OS - principles and planning

Question 1

What are goals of MOS?

Answer 1

Removal of tooth/ root
Removal of part of a tooth (coronectomy)
Apicectomy
Peri-radicular surgery
Preservation of bone, adjacent tooth, soft tissue and anatomical features

Question 2

what are the 7 steps in MOS?

Answer 2

1. flap design
2. incise and reflect
3. account for obstacles
4. methods to overcome obstacle (i.e., bone removal)
5. position of instruments to elevate
6. path of withdrawal
7. tooth removal

Question 3

what scalpels are used for MOS?

Answer 3

no 15 and no 11

Question 4

what grip is the scalpel held in?

Answer 4

standard pen grip

Question 5

what type of incisions can the scalpel create?

Answer 5

crevicular
relieving

Question 6

at what angle do you cut with a scalpel?

Answer 6

perpendicular to mucosal surface
parallel to long axis of tooth within gingival crevis

Question 7

how thick do you cut with a scalpel?

Answer 7

mucosa and periosteum (full thickness)

Question 8

where is a relieving incision cut?

Answer 8

from crevicular area to apices of teeth

Question 9

what are the incisions for an envelope style flap?

Answer 9

crevicular incision

Question 10

what are the incisions for a ‘two sided flap’?

Answer 10

crevicular incision
1 relieving incision (at mesial aspect)

Question 11

why do a ‘two sided flap’?

Answer 11

larger area of exposed alveolus - for access

Question 12

what incisions make a ‘three sided flap’?

Answer 12

crevicular incision
2 relieving incisions (1 ant 1 pos)

Question 13

when may you use a ‘three sided flap’?

Answer 13

periradicular surgery with apicectomy

Question 14

what are the 12 basic principles of flap design?

Answer 14

1. flap broad base
2. ensure blood supply
3. extend 1 unit either side
4. incision margins supported
5. avoid/ include important structures
6. flap without tension
7. include papilla
8. incisions avoid leaving areas avascular
9. relieving incisions
10. anterior generally
11. be mindful of anatomy/ cosmesis
12. extent dictated by relief

Question 15

what lays beneath the lower 4 and 5s that you need to be cautious of when cutting flaps?

Answer 15

mental neurovascular bundle

Question 16

why do we not want tension on flaps?

Answer 16

tension promoted wound breakdown

Question 17

what areas are good suture points?

Answer 17

interdental papilla

Question 18

what 6 factors must be planned before tooth removal?

Answer 18

1. path of withdrawal
2. position of instruments to elevate
3. identification of obstacles
4. methods to overcome obstacle
5. bone removal
6. incision

Question 19

what 3 things to we draw on to radiographs when planning for surgical removal of a tooth?

Answer 19

obstacle
path of withdrawal
point of application

Question 20

list all extrinsic obstacles to xla?

Answer 20

bone
soft tissues
anatomic features
adjacent teeth
pathology
space (lack of)
location (palatal/ lingual)
maxillary sinus
inferior alveolar neurovascular bundle

Question 21

list all intrinsic obstacles to xla?

Answer 21

crown (size, shape)
roots (number, morphology, angulation)
pathology
caries
resorption
ankylosis

Question 22

what obstacle do endodontically teeth pose?

Answer 22

they are more brittle/ weak and prone to root fracture

Question 23

when cutting a flap for removal of a lower 8, where should you palpate?

Answer 23

palpate the bony ramus

Question 24

when cutting flap for removal of lower 8, why should you not follow the curve of the teeth?

Answer 24

medial to the ramus holds many nerves