Surgical Principles of Exodontia

Question 1

5 characteristics of a flap

Answer 1

1- soft tissue outlined by surgical incisions
2-caries its own blood supply
3-allows for access to underlying tissues
4-can be replaced into original position
5-maintained with sutures

Question 2

Why do you want the base of a flap wider than the free margin?

Answer 2

preserves blood supply

Question 3

what are the 4 reasons size is important to the flap?

Answer 3

1-good visualization
2-adequate access for instruments
3-able to place and hold retractor on bone without tension
4-straight incisions heal faster than torn tissue

Question 4

what cutting a envelope flap, extend ____ teeth ____, and __ tooth _______.

Answer 4

Two, posterior
one, anterior

*only need 1 tooth posterior if using a releasing incision

Question 5

what three layers are cut through when doing a full thickness flap?

Answer 5

mucosa, submucosa, periosteum

*area between periosteum and bone is least vascular

Question 6

what tissue is the primary tissue for healing?

Answer 6

periosteum

Question 7

how many mm away from defect must incisions be made for a full thickness flap?

Answer 7

6-8mm

Question 8

Maxillary flaps are at higher or lower risk of damaging vital structures?

Answer 8

lower

*there are no nerves or arteries buccally

Question 9

T/F releasing incisions are very common

Answer 9

False, and should only be used when necessary

Question 10

what 3 things should you avoid when doing a releasing incision?

Answer 10

1-boney prominences (cuspid)
2-cutting through papilla (go anterior or posterior)
3-cutting directly on the facial aspect

Question 11

When using a releasing incision what 4 things should you do?

Answer 11

1-cross free gingival margin at line angle of tooth
2-oblique angle should be wider at the base
3-release on the anterior side
4-use only when necessary

Question 12

what are the 5 types of flaps?

Answer 12

1-envelope
2-vertical release
3-edentulous envelope flap
4-semi-lunar incision
5-palatal y incision

Question 13

when using a endentuous flap, where do you cut?

Answer 13

through the scar at the crest of ridge (not vital structure)

• can reflect buccal or lingually
• watch out for mental nerve

Question 14

when would you use a semi-lunar flap?

Answer 14

when trying to access the apex of a tooth

Question 15

when would you use a Y flap?

Answer 15

access tori

Question 16

where are the releasing incisions on a Y flap?

Answer 16

anterior to the cuspids at junction of GPA and NPA

Question 17

in what direction do you start your sulcus incision?

Answer 17

posterior to anterior

Question 18

what 3 things are important to remember when suturing?

Answer 18

1-coapt wound margins
2-control bleeding
3-cover the bone to avoid necrosis

*avoid tension

Question 19

what suture is resorb-able and natural?

Answer 19

plain and chromic gut

Question 20

what suture is resorb-able and synthetic?

Answer 20

Vicryl, PDS, dexon

Question 21

what sutures is non-resorbable and natural?

Answer 21

silk

Question 22

what suture is non resorbable and synthetic?

Answer 22

nylon

Question 23

what are 4 suturing technique?

Answer 23

1-pass needle at right angle to mucosa
2-pass through papilla (not empty socket)
3-pass through mobile (buccal) flap first, then pick up fixed mucosa
4-don’t tie too tightly

Question 24

T/F an open extraction technique may be more conservative and cause less operative morbidity than a closed extraction

Answer 24

True

Question 25

8 indications for open extractions

Answer 25

1-anticipate excess force
2-initial attempts at forceps extraction have failed
3-thick/dense bone (buccal) (common in older patients)
4-short clinical crowns and bruxers
5-hypercementosis
6- dilacerated or divergent roots
7-roots in max. sinus
8-excess caries or large amalgams (forceps will shatter tooth)

Question 26

4 times you are justified to leave root tips

Answer 26

1-smaller than 5mm
2-deeply imbedded in bone
3-tooth not infected
4-risk of surgery is great than benefit

Question 27

What is the extraction sequence of a FMX

Answer 27

1-Mx post, 2- Mx ant, 3-Mx cu, 4-Md post, 5-Md ant, 6-Md cu