Third Molars - L4 Flashcards
for surgical removal of 8’s, what is needed?
- Anaesthesia
- Access
- Bone removal as necessary
- Tooth division as necessary
- Debridement
- Suture
- Achieve haemostasis
- Post-op Instructions
types of anaesthesia that can be used for surgical removal of 8s?
- LA
- IV Sedation & LA
- GA
[Depends on Pt & difficulty of XLA]
Key points in surgical removal of 8s when gaining ACCESS?
- Access to tooth gained by raising buccal mucoperiosteal flap
- MAX ACCESS with minimal trauma
- Large flaps heal just as quickly as small ones
- scalpel in 1 firm continuous strokes
- MINIMISE TRAUMA TO PAPILLAE
Surgical Removal: Reflection
Surgical Removal: Retraction
Surgical Removal: Bone removal
- electrical straight handpiece with saline cooled bur
- AIR DRIVEN HANDPIECE = EMPHYSEMA
- Round/fissure stainless steel & tungsten carbide burs
- Protection of soft tissues
Goals of surgical bone removal?
- intention to create a DEEP, NARROW gutter around crown of wisdom tooth
- bone should be removed to allow application of elevators
If tooth cannot be removed with bone removal, what happens?
Tooth division
what is tooth division during surgical removal?
- most commonly crown is sectioned from roots to be removed separately
Debridement in surgical removal?
Physical:
- bone file/handpiece to remove sharp edge
- mitchell’s trimmer
Irrigation:
- Sterile saline into socket & under flap
Suction:
- Aspirate under flap to remove debris
must irrigate under flap & removal of all DEBRIS before repositioning it
Purpose of suturing in surgical removal of teeth?
- Approximate tissues
- Compress blood vessels
Aims: - reposition tissues
- cover bone
- prevent wound breakdown
- haemostasis
when is coronectomy carried out and what is it?
- alternative to surgical removal of ENTIRE tooth where appears to be increase risk of nerve damage with full removal
- crown removed with deliberate intention to leave root
Coronectomy main points?
- flap design to gain access
- horizontal cut of crown 3-4mm below CEJ
- elevate/lever crown off without mobilising roots
- Pulp left in place
- untreated
Review pt
what must you warn a pt for a coronectomy in regards to the roots?
- IF root is mobilised during crown removal, entire tooth must be removed
- leaving roots could result in infection
- can get slow healing/painful socket
- roots may migrate upwards and require XLA
key points regarding maxillary 8s?
- generally easier to remove
- bayonet/upper 8s forceps
- support tuberosity with thumb+finger