11 - Third molars 4 Flashcards

1
Q

What are the basic principles of of surgical removal?

A
  • risk assessment
  • aseptic technique
  • minimal trauma to hard and soft tissues
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2
Q

What are the steps of surgical removal?

A
  • anaesthesia
  • access
  • bone removal
  • tooth division
  • debridement
  • suture
  • haemostasis
  • POI
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3
Q

Describe access for surgical removal.

A
  • raise a buccal mucoperiosteal flap
    +/- raise a lingual flap (high risk)
  • open a larger slap than you may think, as minimal trauma required
  • use scalpel with one firm continuous stroke
  • minimise trauma to dental papilla
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4
Q

How do you reflect a flap?

A
  • begin raising flap at base of relieving incision
  • undermine and free papilla before proceeding distally
  • reflect with elevator firmly on bone
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5
Q

What instruments can be used to reflect a flap?

A
  • Mitchell’s trimmer
  • Howarth’s periosteal elevator
  • Ash periosteal elevator
  • Curved Warwick James elevator
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6
Q

Why do you retract a flap?

A
  • access to operative field
  • protection of soft tissues
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7
Q

Describe how to retract a flap.

A
  • the flap design facilitates retraction
  • atraumatic and passive retraction s done by resting the instrument firmly on bone
  • be aware a adjacent structures
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8
Q

What instruments can be used to retract a flap?

A
  • Howarth’s periosteal elevator
  • rake retractor
  • Minnesota retractor
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9
Q

Describe a rake retractor.

A

Has small “teeth” at the end to grip the tissue

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10
Q

Describe a Minnesota retractor.

A
  • wide application point
  • reflects light into surgical field
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11
Q

What is used to remove bone?

A

Electrical straight handpiece with saline cooled bur

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12
Q

Why can you not use air driven handpieces in oral surgery?

A
  • can cause surgical emphysema
  • air is driven into soft tissues and can cause severe infection
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13
Q

Which burs are used for bone removal?

A
  • round or fissure
  • stainless steel
  • tungsten carbide
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14
Q

Describe bone removal for third molar extraction.

A
  • buccal aspect drilled and onto distal aspect of impaction
  • deep but narrow gutter
  • bone removed to allow application of elevators on mesial and buccal aspect
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15
Q

Describe tooth division.

A
  • most common to section the crown from the roots
  • occasionally roots require sectioning
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16
Q

How do you section a tooth horizontally for removal?

A
  • placed bur horizontally and begin to cut above the CEJ
  • once initial cut is made, insert elevator and rotate to crack tooth
  • warn patient about noise
17
Q

How do you section a tooth horizontally for a coronectomy?

A
  • placed bur horizontally and begin to cut below the CEJ
  • once initial cut is made, insert elevator and rotate to crack tooth
  • warn patient about noise
18
Q

How do you section a tooth vertically?

A
  • cut along crown
  • feel for a drop into the furcation
  • elevate roots and crown, distal first then mesial
19
Q

Describe the debridement of the extraction socket.

A
  • physical debridement can be carried out using a bone file or handpiece
  • irrigate the socket with saline and under flap
  • aspirate under flap to remove any debris
20
Q

What instruments are used to physically debride the socket?

A
  • Mitchells trimmer
  • Victoria curette
21
Q

What is the purpose of suturing?

A
  • approximate tissues
  • compress blood vessels
  • cover bone
  • prevent wound breakdown
  • achieve haemostasis
22
Q

What POI should be given to the patient after a surgical extraction?

A
  • avoid disturbing socket
  • no smoking for as long as possible
  • no alcohol for >24 hours
  • no vigorous exercise for >24 hours
  • optimal pain relief advice
23
Q

What is a coronectomy?

A
  • alternative to removal of entire tooth when the roots are in close proximity to the ID canal
  • crown is removed with deliberate retention of roots
24
Q

Describe the coronectomy procedure.

A
  • flap design as necessary for access
  • transaction of tooth 3-4mm below enamel of crown into dentine
  • elevate/lever crown without mobilising roots
  • pulp left in place and untreated
  • socket irrigated
  • flap repositioned
25
Q

Describe the follow for a coronectomy.

A
  • review 1-2 weeks
  • further review 6-12 months then discharge to GDP
26
Q

What are the risks you must inform the patient of regarding coronectomy?

A
  • if roots mobilised the entire tooth must be removed
  • leaving roots behind can result in infection although rare
  • can heal slowly and painfully
  • roots may migrate after surgery and begin to erupt, these would require extraction although would now be safer
27
Q

How are upper third molars extracted?

A
  • generally easier
  • can be removed by elevation only or with forceps
28
Q

What instruments are used to remove upper third molars?

A
  • straight or curved Warwick James elevator
  • couplands
  • Bayonet forceps