Oral Surgery Techniques

Question 1

For a right handed operator where do you stand for extraction of right lower molars/premolars?

Answer 1

behind and to the patients right

Question 2

For a right handed operator where do you stand for extraction of lower left teeth and all upper teeth?

Answer 2

in front and to the patients right

Question 3

What should your non-dominant hand be doing during an extraction?

Answer 3

retracting the tissues

supporting the jaw and the alveolar bone (tooth supporting structures)

Question 4

What movements can be used to elevate a tooth during an extraction? (3)

Answer 4

wheel and axle - rotation of the wrist - commonly used in cryers

lever -using a fulcrum

wedge - between PDL and the root

Question 5

List the stages of carrying out a minor oral surgery procedure (13)

Answer 5

consent

surgical safety checklist

radiograph

anaesthesia

access - flap

possible bone removal

possible tooth division

debridement

suture

haemostasis

PO instructions

prescribe medication

follow up

Question 6

What kind of consent is required for all oral surgery procedures (surgical and NS)?

Answer 6

Written (and verbal)

Question 7

During minor oral surgery how do we gain access?

Answer 7

mucoperiosteal flaps

- mucosa and periosteum raised together.

Question 8

In terms of the flap and soft tissues; What must we assess and ensure we do after creating the access flap? (5)

Answer 8

ensure that the flap is an adequate size - maintains circulation

ensure no sharp angles created in the tissues

ensure the flap is not crushed and kept moist during the procedure

minimise trauma to the papillae

Question 9

What must we ensure after when closing the mucoperiosteal flap? (2)

Answer 9

That the margins of the flap are laid and sutured on sound bone

must not be closed under tension

Question 10

What types of flaps can you lift?

Answer 10

1 sided - long crevicular incision

2 sided - crevicular incision with either a medial or distal relieving incision

3 sided is a crevicualr incision with a medial and distal

Question 11

What is the risk of a distal relieving incision?

Answer 11

can damage the lingual nerve - if done in lower molars

Question 12

What instruments do we use to retract soft tissues?

Answer 12

Rake retractor/ Bowdler-Hendry retractor

Howarth’s periosteal elevators

Question 13

What instrument is used to carry out bone removal? (1)

What burs do we use? (2)

Answer 13

electrical straight handpiece
with a saline/sterile water cooled bur

fissure or round tungsten carbide bur

Question 14

What instruments cannot be used to carry out bone removal?

Answer 14

air driven handpieces

Question 15

Why can air driven handpieces not be used to carry out bone removal?

Answer 15

Can cause surgical emphysema - driving air/gas underneath the mucosa

Question 16

What type of bone removal is carried out during a surgical extraction?

Answer 16

buccal guttering

Question 17

How is the area managed before suturing (debridement and curettage)? (5)

Answer 17

use bone file/handpiece to remove sharp edges

remove soft tissue debris with Victoria curette

irrigate with saline

aspirate under the flab

check for retained apices

Question 18

What instruments are used to deride soft tissue debris from a socket?

Answer 18

Mitchells trimmer

Victoria curette

Question 19

List the types of suture material available.

Answer 19

non-absorbable

absorbable

monofilament

polyfilaments

Question 20

Name examples of Non-absorbable suture materials

Answer 20

mersilk - polyfilament
prolene- monofilament
ethylon - monofilament

Question 21

when are Non-absorbable suture materials used?

Answer 21

when wounds have to be supported for long periods of time

i.e. Closure of an OAF

Question 22

Name examples of absorbable suture materials

Answer 22

Velosorb - polyfilament

Question 23

when are Absorbable suture materials used? (2)

Answer 23

when sutures cannot be removed

when edges have to be held temporarily

Question 24

How are absorbable sutures broken down?

Answer 24

hydrolysis

Question 25

Name examples of monofilament suture materials

Answer 25

prolene

ethylon

Question 26

Name examples of polyfilament suture materials

Answer 26

velosorb - absorbable

mersilk - non absorb

Question 27

How are suturing needles categorised?

Answer 27

shape - 3/8 of a circle or 1/2 a circle

size and length

cross section - triangle/round

Question 28

How do you achieve haemostasis during the surgery? (4)

Answer 28

LA + vasoconstrictor

diathermy

bone wax

artery forceps

Question 29

How do you achieve haemostasis after the surgery? (4)

Answer 29

Pressure

LA infiltration

diathermy

surgicel pack and sutures

Question 30

When are follow ups required fro patients? (3)

Answer 30

If complications are expected

if sutures have to be removed

if healing has to be monitored

Question 31

Why do teeth fracture during extraction? (7)

Answer 31

poor extraction technique

thick cortical bone which Is hard to expand

there is an abnormal root shape

there are multiple roots

hypercementosis

ankylosis - fusion of root and bone

caries

Question 32

What do we need to include in the consent conversation for oral surgery? (5)

Answer 32

what’s involved in the procedure - why, risks, benefits

options

who’s doing the procedure

expectations during

• pressure not pain
• sutures after
• drilling soudns

complications - perio and post

Question 33

What technique do you use with the scalpel when carrying out the access incision?

Answer 33

one continuous stroke

Question 34

Why should you avoid trauma to the papillae whilst carrying out the flap design?

Answer 34

Will cause recession

Question 35

What are the benefits of using a one sided flap? (3)

Answer 35

less bruising

less swelling

less chance of damaging a nerve

Question 36

Why is the border between the free and the attached gingivae important in flap design?

Answer 36

junction must be crossed in order to gain enough access

this area is very vascular = more bleeding, swelling and bruising

Question 37

describe the flap design for the surgical removal of a premolar.

Answer 37

2 sided flap

- crevicular + M or D relieving incision

Question 38

describe the flap design for the surgical removal of a 6 (molar).

Answer 38

1 sided crevicular flap from 7 to the 4

with semilunar access

Question 39

describe the flap design for the surgical removal of an 8/wisdom tooth. (2)

Answer 39

2 sided flap
- crevicular + M/D relieving incision

3 sided flap
- crevicular + M and D relieving incisions

Question 40

describe the flap design for the surgical removal of retained roots.

Answer 40

1 sided flap with semilunar access