Surgical Extractions And Resorptive Lesions Flashcards
Outline an analgesia protocol for oral surgery
Multimodal pain control perioperatively (opioid and NSAID premed, regional nerve blocks) and post- op pain control
List 4 indications for surgical extraction
Big rooted teeth (canine tooth, mandibular first molar tooth), persistent deciduous canine tooth, limitation of the risk of iatrogenic jaw bone fracture, dealing with or preventing extraction complications
What is an envelope flap?
No vertical release incision. It is mostly used in cases of feline tooth resorption.
Describe a vertical release incision
Small tooth - one release incision can be sufficient
Larger tooth - 2 release incisions and longer incisions permit better exposure. The two incisions should be divergent to provide a broader base.
Outline some examples of gentle tissue handling considerations
Elevate slowly and gently with sharp periosteal elevators. Use fine tipped a traumatic tissue forceps and use them cautiously. Use retraction at base of flap more than holding onto and pulling on flap when retracting.
What should you be cautious of not cutting into? 2
Infra orbital foramen and mental foramen
How should you avoid the infra orbital foramen?
Palpate the bundle and push it up and out of the way before making the caudal oblique release incision for the canine tooth extraction
How should you avoid the mental foramen? And when?
Avoid during vertical release incisions for mandibular premolar extractions. You will likely visualise it during the flap-retraction for the mandibular canine tooth extraction.
What passes through the infraorbital foramen? 3
infraorbital artery and vein. maxilllary branch of the trigeminal nerve
What passes through the mental foramen? 3
mental artery and vein. mandibular branch of the trigeminal nerve (n.b. there are often accessory mental formanina)
What should you be careful of when doing surgical extraction of maxillary PM4?
spare the parotid duct and its orifice (the parotid pailla - above the distal root of the maxillary PM4)
What is one of the most common dental diseases in cats?
tooth resorption - at least a third of adult cats have one or more lesions, prevalence increases with age.
Pathogenesis - tooth resorption
teeth attacked by odontoclasts (these cells are similar to oestoclasts) –> adhere to surface of tooth and form resoprtive lacunae. Vasuclar granulation tissue fills the lesion and may be replaced by bone and cementum-like tissue (looks similar to jaw bone on xray)
Why do adult roots get attacked?
degeneration and narrowing of the periodontal ligament and changes to the cementum of roots in the pre-resorption stages. An intact periodontal ligament exerts a protective function, inhibiting root resorption.
Name 2 anatomical landmarks of dental radiographs
LAMINA DURA - white line around root is made of alveolar bone which is denser immediately around the root
PERIODONTAL LIGAMENT SPACE = thin black line around root
What is type 1 resorption?
focal lesion, periodontal ligament around root is still intact. Requires standard extraction technique
What is type 2 resorption?
usually has root replacement resorption or at least partial loss of periodontal ligament. can often be treated by crown amputation with intentional root retention.
What is type 3 resorption?
a combination of type 1 and 2 resorption. very common.
3 treatment options for tooth resorption
- extraction - currently only accepted option
- restorations - attempted previously but lesions may continue under the filling.
- medical therapy to prevent or stop further progression
When is crown amputation for type 2 resorption contra-indicated? 2
in the presence of infection or inflammation at root-level (check radiographs for inflammation). In stomatitis patients and if the can has a systemic condition that compromises the immune system.
How to perform a crown amputation.
elevate a muco-gingival flap for exposure and closure of the defect, sutures must be tension free. no drilling without visualisation!!! drill any dental material only to 1-2mm below the alveolar margin. if in doubt consider referral!
What might be the signs of infected retained root remnants?
a painful inflammatory swelling and drain-tract, radiography revels root remnant surrounded by a lucency, following extraction of the root remnant, the inflammation and infection resolve.
When might you see tooth resorption in dogs?
it is often a coincidental finding during dental radiography.
What should you do with tooth resoption in dogs? 2 cases.
- EXTRACT if supra-gingival/communication of the lesion with the oral cavity.
- LEAVE IN if only subgingival and no sign of pain or radiographic sign of inflammation
What should you elevate a flap with?
periosteal elevator (requires firm action of pushing down onto bone in a controlled push and twist action). flat surface to bone, curved surface to soft tissue, be especially careful when elevating the corners and at the mucogingival junction
How do you push the flap out of the way? 2
using a suitable retractor. some surgeons prefer to use stay sutures to hold back the flap
What do you use to remove the alveolar bone plate?
use a roundbur (this action exposes the root)
What do you inspect the root apex for?
ensure there is no sign of a root fracture
What is alveoloplasty? What do you use for this?
the surgical shaping and smoothing of the tooth socket after extraction. use a large round bur
What should you do if the flap for closure doesn’t cover the defect with no tension?
enlarge release incision and/or incisise the periosteum
How do you close the flap made by release incisions? Materials? Techniques?
NO TENSION. suture materials (5/0 or 4/0 monocryl - better or vicryl = acceptable; reverse cutting needle curved 13-16mm, take fairly big ‘bites’ about 3-5mm away from flap margin, sutures 3-4mm apart.
