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Module 6 - Oral Surgery > Surgical Dentistry Principles + Planning > Flashcards

Surgical Dentistry Principles + Planning Flashcards

1
Q

What does MOS stand for? 6 examples

A

Minor oral surgery.

  • Trans-alveolar surgical removal.
  • Surgical extraction.
  • Peri-radicular surgery.
  • Apicectomy.
  • Implantology.
  • Soft tissue surgery.
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2
Q

What is another term for surgical extraction?

A

Trans alveolar surgical removal.

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3
Q

What is an apicectomy?

A

The apex of a tooth is removed.

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4
Q

What is the ideal appointment time for a surgical procedure?

A

45 minutes

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5
Q

What is excessive bleeding called?

A

Exsanguination.

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6
Q

What are the 4 types of access needed?

A
  1. Physical.
  2. Visual.
  3. Emotional.
  4. Social.
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7
Q

What plain film radiography can be used to help localize a structure?

A

Parallax.

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8
Q

What are the 8 steps to planning surgical extraction?

A
  1. Tooth removal
  2. Dependent on path of withdrawal
  3. Dictates position of instruments to elevate
  4. Identification of obstacles
  5. Methods to overcome obstacles
  6. Bone removal
  7. Incision
  8. Flap Design
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9
Q

What is the grip for a scalpel?

A

Standard pen grip.

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10
Q

What are the common sizes of scalpels?

A

No 15 (more curved) and No 11 (more straight).

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11
Q

What is the shape of a No11 blade? What motion is it used in? What is it often used for?

A
  • More STRAIGHTER BLADE.
  • Used for a STABBING MOTION.
  • Ex. Incision and drainage of swelling.
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12
Q

At what angle relative to the mucosa do you hold the scalpel?

A

PERPENDICULAR to mucosal surface.

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13
Q

What is a crevicular incision?

A

Cut PARALLEL TO THE LONG AXIS OF THE TOOTH within the GINGIVAL CREVICE down to the CRESTAL BONE.

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14
Q

What is a relieving incision?

A

From the CREVICULAR area towards the APICES of the teeth (to ultimately expose the alveolar bone).

  • usually FULL THICKNESS (mucosa and periosteum).
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15
Q

What is the motion we would like to use the blade in? Why?

A

Want a SINGLE SWEEPING MOTION
- Multiple cuts may lead to LACERATION of the tissue in multiple areas.

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16
Q

What is LEADING EDGE CUTTING?

A

When focusing on the tip of the blade for cutting, may become unaware of the rest of the blade which can cause lacerations further from the intended site.

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17
Q

What type of flap is a distal crevicular incision without any relieving incisions considered?

A

ENVELOPE STYLE.

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18
Q

What type of flap is a crevicular incision with a mesial relieving incision considered?

A

TWO SIDED FLAP.

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19
Q

How can you improve access of a distal crevicular incision with a mesial relieving incision (2)

A
  1. Make crevicular incision LONGER (more distal).
  2. Engage in another relieving incision.
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20
Q

What type of flap is a crevicular incision with a mesial and distal relieving incision considered?

A

THREE SIDED FLAP.

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21
Q

What style flap is commonly indicated for an apicectomy/ periradicular surgery?

A

THREE SIDED FLAP WITH 2 RELIEVING INCISIONS.

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22
Q

What is required to gain greater access when creating incisions?

A

RELIEVING INCISIONS.

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23
Q

Where do you gain access to with a crevicular incision WITHOUT any relieving incisions?

A

THE SUPERIOR ASPECT OF THE ALVEOLUS.

24
Q

Why do we want a flap to have a BROAD BASE?

A
  • To ensure it has an appropriate blood supply (ensure they do not become necrotic as you work).
25
Q

Why do we like to include the papilla when making incisions (2)?

A
  • Relocation of flap.
  • Suturing (meaty sites that allow for sutures to be placed).
  • Suture points.
26
Q

8 basic principles of flap design?

A
  • Flap broad base.
  • Ensure blood supply.
  • Extend 1 unit either side.
  • Incision margins supported.
  • Avoid/include important structures.
  • Flap without tension.
  • Include papilla.
  • Incisions avoid leaving
    areas avascular.
27
Q

In what direction does blood supply run?

A

From SULCUS to CREST.

28
Q

Why do we extend flaps 1 unit either side?

A

To ensure the INCISION MARGINS ARE SUPPORTED (usually with bone) when they are replaced.

29
Q

Why do we want to avoid placing tension on a flap?

A

Produces forces that may result in WOUND BREAKDOWN.

30
Q

Are flaps generally retracted or reflected? Why?

A

RETRACTED to avoid tension.

31
Q

Give an example of an incision where avoiding leaving areas avascular failed.

A

Cutting the papilla into “3rds”, 2/3rds in the flap and 1/3rd not in the flap.
- Challenges both fixed papilla and papilla in flap - at risk of becoming AVASCULAR.

32
Q

Why is it important to determine the sites of elevation?

A

Guide BONE REMOVAL.

33
Q

What guides the elevation points?

A

The ERUPTION PATH/ PATH OF WITHDRAWAL.

34
Q

Where are elevation points often located?

A

Often MESIAL.

