Third Molars 4

Question 1

how to gain access

Answer 1

raising a buccal mucoperiosteal flap

Question 2

surgical access rules

Answer 2

max area with min trauma
scalpel in one firm continuous stroke
minimise trauma to dental papillae
large flaps heal as quick as small ones

Question 3

how to reflect?

Answer 3

raise flap at base of relieving incision
undermine free ant papillae before distal reflection
reflect with periosteal elevator

Question 4

instruments used to reflect

Answer 4

mitchell’s trimmer
howarth’s periosteal elevator
ash periosteal elevator
cured warwick james elevator

Question 5

why use retraction?

Answer 5

access to operative field
protect soft tissues

Question 6

instruments used for retraction?

Answer 6

howarth’s periosteal elevator
rake retractor
minnesota retractor

Question 7

how to do bone removal?

Answer 7

electric straight handpiece with saline cooled bur
DONT USE AIR….SURGICAL EMPHYSEMA
round fissure stainless steel and tungsten carbide burs

Question 8

where to remove bone?

Answer 8

buccal aspect of tooth
distal aspect of impaction
create deep, narrow, buccal gutter around the crown
bone removed to allow for application of elevators

Question 9

horizontal crown sectioning

Answer 9

section above CEJ
coronectomy section below CEJ

Question 10

vertical crown sectioning

Answer 10

allows for removal of distal portion fist
then remove mesial portion

Question 11

types of debridement

Answer 11

physical- using mitchell’s trimmer and bone trimmer
irrigation- using saline into socket under flap
suction- aspirate under flap to remove debris

Question 12

aims of suturing

Answer 12

to compress blood vessels
reposition tissues
cover bone
prevent wound breakdown
achieve haemostasis

Question 13

coronectomy

Answer 13

alternative to surgical removal of entire tooth when there is an increased risk of IAN damage

Question 14

coronectomy procedure

Answer 14

surgical flap for access
transection of tooth 3-4mm below enamel into dentine
elevate crown without mobilising roots
pulp left in place
irrigate
flap replaced

Question 15

coronectomy follow up

Answer 15

review 1-2 weeks
further revie 3-6 months then 1 year
radiographic review 6 months/year

Question 16

what to warn patient about coronectomy

Answer 16

if roots mobilies during surgery, whole tooth must be removed
leaving roots behind can lead to infection
can get slow/painful socket
roots can migrate and begin to erupt later

Question 17

upper 3rd molars

Answer 17

easier to remove
removed by elevation and forceps only
straight/curved warwick james / couplands
bayonets

Question 18

how to remove upper 3rd molars

Answer 18

support tuberosity with finger and thumb
if cant access then raise buccal flap and remove bone