Surgical Technique Flashcards
When making an incision, where should the operator start ?
the operator should start posteriorly and they should work towards the front of the flap
Describe how sulcular incisons should be done
- the blade should be placed vertically into the gingival sulcus
- following the shape of the tooth, keep the shapr edge of the blade against the tooth surface to prevent unnecessary damage to teh gingiva
- interdental papilla should be preserved to ensure apposition of flap post-operatively
What should the operators supporting hand do when making the relieving incision?
it should be retracting the cheek to exert tension on the alveolar mucosa
What is the benefit of tension on the alveolar mucosa when making the relieving incision?
it ensures that the blade runs cleanly through the tissues
An incision should be made in a ________, ________ stroke
a single, smooth stroke
Where should an incision stop?
at the level of the apices of the teeth
Incisions should be made at ________ angle and must be straight down to the _________.
right angle
straight down to the bone
Why should incisions be made down to bone level?
this is to permit easy reflection of the flap without any soft tissue still being attached to periosteum and the bone
The periosteum plays an important role to the healing of the flap. True or false
True
Where does flap reflection begin?
it begins with the papillae
What instruments can be used to seperate and turn out a flap from the underlying bone?
- warwick james elevator
- Mitchells trimmer
How should a mitchells trimmer be used to seperate and turn out a flap from the underlying bone?
- keep the smooth edge of the instrument against the soft tissue to prevent any unnecessary damage
List periosteal elevators that can be used to reflect a flap
- Howarths
- Symes
- Molt No.9
- Hu-friedy
Why are the Symes and Molt No.9 preferred over the howarths elevator?
the howarths elevator is blunt which can cause damage to the soft tissues
Symes and Molt No.9 are sharper
What elevator is preferred for use in periodontal surgery and why?
Hu-Friedy 24G
This is because they are sharp and small which minimises soft tissue damage
What is the hardest part of the flap to reflect?
the attached gingiva
What is a full thickness flap ?
a flap that includes both the mucosa and the periosteum
Why should we avoid putting tension on the flap?
to avoid tears
Why must we take care not to strip the periosteum further than required?
this is because it reduces blood supply to the bone
State one way which you can strengthen the flap and prevent tears
lengthening the flap
Give examples of retractors that can be used
- Morris rake
- Minnesota
- Lacks tongue retractor
Before a retractor is placed, what must be created?
A pocket underneath the periosteum is created using a periosteal elevator. Care must be taken not to strip the periosteum further than required.
Briefly describe how a retractor is placed
The chosen retractor is placed over the periosteal elevator into the pocket created and then the periosteal elevator is removed
The retractor sits against the _______, protecting the soft tissues.
bone
In the mandibilar premolar area, what must you be careful of when raising a flap?
you must be careful not to trap the mental nerve berween the retractor and the bone as damage could occur
Give examples of braided resorbable sutures
Vicryl (polyglactin)
vicryl rapide
Give an example of a braided non resorbable suture
silk
Give examples of monofilament non- resorbable sutures
- nylon
- prolene
What must be achieved before repositioning of the flap ?
Bony haemostasis
(area must also be thoroughly irrigated and debrided)
What structure can be used as a guide to replace the flap to its original position?
interdental papillae
Give examples of flaps that are placed in new positions
not the original position of the flap
- buccal advancement flap
- apically repositioned flap
What are the aims of a suture?
- approximate wound edges to maximise healing by primary retention
- to cover bone as much as possible, preventing bony necrosis
- hold the flap in the desired position
- to aid soft tissue haemostasis
Monofilament sutures required more ______ to ensure a firm knot
ties
What instances can silk sutures be used ?
where the wound needs to be very firmly held together e.g. Oro-antral communications
The more zeros in the number, the _______ the suture strand
smaller
Smaller in diameter
00000 is referred to as …
5-0
(a 5-0 is a smaller suture strand than a 3-0)
The higher the gauge (smaller the diameter), the lower the …
tensile strength
How do you minimise excess tissue reaction when choosing suture diameter?
you should choose the smallest diameter suture with sufficient strength for the task
Where is the sharp edge of a conventional cutting needle located ? What is the advantage of this?
on the inner curve of the needle
it is easier to pass through tissue (although there is an increased risk of tearing)
Where is the sharp edge of the reverse cutting needle located?
sharp edge is located on the outer curve of the needle; directed away from the wound edge
it reduces the risk of the suture pulling through the tissue
Where should the first suture always be placed? Why is this?
- it should always be placed at the most anterior papilla of the flap
- or the middle papilla if it is an envelope flap
It ensures that the rest of the flap lies correctlt
How should the needle always enter the tissue?
at a right angle
How long should intra-oral sutures be left in for?
5-7 days
Briefly describe how you would remove a suture
- pick up thhe knot of the suture using tweezers (in doing this, the part of the suture that has been within the mucosa and therefore “clean” is exposed)
- cut the suture at the “clean” point using sharp scissors and pull the suture free
(this technique prevent dragging the dirty part of the suture through the wound)
https://www.youtube.com/watch?v=OXuhMZ-4M1I
