Third Molars 4 Flashcards
how is access gained to surgically remove a 3rd molar (3 points)
raising a buccal mucoperiosteal flap
maximal access with minimal trauma
use scalpel in one continuous stroke
how is the flap reflected during 3rd molar surgery
raise flap at base of relieving incision
undermine/ free anterior papilla before proceeding to reflect flap distally
why is a periosteal elevator placed firmly on bone when raising a flap to surgically remove 3rd molars (2 points)
avoid dissection occurring superficial to periosteum
reduces soft tissue bruising and trauma
name some instruments that can be used to raise a flap (3)
mitchell’s trimmer
Ash periosteal elevator
curved warwick James elevator
what does retraction provide when surgically removing 3rd molars
access to operative fields
protection of soft tissue
why are air driven handpieces not used in the surgical removal of 8s
may lead to surgical emphysema
what is used to remove bone when surgically removing 8s
electrical straight handpiece with saline cooled bur
what is the ideal bone removal for surgical extraction of 8s
create buccal gutter around the crown of the 8 to allow position of elevators mesially and buccally
what is a horizontal crown section
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
what is a vertical crown section
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
what are the three aspects of debridement
physical
irrigation
suction
what is physical debridement following surgical removal of an 8
using bone file or handpiece to remove sharp/ bony edges
what can be used to remove soft tissue debris
mitchell’s trimmer
victoria curetter
what are the aims of suturing a flap (4)
reposition tissues
cover bone
prevent wound breakdown
achieve haemostasis
what are the two main types of flap design
3- sided
2-sided (envelope)
what instructions should be given post operatively to a patient who has had surgical removal of an 8 (5 points)
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
what is coronectomy
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
how far down the length of the tooth should be sectioned for a coronectomy
3-4mm below the CEJ into dentine
how is the flap over a coronectomy treated tooth repositioned
flap replaced - primary closure with periosteal release if necessary
what is the initial follow up recall for a coronectomy
1-2 weeks
what four things should you warn patient about when performing coronectomy surgery
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
