Surgery Flashcards
Impacted Teeth most to least coomon
Mandibular third molars > maxillary third
molars > maxillary canines
Ideally, extractions should be done __________ weeksbefore radiation treatment.
3-6 weeks
How long after the placement of an implant will the collagen matrix be deposited?
4-6 weeks
Junctional epithelium around implant evident at ______
2 weeks
Winter’s Classification
easiest extraction
most difficult extraction
– Mesioangular= easiest
– Distoangular= most difficult
Pell and Gregory Classification- most difficult extraction
Class C
Class 3
Oro-Antral Communication (OAC)
Most common with __________
Tx:
Most common with maxillary first molars
Tx: if <2mm do nothing, 2-6mm 4As and
figure-eight suture, >6mm flap surgery
Alveolar Osteitis
cause and Tx:
- When blood clot dislodges or dissolves before wound heals following an extraction
- Does not require antibiotics
- Tx: irrigation and local pain control
- Most common with __________
- Tx:
- Patients with numbness lasting more than _____
weeks should be referred for
microneurosurgical evaluation
- Most common with lower third molars & IAN
- Tx: medrol dosepak
- Patients with numbness lasting more than 4
weeks should be referred for
microneurosurgical evaluation
Tooth Displacement
* Maxillary first/second molar
* Maxillary third molar
* Mandibular third molar
Tooth Displacement
* Maxillary first/second molar -maxillary sinus
* Maxillary third molar -infratemporal fossa
* Mandibular third molar - submandibular space
Suction Tips
* Yankauer suction= ________ tissue
* Frazier suction= _________ tissue
Suction Tips
* Yankauer suction= soft tissue
* Frazier suction= hard and soft tissue
Tissue Retractors
Austin uses:
minnesota
wieder
seldin
- Austin
– Right angle
– For small
flaps - Weider
(Sweetheart)
– Broad heart- shaped to protect
and retract tongue
– For mandibular
lingual surgery - Minnesota
– Offset curved
and broad
– For cheek/flap - Seldin
– Long and flat
– For elevating down to
floor of mouth as in
mandibular tori
removal
Types of periosteal elevator
- Woodson periosteal= small and delicate
- # 9 Molt periosteal= larger
Elevators
Wedge ______ elevator
wheel and axle
lever
Pick
triangular
straight
Uses:
Pick elevator
triangular
Retained and broken roots
broken roots
Lower Cowhorn Forceps
* no.#
– _________teeth
Lower Cowhorn Forceps
* #23
– Lower molars
Extraction Forceps
– Universal, uppers no.#
– Universal, lowers no.#
teeth__________
150
151
Premolars
Upper Cowhorn Forceps
* no.#
– ____________
– Two beaks-
– One beak -
Upper Cowhorn Forceps
* #88R/L
– Upper molars
– Two beaks - palatal root
– One beak - buccal bifurcation
Ash Forceps
* #
–_______teethAsh Forceps
Ash Forceps
* #74
– Mandibular premolars
Upper Root Forceps
no.#
65
Blades;
#10
#11
#12
#15
15
– Most common for
intraoral surgery
* #10
– Large skin incisions
* #12
– Mucogingival surgery
– Curved shape
enhances ease of
access to the sulcus
* #11
– Stab incisions
- Rongeurs uses:
- Osteotome (Bone Chisel)
– Monobevel -
– Bibevel - - Bone File
- Surgical Handpiece
– Straight fissure burs -
– Round burs -
- Rongeurs
– Double spring
pliers
– Trim interradicular
bone - Osteotome (Bone Chisel)
– Flat end tapped with
surgical mallet
– Monobevel à remove
torus
– Bibevel à section teeth - Bone File
– For final smoothing
before suturing
– Removes bone with
pull stroke - Surgical Handpiece
– Do NOT use airdriven handpiece
– Straight fissure burs
à section teeth
– Round burs à
remove bone
- Useful for blunt dissection of soft tissue such
as in I&D
Hemostat
suture
* Primary purpose is to __________
* Suture should be placed from _______ tissue to _________ tissue
*_________ suture is the easiest and most
common technique
* Silk has ___________ property that allows
bacteria to invade
- Primary purpose is to immobilize a flap
- Suture should be placed from movable tissue
to non-movable tissue - Simple interrupted is the easiest and most
common technique - Silk has wicking property that allows
bacteria to invade
- Adson Tissue Forceps
– Toothed uses
– Non-toothed
- Adson Tissue Forceps
– Toothed -periosteum, muscle, aponeurosis
