Surgical Technique Flashcards
Why might teeth fracture?
Thick cortical bone
Gross caries
Morphology of roots- hooked, fused, dilacerated
Root number- extra roots
Hypercementosos
Ankylosis
Alignment
Why might retained roots be present?
Failed extraction- crown fractured off from the roots
Trauma
Gross caries
Coronectomy
If you think it is likely that an extraction will turn surgical, how would you explain it to the patient?
If the tooth doesn’t want to come out with the usual instruments, we might have to make a cut in the gum in order to drill away some of the bone and remove the tooth that way.
You’ll still feel pressure but no sharp pain should be felt.
Similar drill to the one we use when you have a filling, sprays a lot of water but we will make sure to get that with the hoover.
Explain that the tooth might need sectioned- explain this.
Then we put the gum back its original place and stitch it back together.
Stitches are resorbable, so you won’t need to come back to have they taken out.
Prior to removal of a tooth, what would you do?
Full history- emphasis on medical history.
Examination- E/O and I/O
Radiographic assessment
If the extraction turns surgical, what would you do?
Remove the crown
Stop and evaluate the roots left in situ
Explain to the patient what has happened
Ensure pre-op radiograph has been taken
Discuss treatment options with the patient- leave and monitor, proceed to surgical removal or refer.
Why might we decide to not remove a retained root?
Preserves bone height for future implant placement
Near vital structures, IAN, lingual nerve- might decide too risky.
Present with a number of years without any pathology or symptoms.
Give patient all the options.
Record conversation in notes.
What equipment might you need for a surgical extraction?
LA
Scalpel with blade holder
Mitchell’s trimmer
Victoria curette
Ash
Howarth’s
Rake retractor
Tongue retractor
Elevator
Luxator
Electric drill
Burs
Mirror
College tweezers
What are the general surgical principles?
Maximal access with minimal trauma
Bigger flaps heal just as quickly as smaller flaps
Wide-based incision- circulation
Use scalpel in one firm continuous stroke
No sharp angles
Adequate sized flap
Minimise trauma to dental papillae
Flap resection should be down to bone and done cleanly
No crushing
Keep tissue moist
Ensure flap margins and sutures remain on sound bone
Make sure wounds are not closed under tension- score the underside of the flap
Aim for healing via primary intention to minimise scarring
Why is it important to retract the soft tissue?
Access to operative field
Protection of soft tissues
Flap design facilitates retraction
What might you use to retract the soft tissues?
Howarth’s periostea elevator
Rake retractor
Ash
Minnesota
Tongue retractor
What anatomical structures do you need to be aware of when deciding what flap design to do?
Mental nerve/mental foramen
Buccal nerve
What flap designs have you got to choose from?
1-sided flap
2-sided flap- 1 relieving incision
3-sided flap- 2 relieving incisions
What are the advantages and disadvantages of the three different flap designs?
1-sided flap
- Good for superficial surgical access
- but it involves more papilla and is relatively long.
2-sided flap
- Better access
- Can be difficult to suture a relieving incision
3-sided flap
- Even better access
- Difficult to suture
- Risk to neighbouring structures
Large flaps heal just as quickly as smaller flaps.
What instruments would you use to deride the socket once the tooth and roots had been extracted?
Physical- Mitchell’s trimmer
- Victoria curette
Irrigation
- Saline under the flap
Suction
- Aspirate under flap to remove debris
Check socket for retained apices.
What are the aims of suturing?
Approximate tissues
Cover bone
Prevent wound breakdown
Achieve haemostasis
Encourage healing by primary intention
