Third Molars 4

Question 1

how is access gained to surgically remove a 3rd molar (3 points)

Answer 1

raising a buccal mucoperiosteal flap
maximal access with minimal trauma
use scalpel in one continuous stroke

Question 2

how is the flap reflected during 3rd molar surgery

Answer 2

raise flap at base of relieving incision
undermine/ free anterior papilla before proceeding to reflect flap distally

Question 3

why is a periosteal elevator placed firmly on bone when raising a flap to surgically remove 3rd molars (2 points)

Answer 3

avoid dissection occurring superficial to periosteum
reduces soft tissue bruising and trauma

Question 4

name some instruments that can be used to raise a flap (3)

Answer 4

mitchell’s trimmer
Ash periosteal elevator
curved warwick James elevator

Question 5

what does retraction provide when surgically removing 3rd molars

Answer 5

access to operative fields
protection of soft tissue

Question 6

why are air driven handpieces not used in the surgical removal of 8s

Answer 6

may lead to surgical emphysema

Question 7

what is used to remove bone when surgically removing 8s

Answer 7

electrical straight handpiece with saline cooled bur

Question 8

what is the ideal bone removal for surgical extraction of 8s

Answer 8

create buccal gutter around the crown of the 8 to allow position of elevators mesially and buccally

Question 9

what is a horizontal crown section

Answer 9

removal of the entire tooth section above the ECJ
leaving some crown behind to allow for orientation
further sectioning of the roots may be required

Question 10

what is a vertical crown section

Answer 10

where roots are separate - the tooth may be sectioned longitudinally
allows for removal of distal crown and root separate to removal of mesial crown and root

Question 11

what are the three aspects of debridement

Answer 11

physical
irrigation
suction

Question 12

what is physical debridement following surgical removal of an 8

Answer 12

using bone file or handpiece to remove sharp/ bony edges

Question 13

what can be used to remove soft tissue debris

Answer 13

mitchell’s trimmer
victoria curetter

Question 14

what are the aims of suturing a flap (4)

Answer 14

reposition tissues
cover bone
prevent wound breakdown
achieve haemostasis

Question 15

what are the two main types of flap design

Answer 15

3- sided
2-sided (envelope)

Question 16

what instructions should be given post operatively to a patient who has had surgical removal of an 8 (5 points)

Answer 16

expect pain, bleeding, swelling, bruising
dissolvable vs non-dissolvable sutures
do not disturb the operation site for the first few hours
do not be alarmed by blood stained saliva
bleeding instructions

Question 17

what is coronectomy

Answer 17

alternative to surgical removal of entire tooth where there appears to be increased risk of IAN damage
crown is removed with deliberate retention of root adjacent to IAN

Question 18

how far down the length of the tooth should be sectioned for a coronectomy

Answer 18

3-4mm below the CEJ into dentine

Question 19

how is the flap over a coronectomy treated tooth repositioned

Answer 19

flap replaced - primary closure with periosteal release if necessary

Question 20

what is the initial follow up recall for a coronectomy

Answer 20

1-2 weeks

Question 21

what four things should you warn patient about when performing coronectomy surgery

Answer 21

if root is mobilised during crown removal the entire tooth must be removed
leaving roots behind can result in infection
slow healing or a painful socket could occur
roots may migrate later and begin to erupt through mucosa - may require extraction