Surgical Techniques

Question 1

Why do teeth fracture?

Answer 1

Thick cortical bone
Root shape
Root number
Hypercementosis
Ankylosis
Caries
Alignment

Question 2

What are some post-op complications of surgical extractions?

Answer 2

Pain
Swelling
Bruising
Jaw Stiffness
Bleeding
Dry socket
Infection (unusual)

Depending on anatomical location
- Nerve damage risk - temporary, permanent, altered
- OAF

Question 3

What are the aims of soft tissue retraction?

Answer 3

Access to operative field
Protection of soft tissues
Flap design facilitates retraction
Be careful

Question 4

What are the 3 stages of debridement?

Answer 4

Physical - handpieces or hand instruments
Irrigation - sterile saline into socket and under flap
Suction - aspirate underneath flap to remove debris and check socket for retained apices.

Question 5

Why do you need to lift mucosa and periosteum in a flap?

Answer 5

You need to get down to bone.
Will not heal properly if you only lift the mucosa

Question 6

How many revs per minute is a motor driven handpiece?

Answer 6

40 revs per minute

Question 7

Why do we not use turbine-driven handpieces in surgical extractions?

Answer 7

Can lead to SURGICAL EMPHYSEMA.
Air is driven between bone and soft tissues (in subcutaneous tissues)- can spread to the neck and chest - becomes an airway risk.
Can also become infected.

Question 8

What are the 3 actions used in elevation?

Answer 8

Wedge
Wheel and axel
Lever (not used a lot)

Question 9

What are the aims/ steps of suturing?

Answer 9

Reposition tissues
Cover bone
Prevent wound breakdown
Achieve haemostasis
Encourage healing by primary intention

Question 10

What type of suture is rarely used and why?

Answer 10

Resorbable monofilament
Takes very long to resorb

Question 11

What are 2 main priorities for raising a flap?

Answer 11

Maximal access
Minimal trauma

Question 12

Are bigger or smaller surgical flaps better?

Answer 12

Bigger flaps heal the same as small ones and give better vision/ access.

Question 13

What is the criteria for good surgical flaps?

Answer 13

WIDE BASE - ensures good perfusion - lots of blood vessels and nerves still flowing, preventing necrosis
Use scalpel in one firm, continuous stroke
Ensure tissues are sutured back together PASSIVELY - not under tension or will not heal well.
Keep tissue moist
No sharp angles
Ensure flap margins and sutures will lie on sound bone

Question 14

What situation would you use a non-absorbable suture?

Answer 14

When you want them in the body for a longer period of time - for example OAF.

Question 15

What is an envelope flap?

Answer 15

One-sided extended incision along gingival crevices/ margins freeing the inter-dental papillae.
Requires sufficient length of incision to permit adequate reflection

Question 16

What are the advantages of an envelope flap?

Answer 16

Lower risk of damage to vital structures
Wide base assures perfusion
Reduced scarring
Easy approximation

Question 17

What are the disadvantages of an envelope flap?

Answer 17

Periodontal damage and recession due to sulcular incision
Reduced access - challenging to reflect
Tearing

Question 18

What is a triangular/ 2-sided flap?

Answer 18

Horizontal incision along the gingival crevice with a single vertical relieving incision.
Relieving incision should include interdental papillae.

Question 19

What are the advantages of a triangular/ 2-sided flap?

Answer 19

Satisfactory visualisation
Flap stability
Adequate blood supply
Easy to adapt
Decreases tension forces

Question 20

What is a disadvantage of a triangular/ 2-sided flap?

Answer 20

Easy to tear adjacent tissues if exposure inadequate.

Question 21

What flap is typically used for surgery involving incisors, canines and premolars?

Answer 21

Envelope flap

Question 22

What flap is typically used for surgical removal of root tips and is useful in cases where access may need to be extended?

Answer 22

Triangular/ 2-sided flap