Techniques Flashcards
What handpiece do you use for minor surgical procedures? Why not a turbine? What kind of bur?
A motorised handpiece, no air produced
Turbine can cause surgical emphysema due to air
Round or fissure tungsten carbide burs
What are some common post operative complications?
Pain
Swelling
Bruising
Jaw stiffness
Bleeding
Dry socket
What does soft tissue retraction involve?
Access to operative field
Protection of soft tissues
Flap design facilitates retraction
Howarth’s Periosteal Elevator or Bowdler-Henry Retractor (rake)
What does suturing aim to do?
Reposition tissues
Cover bone
Prevent wound breakdown
Achieve haemostasis
Encourage healing by primary intention
What types of suture do you get?
Resorbable
Non-Resorbable
What are the types of resorbable stiches? Give 1 example of each.
Monofilament
-MONOCRYL
Multifilament
-VICRYL RAPIDE
What are the types of non-resorbable stitches? Give 1 example of each.
Monofilament
-PROLENE
Multifilament
-MERSILK (black silk)
How is peri-operative haemostasis achieved?
LA with vasoconstrictor
Artery forceps
Diathermy
Bone wax
How is post-operative haemostasis achieved?
Pressure
LA with vasoconstrictor
Diathermy
Surgicel
Sutures
What are the basic principles of surgical technique?
Risk assessment (good planning and medical history)
Aseptic techniques
Minimal trauma to hard and soft tissues
What are some principles of surgical access?
Maximal access with minimal trauma
Bigger flaps heal just as quickly as smaller flaps
Preserve adjacent tissues
Use the scalpel in one firm continuous stoke
Flap reflection should be down to bone and done cleanly
No sharp angles
No crushing
Keep the tissue moist
Minimise trauma to dental papillae
What are some principles of suturing?
Ensure that flap margins and sutures will lie on sound bone
Make sure wounds are not closed under tension
Aim for healing by primary intention to minimise scarring
What is an envelope flap design?
2 sided, e.g. mesial and buccal
What are the ways to use an elevator?
Wheel and axle
-push elevator into the PDL and rotate slightly to create space
Wedge
-slip the elevator as far down the PDL as possible and hope that the tooth starts to slide upwards as it pushes down
Lever
-push the elevator into the PDL and then use the instrument as a lever
What are the uses of an Elevator?
To provide a point of application of forceps
To loosen teeth prior to using forceps
To extract a tooth without the use of forceps
Removal of multiple root stumps
Removal of retained roots
Removal of root apices
What are the uses of non-resorbable sutures?
If extended retention periods are required
Must be removed postoperatively
Closure of oro-antral fistula or exposure of canine tooth
What are the uses of resorbable sutures?
Holds tissue edges together temporarily
If removal of suture not possible/desirable
May mean that review is not required
What is a monofilament suture?
Single strand
Pass easily through tissue
Resistant to bacterial colonisation
What is a multifilament suture?
Several filaments twisted together
Easier to handle
Prone to wicking
-oral fluids and bacteria move along the length of the suture and can result in infection
When is the lingual nerve at risk of being damaged?
Incision of flap
Raising of buccal and lingual flaps
Retraction of flaps
Bone removal
Extraction with forceps
What are the 4 nerves that can be damaged during removal of third molars?
Lingual
Inferior alveolar
Mylohyoid
Buccal
What is peri-radicular surgery?
Surgery to the external root surface
What are the aims of peri-radicular surgery?
Establish a root seal at the apex of a tooth or at the point of perforation of a lateral perforation
To remove existing infection
–curettage, enucleation of cyst
–removal of apical part of root which may have infected lateral canals
