Surgical Principles of Exodontia Flashcards
5 characteristics of a flap
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
Why do you want the base of a flap wider than the free margin?
preserves blood supply
what are the 4 reasons size is important to the flap?
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
what cutting a envelope flap, extend ____ teeth ____, and __ tooth _______.
Two, posterior
one, anterior
*only need 1 tooth posterior if using a releasing incision
what three layers are cut through when doing a full thickness flap?
mucosa, submucosa, periosteum
*area between periosteum and bone is least vascular
what tissue is the primary tissue for healing?
periosteum
how many mm away from defect must incisions be made for a full thickness flap?
6-8mm
Maxillary flaps are at higher or lower risk of damaging vital structures?
lower
*there are no nerves or arteries buccally
T/F releasing incisions are very common
False, and should only be used when necessary
what 3 things should you avoid when doing a releasing incision?
1-boney prominences (cuspid)
2-cutting through papilla (go anterior or posterior)
3-cutting directly on the facial aspect
When using a releasing incision what 4 things should you do?
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
what are the 5 types of flaps?
1-envelope 2-vertical release 3-edentulous envelope flap 4-semi-lunar incision 5-palatal y incision
when using a endentuous flap, where do you cut?
through the scar at the crest of ridge (not vital structure)
- can reflect buccal or lingually
- watch out for mental nerve
when would you use a semi-lunar flap?
when trying to access the apex of a tooth
when would you use a Y flap?
access tori
where are the releasing incisions on a Y flap?
anterior to the cuspids at junction of GPA and NPA
in what direction do you start your sulcus incision?
posterior to anterior
what 3 things are important to remember when suturing?
1-coapt wound margins
2-control bleeding
3-cover the bone to avoid necrosis
*avoid tension
what suture is resorb-able and natural?
plain and chromic gut
what suture is resorb-able and synthetic?
Vicryl, PDS, dexon
what sutures is non-resorbable and natural?
silk
what suture is non resorbable and synthetic?
nylon
what are 4 suturing technique?
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
T/F an open extraction technique may be more conservative and cause less operative morbidity than a closed extraction
True
8 indications for open extractions
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)
4 times you are justified to leave root tips
1-smaller than 5mm
2-deeply imbedded in bone
3-tooth not infected
4-risk of surgery is great than benefit
What is the extraction sequence of a FMX
1-Mx post, 2- Mx ant, 3-Mx cu, 4-Md post, 5-Md ant, 6-Md cu
