Surgical Technique

Question 1

What are the main principals of basic surgery?

Answer 1

Maximal access with minimal trauma

No sharp angles

Continuous single scalpel stroke

As minimal damage to tissue as possible.

Question 2

What aspects should be considered with creating a surgical flap?

Answer 2

Bigger flaps heal just as quickly as small ones

Wide base for circulation

Flap reflection should be down to bone

Ensure flap margins lie on sound bone

Question 3

How can you promote healing by primary intention when raising a flap?

Answer 3

Keep tissue moist

No crushing

Wounds not closed under tension

Question 4

What is meant by the term healing by primary intention?

Answer 4

Healing with minimal tissue damage/loss using sutures, to create a thin scar.

Question 5

What instruments are used for retracting the gingiva?

Answer 5

The Bowdler-Henry (rake) Retractor and Howarth’s Periosteal Elevators.

Question 6

What would you tell the patient if a tooth required surgical extraction?

Answer 6

The tooth need to section the tooth, basically break it down into pieces so we can take it fully out.

You’ll experience pressure, but no pain as we lift the gum up. There may be some drilling, and stitches at the end.

There may also be damage to the teeth next to the site.

Question 7

What handpiece should be used for bone removal under surgical conditions?

Answer 7

Electical straight handpieces
Cooled with Saline
Tungsten Carbide burs

Question 8

What may happen if an air driven handpiece is used under surgical conditions?

Answer 8

There is a risk of surgical emphysema.

Question 9

What are the three types of debridement during a surgical extraction?

Answer 9

Physical
Irrigation
Suction

Question 10

What instruments are available for physcial debridement during oral surgery?

Answer 10

Bone File, a handpiece, Mitchell’s Trimmer or a Victoria Curette.

Question 11

What should be used for irrigation debridement during oral surgery?

Answer 11

Sterile saline solution to be used in sockets and under any flaps.

Question 12

What are the aims of suturing?

Answer 12

Reposition tissues

Cover exposed bone

Prevent wound breakdown

Achieve haemostasis

Promote healing by primary intention.

Question 13

Outline the process of a typical surgical extraction.

Answer 13

1. Anaesthesia
2. Access (flap)
3. Bone removal
4. Tooth divison
5. Debridement
6. Suture
7. Achieve haemostasis
8. Post-ops.

Question 14

What key anatomical structures should be concerned about if you are raising a LINGUAL and BUCCAL flap for tooth 44?

Answer 14

Lingial nerve
Mental nerve

Question 15

In what % of cases does the lingual nerve lay above the buccal bone plate?

Answer 15

15-18%.

Question 16

Which MOPS related procedures can have a risk of damaging the lingual nerve?

Answer 16

Raising a flap (incision, raising, retraction)

Bone removal

Extraction with forceps

Question 17

Which nerves may be damaged during the removal of third molars?

Answer 17

Lingual
Inferior Alveolar
Mylohyoid
Buccal

Question 18

What are the benefits of non-absorbable sutures?

Answer 18

Can hold tissue in place for longer, so in wounds which require a long time period to heal (OAF, buccal advancement flap).

Question 19

What is the benefit of absorbable sutures?

Answer 19

May not need to be removed chairside, and patient will not need review appointment.

Question 20

Why do absorbably sutures break down within the mouth?

Answer 20

Water interacts with the vicryl, causing the polymer to degrade and breakdown.

Question 21

What are the benefits of monofilament sutures?

Answer 21

Pass through tissues easier, resistant to bacterial colonisation.

Question 22

What are the benefits of polyfilament sutures?

Answer 22

Easier to handle than monofilament, but are prone to wicking - which can allow bacterial colonisation and infection.