OACs and retained roots Flashcards

1
Q

causes of retained roots

A

gross caries
trauma
coronectomy
attempted extraction

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2
Q

why do teeth fracture?

A
  • thick cortical bone
    • less expansion of socket so harder to ext
  • root shape
    • divergent, bulbous, apical hooks
  • root number
  • ankylosis
    • often LEs
    • chance increases with age - beware with elderly
  • caries
  • prev RCT
    • can make root weaker/more brittle
  • alignment
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3
Q

why do retained roots not always need to be removed?

A

preserve bone height e.g. future implant
near vital anatomical structures e.g. IDC
present for a number of years with the absence of PA pathology

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4
Q

discussing retained roots w pt

A

give pts the option
can be left alone and monitored to ensure no caries/PA pathology, however if becomes carious or infected recommend removal
- document discussion w pt

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5
Q

general flap design principles

A
  • max access with min trauma
  • bigger flap heal just as quickly as smaller ones
  • wide -based incision - circulation
  • use scalpel in one firm continuous stroke
  • no sharp angles
  • adequate sized flap
  • min trauma to dental papillae
  • flap reflection should be down to bone and done cleanly
  • no crushing
  • keep tissue moist
  • ensure that flap margins and sutures will lie on sound bone
  • make sure wounds are not closed under tension
  • aim for healing by primary intention to minimise scarring
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6
Q

OAF

A

epithelialised pathological unnatural communication between oral cavity and maxillary sinus
when OAC fails to close spontaneously, remains patent and gets epithelialised
migration of oral epithelium into the defect
epithelialisation usually occurs when the perforation persists for at least 48-72hrs
U3-8

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7
Q

how does an OAC occur?

A
routine forceps ext
surgical ext
tuberosity fracture
dentoalveolar/periapical infections of molars
implant dislodgement into MS
trauma
maxillary cysts or tumours
Osteoradionecrosis
dehiscence following implant failure
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8
Q

risk factors for OAC

A

extraction of upper molars and premolars
close relationship of roots to sinus on radiograph
large bulbous roots
last standing molars
older pt
prev OAC
recurrent sinusitis

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9
Q

pre-op signs of OAC

A

size of tooth and radiographic position of roots in relation to antrum

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10
Q

peri-op signs of OAC

A
bone removed at trifurcation
bubbling at socket
Valsalva test - pt pinches nose and blows gently, see bubbling at socket
change in suction sound (high pitched)
direct vision
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11
Q

post-op signs of OAC

A

brown unilateral discharge
fluid from nose when drinking
salty discharge
difficulty smoking/drinking through straw
non-healing socket

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12
Q

radiographic signs of OAC

A

break in floor of sinus
cloudy sinus
root fragment

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13
Q

management of OAC

A

inform pt, gain consent to monitor, close or refer

if small (<2mm) may heal spontaneously
close (or refer for closure) with buccal advancement flap and ABs if >2mm

conservative advice

consider ABs ( in >2mm, almost always risk of sinusitis)

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14
Q

management of OAC - conservative advice

A
no nose blowing, 
do not hold in sneezes
do not agitate area
HSMW or CHX rinse
avoid using straws
smoking cessation advice
steam inhalations with menthol crystals
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15
Q

management of OAC - decongestant/nasal drops

A

ephedrine nasal drops 0.5% 10ml - 1 drop 4 times daily
max 7 days

not applicable anymore

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16
Q

management of OAC - ABs

A

if any signs of infection consider ABs- sinusitis
- Phenoxymethylpenicillin (Pen V)
- 500mg
- QDS (4 times daily)
- 5 days

17
Q

sequelae if OAC not closed

A
if not closed promptly - sinusitis
 - 50% within 48hrs, 90% within 2wks
food/saliva accumulation in sinus
infection
impaired healing
18
Q

management of OAC - surgical closure with BAF

A
  • (OAF extra step) - excise eptheilal tract
  • incision of full thickness mucoperiosteal buccal flap
  • reflect flap and score periosteum only - more stretch
  • stretch the flap over the defect and suture to palatal mucosa over bone
 - horizontal mattress suture
can use buccal fat pad if necessary
 - may affect denture wearer or thin face
19
Q

management of root dislodged into sinus

A

confirm presence of roots with PA +/- OPT
if small consider monitoring but advise always possibility of infection
raise BAF
use copious amounts of saline and suction to see if root can be retrieved
widen socket with water cooled bur to increase the chance of retrieval of root
ribbon gauze
consider endoscopic or caldwell-luc procedure

20
Q

peri-op haemostasis

A

LA with vasoconstrictor
artery forceps
diathermy
bone wax

21
Q

post-op haemostasis

A
pressure
LA with vasoconstrictor
diathermy
sutures
WHVP
surgicel - oxidised regenerative cellulose matrix
22
Q

management of chronic sinusitis

A

prescribe ABX
- Penv (phenoxymethypenicllin)
- 500mg
- QDS
- 5 days

signs: purulent discharge from socket
cant close as pus still coming out