– Non-toothed - fascia, mucosa, pathological tissue for
biopsy
Scissors
* Dean
* Mayo
Scissors
* Dean
– For cutting sutures
* Mayo
– For cutting fascia and dissecting soft tissue
- Outward (buccal/labial) - initial movement for
___________ teeth - Inward (lingual/palatal) - initial movement for
_________ teeth - Rotary - initial movement used in __________ teeth
- Apical - applied to _________ tooth, avoid excessive
pressure in _________
- Outward (buccal/labial) à initial movement for
most permanent teeth - Inward (lingual/palatal) à initial movement for
most primary teeth - Rotary à initial movement used in conical- rooted teeth
- Apical à applied to every tooth, avoid excessive
pressure in maxillary molars
during extraction with elevator fulcrum is _________
Alveolar bone
Types of Mucoperiosteal Flaps
* Envelope= __________ vertical releases
* Three-Cornered= _________ vertical release
* Trapezoidal= __________ vertical releases
Types of Mucoperiosteal Flaps
* Envelope= 0 vertical releases
* Three-Cornered= 1 vertical release
* Trapezoidal= 2 vertical releases
- Semilunar incision
– For ____________
– Apically displaced flap is impossible
in ________ - Double Y incision
– For
Apicoectomy
maxillary palate
Palatal torus removal
Is adolescent’s contraindication for implant
Yes
Anti-roration is seen in one-piece/Two-piece abutment?
Two- piece
Cement may be trapped subgingivally
and cause __________
Cement may be trapped subgingivallyand cause periimplantitis
Antirotation Component
* Prevents ________ of abutment
* Provides ________ of abutment
Antirotation Component
* Prevents rotation of abutment
* Provides stabilization of abutment
Implant Placement
* 1mm -
* 1.5mm -
* 2mm -
* 3mm -
* 5mm -
Implant Placement
* 1mm - buccal plate, lingual plate, inferior
border, maxillary sinus, nasal cavity
* 1.5mm - adjacent natural teeth
* 2mm - IAN
* 3mm - adjacent implant
* 5mm - mental nerve (due to anterior loop)
Bone Quality
* Implant success rate goes from high to low
* Type I=
* Type II=
* Type III=
* Type IV=
Bone Quality
* Implant success rate goes from high to low
* Type I= anterior mandible
* Type II= posterior mandible
* Type III= anterior maxilla
* Type IV= posterior maxilla
Osseointegration is by _________ stability
secondary
- Analog=
implant replica
Impression coping use
used to transfer location and angulation of implant to a
master cast
- Gingival fibers orient next to implant ___________
with cuff
parallel
Peri-implant bone loss _______ mm per year after
first year is normal
<0.2mm
Implant Failure
* ______˚C for 1 minute or _______˚C for 7 minutes is
enough to compromise osseointegration
Implant Failure
* Gram negative anaerobic rods and filaments
* 47˚C for 1 minute or 40˚C for 7 minutes is
enough to compromise osseointegration
Mandibular Fractures
* Best evaluated with a _________ radiograph
Most to least common areas of fracture:
Mandibular Fractures
* Best evaluated with a panoramic
* Condylar > Angle > Symphysis
Midface Fractures
* Best evaluated with a _________
* Le Fort I=
* Le Fort II=
* Le Fort III=
* Zygomaticomaxillary complex fracture= formerly
known as a tripod fracture, caused by direct blow
to the ________ , involves bleeding under
conjunctiva
Midface Fractures
* Best evaluated with a CBCT
* Le Fort I= horizontal across maxilla
* Le Fort II= pyramidal
* Le Fort III= complete craniofacial disjunction
* Zygomaticomaxillary complex fracture= formerly
known as a tripod fracture, caused by direct blow
to the malar eminence, involves bleeding under
conjunctiva
Mandible fractures are ideally treated with _________ reduction and ___________ fixation
Mandible fractures are ideally treated with open reduction and
internal fixation (ORIF)
wiring the jaws closed, archbars and
elastics is called __________ fixation
Intermaxillary fixation
- Macrogenia=
- Microgenia=
Horizontal transverse discrepancy=
Apertognathic=
- Macrogenia= chin too big
- Microgenia= chin too small
Horizontal transverse discrepancy= posterior
crossbite
Apertognathic= anterior open bite
Bisagittal Split Osteotomy (BSSO)
* Most common post-op complication is _________
* _________ position should be unaltered
