomplicated or complicated extraction?
- Uncomplicated
- Removal of tooth using forceps or elevator only
- Complicated
- Removal of tooth requiring use of a surgical flap
What are the parts of a pre-surgical assessment?
- Medical Risk Assessment
- Emotional Condition
- Clinical Evaluation
- Radiographic Evaluation
- Overall Difficulty
- Surgical Approach
What is the medical risk assessment?
- Consultation with physician or other dentist
- Evaluation of medicine
- Identifying medical problem
- Potential drug interaction
What are the four types of patients during a medical risk assessment?
1: no foreseeable medical risk
2: some potential problem but can handle with proper training and equipment in general dentist office
3: can be managed by general dentist with proper consultation / lab
4: need to let specialist take care of it due to serious risk
What do you need to find out about emotion condition?
- Able to identify apprehensive or hostile patients
- High anxiety patient need general anesthesia or special sedation
- Always “up stage” patient’s claim of anxiety
What are the four types of patients when considering emotional condition?
4: Extremely apprehensive -> general anesthesia
3: Moderately apprehensive -> Pre op sedation and/or IV sedation
2: Little apprehensive -> Controllable with good management
1: Unconcerned -> Ready to numb and go!
What are the four types of patients when considering the presence of infection?
4: Infection spread bilaterally to neck, below mandible, dysphagia, systemic toxicity -> to hospital NOW
4: Serious unilateral infection -> refer to OMS
3: Moderate soft-tissue swelling (not airway or neck) -> Intraoral drainage
2: Infection confined to alveolar ridge, palate
1: No infection present
What are the four types of patients when considering mouth opening?
4: Inadequate for forceps placement -> refer to specialist
4: Inadequate to retrieve root tips -> refer to OMS
3: Restricted but OK for forceps placement or root tip retrieval
2: Normal mouth opening and surgical access
— MIO is usually 3-4 fingerbreadth or ~50mm
1: Greater than normal mouth opening
What is important to notice about caries/fractures?
- Degree of Carious involvement can influence your surgical approach
— Reflection of surgical flap or bone removal
— Selection of a forceps which does not rely on coronal purchase
What are the four types of patients when considering caries and fractures?
4: Tooth decayed or fractured below alveolar bone -> Flap first then extraction
3: No clinical crown present but root is intact -> different forceps selection
— Example: use Forceps #23 as oppose to #151 for mandibular molar
2: Decay or fracture present but most of the crown is available
1: No caries or fracture
Mobility due to periodontal bone loss makes extraction…
easier
What are the four types of patients when considering tooth mobility?
4: No mobility -> high potential for ankylosis
— Primary molars, endodontically treated teeth or Erupted 3rd molars.
3: No mobility, but ankyloses not to be a problem.
2: Normal tooth mobility
1: Greater than normal mobility
What are the miller classifications for tooth mobility?
- Class 1: <1mm (horizontal)
- Class 2: >1mm (horizontal)
- Class 3: >1mm ( horizontal + vertical mobility)
Physiological tooth mobility is ~____mm
0.25
What do you need to look for considering tooth alignment in arch?
- Position of a tooth in arch affect
- Forceps placement
- Potential damage to adjacent teeth
— Surgical approach needed if tooth is inaccessible
What are the four types of patients when considering tooth alignment in arch?
4: Tooth in lingual version and inaccessible through buccal flap refer to OMS
3: Malpositioned or rotated but can be grasped by forceps and accessible through buccal bone
2: Tooth in normal alignment
1: one or both adjacent teeth missing
What are the four types of patients when considering radiographs?
4: not showing entire tooth or adjacent structure
3: Panoramic only
2: Panoramic + Periapical
1: Multiple Viewing options!
What radiographs are needed for OMS clinical eval?
- PANORAMIC radiograph needed!!
- Periapical may be needed
- Occlusal film or Cone beam CT
What are the teeth with high risk for sinus exposure?
- Maxillary 1st, 2nd, 3rd molar
- Maxillary second premolar
What are the four types of patients when considering the tooth relationship to maxillary sinus?
- 4: Moderate / High risk
- Sinus surround apices of teeth
- 3: Sinus extend to furcation
- 2: low risk, roots are coronal to sinus
Why do you need to be concerned about alloys in teeth as well as caries?
- Weaken tooth structure
- Careful forceps selection
- Alternative surgical approach
The _____ roots the more difficult the surgery
more
What teeth do you need to pay attention to the roots?
- 3rd molar has the ↑ variation in root number
- Mandibular molar: Mesial root is frequently bifurcated
- Premolars ( Except Maxillary first premolar)
— Maybe bifurcated near apex
Root curvature at _____ ½ are more likely to fracture
apical
What is more likely to fracture… maxillary central incisor roots or mandibular incisors roots?
Mandibular incisor roots
Internal/external root __________
weaken root structure
resorption
Teeth gets brittle following ___________ treatment
endodontic
* ↑ fracture during extraction
* More delicate the root
* Longer and Slender
Why do you need to be careful when pulling a primary tooth?
- Primary molar root may encircle
Permanent premolar -> May consider referral to OMS
Does more or less alveolar bone around the tooth make it easier to extract?
bone loss (less bone)
↑ bone density = ___ root fracture
and/or alveolar bone fracture
increase
What is an uncomplicatd extraction?
- No Extraction is “ Simple”
- Removal of teeth with
- Forceps or elevators
- No risk for fractures
— Root, alveolar bone
— Violation of maxillary sinus
What is an complicatd extraction?
- Complicated Procedure involves
- Sectioning
- Flap reflection
- Bone removal
- Additional measures ↓ fracture or sinus exposure risks
What do you need to think about before you do a flap reflection?
- Removal of adjacent teeth has a high risk for surgical complications
- Alveoplasty is planned following multiple extraction
- Apical repositioning of soft tissue to attain more attached gingiva
- Periodontal bone recontouring around adjacent teeth
