Basic Surgical Technique

Question 1

Stages of surgery (10)

Answer 1

1. Consent
2. Safety checklist
3. Anaesthesia
4. Access
5. Bone removal as necessary
6. Debridement/wound management
7. Suture
8. Achieve haemostasis
9. Post op instructions + meds
10. Follow up

Question 2

When must we obtain written consent?

Answer 2

When tx involves conscious sedation or GA

Question 3

how do we obtain surgical access?

Answer 3

Lifting a mucoperiosteal flap

Question 4

What sits between the bone and the gum?

Answer 4

Periosteum

Question 5

Why do we want a wide-based incision?

Answer 5

To allow the flap to maintain good circulation

Question 6

What makes up a 3 sided flap?

Answer 6

1. Distal relieving incision
2. Crevicular incision around tooth
3. Mesial relieving incision between 7 and 8

Question 7

How should we position our distal relieving incision?

Answer 7

Bit more buccal so we dont damage lingual nerve

Follow the external oblique ridge of the mandible

Question 8

What makes up an envelope flap? (2)

Answer 8

1. Distal relieving incision
2. Crevicular incision along gingival crevice
   - Extends midway along 7 or further

Question 9

What instruments are used for soft tissue retraction (3)

Answer 9

1. Ash
2. Rake retractor
3. Howarths periosteal elevator

Question 10

Function of ash

Answer 10

Protecting and retracting lingual soft tissues

Question 11

Function of rake retractor and howarths periosteal

Answer 11

Reflects light in and protects soft tissues/adjacent structures like nerves

Question 12

Compare rake retractor to howarths periosteal

Answer 12

HOWARTHS - narrow + thinner

RAKE - reflects light + protects soft tissues

Question 13

Why do we use electrical straight handpieces for bone removal instead of air driven?

Answer 13

Air driven may lead to surgical emphysema

• driving air or gas underneath mucosa or skin
• can lead to hospital admission

Question 14

What major structures must we be wary of when using an elevator?

Answer 14

1. Antrum - max sinus
2. ID canal
3. Mental nerve

Question 15

Whats the exception for using the adjacent tooth as a fulcrum ?

Answer 15

Only if its to be extracted too

Question 16

List some uses of elevators

Answer 16

1. Loosen tooth before using forceps
2. Extract tooth w/o forceps
3. Removal of retained roots
4. Removal of root apices

Question 17

3 ways that we can perform debridement following an extraction

Answer 17

1. PHYSICAL
   - Bone file or handpiece to remove sharp bony edges
   - Mitchells trimmer or victoria curette to remove soft tissue debris
2. IRRIGATION
   - Sterile saline into socket
3. SUCTION
   - Aspirate under flap to remove debris
   - Check socket for retained apices

Question 18

Aims of suturing (5)

Answer 18

1. Reposition of tissues
2. Cover bone
3. Prevent wound breakdown
4. Achieve haemosasis
5. Encourage healing by primary intention

Question 19

Different types of sutures

Answer 19

NON-ABSORBABLE

• Removed post-operatively
• used when need the wount to be supported + retained for a longer period of time

ABSORBABLE
- Hold tissue edges together temporarily

Question 20

What are monofilament sutures? (3)

Answer 20

• Single stranded
• Pass easily through tissue
• Resistant to bacterial colonisation

Question 21

What are polyfilament sutures? (2)

Answer 21

• Several filaments twisted together

- Easier to handle

Question 22

How is haemostasis achieved peri-operatively?

Answer 22

1. LA with vasoconstrictor
2. Artery forceps
3. Diathermy
4. Bone wax

Question 23

How is haemostasis achieved post-operatively?

Answer 23

1. Pressure
2. LA infiltration
3. Diathermy
4. Surgical
5. Sutures

Question 24

What post op meds will patients take after an extraction?

Answer 24

Analgesia - ibuprofen + painkillers

Chlorrhexidine

Question 25

What nerves can be damaged from a surgical removal from 3rd molars (4)

Answer 25

1. Lingual 2. Inferior alveolar 3. Mylohyoid 4. Buccal

Question 26

List some complications of lower 3rd molar removal (7)

Answer 26

1. Pain 2. Swelling 3. Bruising 4. Bleeding 5. Trismus 6. Infection 7. Dry socket 8. Paraesthesia

Question 27

What is an excision of mucocele?

Answer 27

Flap based soft tissue procedure in removing a lump or sack of saliva (that is created in response to trauma) usually to the lower lip or from damage to the minor salivary glands

Question 28

What is an OAF? (2)

Answer 28

Communication from mouth into the sinus via an epithelial lined tract Following the removal of an upper molar tooth which was close to the floor of the max sinus

Question 29

Function of peri-radicular surgery

Answer 29

Establish a root seal at the apex of the tooth/at the point of perforation, to remove existing infection

Question 30

What flap is used most commonly for periradicular surgery? (2)

Answer 30

1. Triangular | 2. Rectangular

Question 31

Why is a semilunar flap not as popular anymore?

Answer 31

1. Reduced access 2. Only good for apical lesions 3. Scarring

Question 32

Post-op review (3)

Answer 32

1. Review + ROS at 1 week 2. Post op radiographs between 1-6wks 3. Further review 3-6mths later

Question 33

List some reasons for failure (4)

Answer 33

1. Inadequate seal 2. Inadequate support - Perio pockets - Occlusal overload - Excessive root resection 3. Split roots 4. Soft tissue defect over apex post-op