Transalveolar Extractions

Question 0

What are the 8 steps involved in a surgical extraction?

Answer 0

1) LA
2) Drape the patient
3) Incisions
4) Flap elevation
5) Bone removal
6) Tooth sectioing
7) Elevation
8) Debridement
9) Suturing

Question 1

What are the indications for a surgical extraction?

Answer 1

1) failure during a simple extraction (more than 10 minutes)
2) electively for difficult extractions
3) tooth roots covered by bone or mucosa

Question 2

How should local aneasthesia be achieved for the surgical removal of a lower third molar?

Answer 2

1 carpule for a mandibular block

1/2 each for long buccal and lingual

Question 3

What kind of incision should be made?

Answer 3

Many types but most are variations of the buccal one arm or two arm incision.
Two arm flap:
1) Incise over vertical ramus
2) Incise over site of third molar distal to second molar down to buccal vestibule.
Should be a defined anggle between the two arms
Second arm is more acute

Question 4

How should flap elevation be carried out?

Answer 4

Using a periosteal elevator applied to the vestibule of the 2nd anterior arm
If for an envelope flap, just use the sharp end of a periosteal elevator and lift the interdental papilla between second and third molar.

Question 5

How should bone removal be carried out?

Answer 5

Use a round surgical bone bur

1) Buccal trench between the tooth and external oblique ridge created first
2) Remove buccal bone anteriorly to create elevation point
3) Create a small indentation into the tooth
4) Remove bone distolingual to the tooth

Question 6

How should a tooth be sectioned?

Answer 6

Using a round surgical bur and a surgical flat fissure bur.

Question 7

How should the flaps be sutured?

Answer 7

If two arm flap, only one suture required at the corner

Envelope flap -> suture immediately behind second molar.

Question 8

How should a radiograph be assessed prior to the removal of impacted teeth?

Answer 8

1) occlusal line (over first and second molars)
2) Line through long axis of third molars
- > mesioangular/ vertical/ horizontal/ distoangular/ aberrant
3) Line from front of vertical ramus to interdental bone between first and second molar
- > if above the line, should be visible upon rraising the flap
4) Line perpendicular from occlusal line to mandibilar canal