35
Q

What is an important consideration on the position of the elevation point?

A
  • The lower (relative to the bone crest) the application point, the more CHALLENGING to access it and the more BONE that has to be removed.
36
Q

7 EXTRINSIC obstacles

A
  1. Bone.
  2. Soft tissues.
  3. Anatomic features (ex. maxillary sinus, IANB).
  4. Adjacent teeth (for impacted teeth).
  5. Pathology (ex. cyst, tumor).
  6. Space (lack of).
  7. Location (palatal/lingual).
37
Q

What does IANB stand for?

A

Inferior alveolar neurovascular bundle.

38
Q

6 INTRINSIC obstacles

A
  1. Crown (size,shape).
  2. Roots (number, morphology, angulation).
  3. Pathology.
  4. Caries.
  5. Resorption
  6. Ankylosis
39
Q

What problems can the number, morphology and angulation of roots cause?

A
  • Number: Multiple roots have chance of having MULTIPLE WITHDRAWAL PATHS.
  • Morphology: Bulbous apex with thinner rest of root.
  • Angulation: Dilaceration.
40
Q

What problems can the size and shape of crowns cause?

A
  • Large, bulbous crowns more likely to cause problems that small, conical crowns.
41
Q

What is an intrinsic obstacle for endodontically root treated teeth?

A
  • Teeth typically more BRITTLE and thus more at risk of FRACTURE.
42
Q

How can you tell a tooth is inclined on radiograph?

A

Strange superimposition of cusps in the radiograph!! Can be buccal or lingual inclination.

43
Q

What determines the extent of a flap?

A

Extent of flap determined by RELIEF. aka an envelope flap gives much smaller access than a 3 sided flap.

44
Q

What is a standard flap for surgically extracting a mesio-angularly impacted mandibular 3rd molar?

A

TRIANGULAR FLAP (3 sided flap).

45
Q

What is a standard flap for surgically extracting a mesio-angularly impacted mandibular 3rd molar?

A
  • Distal relieving incision: Goes up ascending ramus laterally.
  • Crevicular incision: Around visible part of crown (from distal to mesial) - INCLUDES PAPILLA.
  • Mesial relieving incision: does not go a unit anterior, curves down with a slight CURVATURE.
46
Q

Why do we place a slight curvature on the mesial relieving incision of a mandibular 3rd molar (2)?

A
  • Helps avoid leaving vessels.
  • Helps put the flap back/ self retaining.
47
Q

Can the same flap design used for a mesio angularly impacted molar be used for a distoangularly impacted 3rd molar deeply impacted and close to 2nd molar?

A

NO
- Elevation point/ bone removal point would be more MESIAL and covered by soft tissue aka FLAP DESIGN WOULD BE INADEQUATE.
- Mesial incision margin would fall into the BONE REMOVAL HOLE (would not be supported by bone).

48
Q

What is an envelope flap for an impacted 3rd molar?

A
  • Distal receiving incision lateral of ramus.
  • Goes around 7, includes papilla between 7 and 6 and finishes mid buccal of 6.
49
Q

Does a triangular or envelope flap provide more space for bone removal for a mandibular 3rd impacted molar?

A

ENVELOPE FLAP.
- more freedom of removing bone at the site immediately disto-buccal of the 7.

50
Q

What flap design is indicated for a disto-angularly impacted 3rd mandibular molar? Why?

A

ENVELOPE FLAP.
- more freedom of removing bone at the site immediately disto-buccal of the 7.

51
Q

What flap design consideration is indicated for the surgical XLA of mandibular 6?

A

2 SIDED FLAP.

1 unit distal yet 2 UNITS MESIAL as to avoid the mental foramen (aka go around buccal of 4 as well).

52
Q

How long after surgery will the soft tissue heal?

A

3-7 days.

53
Q

What must you palpate prior to cutting a flap for a 3rd mandibular molar? Why?

A

Palpate the BONY RAMUS.

  • If not done, may cut immediately distal to the ramus, fall into the “gap” aka lack of bone mesial to the ramus.
54
Q

What is a standard incision for the surgical removal of an unerupted/ partially erupted maxillary third molar?

A

SLASH STYLE
- Straight line that runs from DISTOPALATAL accross to MESIOBUCCAL of the 8 and traverses DISTOBUCCAL TO THE 7 and into the BUCCAL SULCUS.

55
Q

7 rules of flap design?

A
  • Flap must never cross a bony defect/ pathology.
  • Releasing incisions should be over CONCAVE bone surfaces and NOT CONVEX bone eminences.
  • The end of the vertical incision at the gingival crest should finish at the MESIAL or DISTAL LINE ANGLES and CURVE so that the incision meets the free gingival margin at 90 degrees to the gingival contour.
  • The other end should NOT enter the mucolabial fold.
  • The base must be as wide as its free edge and vertical releasing incisions should follow the direction of the vascularization network
  • The periosteum must be raised with the flap
  • The retractor must rest on bone and not soft tissue
56
Q

2 goals of flap design?

A
  • Provides adequate access to surgical site.
  • Allow sufficient blood supply to the mobilized and non-mobilized soft tissues.
57
Q
A

Module 6 - Oral Surgery (11 decks)

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