Oral Surgery 1

Question 1

Why study radiographs before extraction

Answer 1

Lone molars
Deep caries/fracture
Weird roots
Lesion under tooth
Crown

Question 2

In the standing extraction position, where should the mandible/maxilla be located

Answer 2

Maxillary arch level with surgeon’s elbow or below

Mandible parallel to floor

Question 3

Instead of pulling the tooth, what do you do

Answer 3

Push
Rock
Rotate

Question 4

3 types of elevators

Answer 4

Wedge
Lever
Wheel and axle

Question 5

2 purposes of elevators

Answer 5

1. Loosen teeth, create space

2. Remove parts of tooth or root (primary mechanism for 3rd molar)

Question 6

A straight elevator does what to the tooth

Answer 6

Pushes DOESN’T SCOOP

Question 7

Primary use of cryer elevators

Answer 7

Removing residual roots of multi-rooted teeth

Question 8

How to use forceps

Answer 8

1. Seat forceps by applying force apically
2. B, L, or rotational force to expand alveolus to release tooth
3. Minimal traditional force

Question 9

8 steps to extraction

Answer 9

1. Anesthesia (profound)
2. Soft tissue release
3. Elevate tooth
4. Adapt forceps to tooth
5. Lunate with forceps
6. Remove tooth from socket
7. Examine socket for soft tissue/granulation (curette)
8. Gauze over socket and compress with occlusal forces

Question 10

150 and 151 forceps remove what

Answer 10

Any, universal

Question 11

Cow horn 23 removes what

Answer 11

Mandibular molar

Question 12

What removes max anterior and premolars

Answer 12

1

150

Question 13

Max canines are removed with what

Answer 13

1

150

Question 14

Max 1st premolar is extracted with

Answer 14

1

150

Question 15

Max 1/2nd molars are extracted with

Answer 15

150
53 R/L
88 R/L

Question 16

Mandibular incisors/canine/premolars forceps

Answer 16

151

Ash

Question 17

Surgical extraction

Answer 17

Removal of tooth with:
Flap
Removal of bone
Tooth in multiple pieces

Question 18

When doing a flap, you should cross the gingival margin when

Answer 18

At the line angle of the tooth

Question 19

5 types of mucoperiosteal flaps

Answer 19

Envelope
Three cornered
Four cornered 
Semi-lunar
Y incision

Question 20

Indications for open extraction

Answer 20

When you need to be more careful

• sinus proximity
• avoid excessive force
• ankylosis
• dense bone

Weird morphology

• roots
• exostosis

Question 21

When can you leave a root tip

Answer 21

Small piece <4mm
Deeply embedded
Not infected
Not mobile
Risk of removal> leaving it
Inform and counsel pt.
Document
Refer if needed

Question 22

Impacted vs unerupted

Answer 22

I: failure to fully erupt within expected time

U: tooth not having perforated oral mucosa

Question 23

T/F all unerupted teeth are impacted

Answer 23

FALSE

Question 24

Formation of 3rd molars
Crown?
50% of root?
Average?

Answer 24

Crown - 14
50% of root - 16
Av. - 20

Question 25

Winter’s classification

Answer 25

Based on inclination of impacted tooth to long axis of 2nd molar M-angular D-angular Horizontal Vertical

Question 26

Therapeutic vs prophylactic indication for 3rd molar removal

Answer 26

T: treat active process/disease P: prevent future disease

Question 27

Indications for removal of third molars

Answer 27

``` Pericoronitis Caries Pathological resorption Pathology Eruption pain Crowding Post-ortho Orthographic surgery In line of a mand. Fracture Perio Lack of att. Ging ```

Question 28

Why is it hard to pull 3rd molars in old people

Answer 28

``` Highly calcified bone, less flexible Slower recoop Mand. Fracture easier Non resolving Pins and needles Osteomyelitis and infection easier ```

Question 29

Order of which teeth get extracted the most

Answer 29

Man 3rd > max 3rd > max canine > man PM > Man canine > max PM > max CI > Max LI > man 2nd molar

Question 30

Peak pain occurs _

Answer 30

12 hrs after surgery

Question 31

The first analgesic should be taken _

Answer 31

Before local wears off

Question 32

Long acting local anesthetic to use before discharge

Answer 32

Marciano

Question 33

Don’t prescribe more than _ worth of pain meds

Answer 33

3 days

Question 34

Two options for meds post surgical extraction

Answer 34

10 of: Tramadol 50 mg Norco 5 mg/325 mg (hydrocodone/acetaminophen)

Question 35

Peak swelling post surgery

Answer 35

36-48 hrs

Question 36

T/F post op infection diagnosis can be made over the phone

Answer 36

FALSE

Question 37

4 stages of wound healing cascade and main cell of each

Answer 37

Hemostasis - platelet Acute inflammation - granulocytes Proliferation - monocyte/macphage Remodeling - fibroblast

Question 38

What happens in the 4 stages of wound healing

Answer 38

Hemo - stop bleeding Inflammation - stabilize clot, signal to cells to clean up wound Proliferation - collagen and caps form on fibrin, provisional matrix where bone can form Remodeling - woven bone replaces collagen, then mature bone

Question 39

Normal healing timeline

Answer 39

1: mild-mod discomfort 3: socket healed over 4-6: lamina dura to resorbed radiographically

Question 40

Things that mess up healing time (6)

Answer 40

``` Bad hygiene Bony pathology Smoking Radiation Anti-resorptive drugs Suppression of host defenses ``` BRASSB

Question 41

Dry socket:

Answer 41

Loss, lysis, or breakdown of the blood clot prior to its maturation into granulation tissue

Question 42

Things that increase risk for dry socket

Answer 42

Mandibular tooth Smoking Oral contraceptive Pericoronitis

Question 43

Osteomyelitis:

Answer 43

Bone infection. Medical and surgical issue, can lead to significant morbidity