third molars 3

Question 1

what are the anaesthesia options for removal of 3rd molars

Answer 1

local anaesthetic - always
IV sedation and LA
GA and LA

Question 2

what type of flap is raised for access for surgical removal of 3rd molars

Answer 2

buccal mucoperiosteal flap
(some situations require a lingual periosteal flap however risk to lingual nerve, operator and situation dependent)

Question 3

name 2 instruments that could be used to raise the flap away from bone

Answer 3

mitchells trimmer
howarths periosteal elevator
ash periosteal elevator
curved warwick james elevator

Question 4

where should flap raising commence

Answer 4

base of relieving incision

Question 5

what are the 3 main instruments used for retraction in oral surgery

Answer 5

howarths periosteal elevator
Minniesota
Rake

Question 6

what handpiece and bur is used for bone removal and why

Answer 6

electrical straight handpiece with saline cooled bur
air driven not used due to risk of surgical emphysema

Question 7

what shape of burs are used for tooth division and bone removal

Answer 7

tooth division - fissure
bone removal - round

Question 8

what is the intention of bone removal during surgical extraction of M3Ms

Answer 8

to create a buccal gutter that will allow adequate application of elevators on mesial and buccal aspects of tooth
gutter should be narrow and deep not shallow and broad

Question 9

what direction is bone removal done in and why

Answer 9

done from distal to mesial to avoid slip into distal soft tissues where nerves are located

Question 10

what are the 2 options of tooth division

Answer 10

horizontal - crown and roots separated and then elevated as individual items
Vertical - may be done to entire tooth or vertical separation of roots after horizontal section of crown

Question 11

where is a tooth sectioned if separating a crown and root compared to a coronectomy

Answer 11

horizontal sectioning - slightly above ECJ to allow orientation and elevation
coronectomy - below ECJ

Question 12

what instruments can be used for physical debridement for removing soft tissue debris

Answer 12

mitchells trimmer or victoria curette

Question 13

what are the 3 steps of surgical debridement

Answer 13

physical - bone file or handpiece to remove sharp bony edges, mitchells or victoria curette to remove soft tissue debris
Irrigation - sterile saline into socket and under flap
Suction - apsirate under flap to remove and debris

Question 14

what are the 4 aims of suturing

Answer 14

reposition and approximate tissues
cover bone
prevent wound breakdown
achieve haemostasis

Question 15

how long should patients ideally wait post op before smoking and drinking alcohol

Answer 15

smoking ideally 48 hours
alcohol - 24 hours

Question 16

how long post op should patients wait before beginning salty mouthwash

Answer 16

8 hours

Question 17

where is tooth transected in a coronectomy

Answer 17

3-4mm below ECJ

Question 18

how is the pulp treated during a coronectomy

Answer 18

it is left in place, untreated

Question 19

name 3 risks associated with a coronectomy

Answer 19

if root mobilised during crown removal entire tooth must be removed due to infection risk
leaving behind roots could result in infection (rare)
a slow healing painful ‘socket’ - similar to dry socket
migration of roots towards surface and another surgery to remove these (can be seen as a postitive as lower risk to IAN)

Question 20

in general, are upper or lower third molars easier to remove

Answer 20

upper

Question 21

what is the most useful elevator and forceps for upper 3M extraction

Answer 21

Warwick james elevators
bayonet forceps

Question 22

what is at increased risk of fracture during extraction of upper 3Ms if not supported

Answer 22

tuberosity