Bisagittal Split Osteotomy (BSSO)
* For retrusive or protrusive mandible
* Most common post-op complication is nerve
damage
* Condyle position should be unaltered
Distraction Osteogenesis (DO)
* Second phase is latency period à appliance is mounted to bone on each side of cut but is not activated for_______ weeks
- Second phase is latency period à appliance is mounted to bone on each side of cut but is not activated for 1 week
Pain
* Axis I - “Bio,” nociceptive input from ___________
tissue, acute
* Axis II - influence from
- Axis I à “Bio,” nociceptive input from somatic
tissue, acute - Axis II à “Psychosocial,” influence of
interaction between thalamus, cortex, and
limbic structures, chronic
Pain Pathway
1. Transduction= pain information travels from ____ to _____
2. Transmission= pain information travels from ________ to _______ and __________
3. Modulation=
4. Perception= the human experience of
pain is the sum total of these ________ processes and the
__________ factors of higher thought and emotion
Pain Pathway
1. Transduction= pain information travels from PNS to CNS
2. Transmission= pain information travels
from CNS to thalamus and higher cortical centers
3. Modulation= limitation of flow of pain
information
4. Perception= the human experience of
pain is the sum total of these physiologic processes and the psychological factors of higher thought and emotion
Increased stimulus yields increased pain is somatic / neuropathic pain
somatic pain
TN, trauma, stroke ________ pain
Neuropathic
Trigeminal Neuralgia (TN)
* Also called
* ____________ women
* Unilateral/ bilateral?
* Tx:
Trigeminal Neuralgia (TN)
* Also called tic douloureux
* Postmenopausal women (older
than 50)
* Trigger point
* Electrical, sharp, shooting, and
episodic, followed by refractory
periods
* Unilateral
* Tx: anticonvulsants
(carbamazepine), surgery
- Phantom toothache
Atypical Odontalgia
Postherpetic Neuralgia
Tx:
Tx: anticonvulsants, antidepressants, or
sympathetic blocks
Burning Mouth Syndrome (BMS)
seen in
* Associated with
Burning Mouth Syndrome (BMS)
* Postmenopausal women (older than 50)
* Associated with type II diabetes, malnutrition,
and xerostomia
bilateral, non-pulsating is a _________ type of headache
unilateral, pulsating is
intense pain near one eye
Tx:
Tension type
Migraine
cluster
Tx: triptan for migraine (selective serotonin
receptor agonist)
conversion reaction, malingering is a _____ pain
Psychogenic Pain
Facial pain of unknown cause/diagnosis
pending
Atypical Pain
Needle anxiety causes _______ syncope
Vasovagal
Most common and second most common types of syncope are
Vasovagal
Orthostatic hypotension
Angina
Tx:
- ONA
- NTG (0.4mg)—5 min—NTG—5 min—NTG, aspirin and call 911
Myocardial Infarction (MI)
Sudden occlusion of major coronary vessel,
usually ______________
Tx:
left anterior descending artery (LAD)
MONA
Hypoglycemia/Diabetes
* If conscious-
* If unconscious -
Hypoglycemia/Diabetes
* If conscious à glucose tab or orange juice
* If unconscious à IV dextrose or IM glucagon
Asthma
* _________ and _________ of bronchioles
* Wheezing= high pitch on ___________
* _____ puffs from emergency inhaler (albuterol)
* Avoid _______ and __________
- Constriction and inflammation of bronchioles
- Wheezing= high pitch on exhale
- 2 puffs from emergency inhaler (albuterol)
- Avoid NSAIDs and narcotics
Seizure/Convulsions
* Grand mal seizure=
* Status epilepticus=
- Grand mal seizure= Dilantin/Phenytoin
- Status epilepticus= Valium/Diazepam
Look for facial droop, arm drift, speech slur are symptoms of
Stroke
Stroke
*Tx:
* Caused by _________
- Oxygen and call 911
- Caused by hyponatremia
Anaphylactic Shock (Severe Allergic
Reaction)
* AEIOU
- Albuterol
- Epinephrine (0.3mg 1:1000)
- IM antihistamine
- Oxygen
- You call 911
Anticoagulation
– CBC
– Bleeding time
– PT
– INR
– PTT
* Herbal anticoagulants:
Anticoagulation
* Check blood tests below:
– CBC à anemia, leukopenia, thrombocytopenia
– Bleeding time à platelet function
– PT à anticoagulants, liver damage, Vit K
– INR à Warfarin/Coumadin, INR=2-3
– PTT à Heparin, renal dialysis, hemophilia
* Herbal anticoagulants: Garlic, Ginger,
Ginkgo, Ginseng
