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Oral Surgery I > EXAM II Surgical Exodontia > Flashcards

EXAM II Surgical Exodontia Flashcards

(68 cards)

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1
Q

what is a flap?

A

soft tissue outlined by surgical incisions

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2
Q

a flap should carry its own ___ supply

A

blood

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3
Q

flaps allow surgical access to ___

A

underlying tissues

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4
Q

can flaps be replaced into their original positions?

A

yes, and they are maintained with sutures

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5
Q

what is the significance of designing a flap with a base that is broader than the free margin?

A

it preserved adequate blood supply

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6
Q

what are some things that an appropriately sized flap can provide?

A
  • good visualization
  • adequate access for instruments
  • able to place retractor on bone and hold without tension
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7
Q

do straight incisions heal faster or slower than torn tissue?

A

faster

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8
Q

with the envelope flap design, how many teeth should be anterior to the tooth being worked on? what about posterior? why?

A

2 anterior, 1 posterior

because you’re usually coming into the mouth from the anterior, having more teeth anterior helps provide better visualization

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9
Q

how many teeth need to be anterior and posterior to the tooth being worked on in a releasing incision?

A

1 anterior and 1 posterior

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10
Q

what are the components of a full thickness flap?

A

mucosa, submucosa, and periosteum

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11
Q

what is the purpose of a full thickness flap?

A

to access bone, therefore subperiosteal

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12
Q

___ is the primary tissue for bone healing

A

periosteum

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13
Q

what component of full thickness flaps make them bleed less?

A

the area between bone and periosteum is less vascular, so there is less bleeding

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14
Q

incisions must be ___mm away from the defect, and need to be over intact ___

A
  • 6-8
  • bone
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15
Q

what should you avoid when creating a flap?

A

local structures, like lingual and mental nerves

mandibular 3rd molar - stay on the external oblique ridge

apical area of bicuspids - mental nerve

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16
Q

are mandibular or maxillary flaps safer and rarely endanger any vital structures?

A

maxillary

  • facial surface of maxillary alveolar process has no nerves or arteries to damage
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17
Q

what is the concern with palatal flaps?

A

blood supply from greater palatine and nasopalatine arteries - want to avoid these

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18
Q

when should releasing incisions be used?

A

only when necessary, for greater visualization

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19
Q

normally, a ___ releasing incision is enough, and is usually where?

A

single, anterior

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20
Q

releasing incisions should have a ___ angle, with the base ___ than the gingival margin

A
  • oblique
  • wider
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21
Q

why is it important not to cross bony prominences when making incisions?

A

tissue is very thin and can tear, causing necrosis

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22
Q

should an incision go through a papilla?

A

no, it should be anterior or posterior, but never through it

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23
Q

releasing incisions should cross the ___ at the ___, and should not be directly on ___ or ___

A
  • free gingival margin at the line angle of the tooth
  • facial aspect of the tooth or in the papilla
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24
Q

what are the 5 types of mucoperiosteal flaps?

A
  • envelope flap
  • vertical release
  • edentulous envelope flap
  • semi-lunar incision
  • palatal Y incision
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25
the ___ flap is a sulcus incision to crestal bone through the periosteum, is a ___ thickness flap, and is usually sufficient for most procedures
* envelope * full
26
vertical releases can create \_\_\_-corner and \_\_\_-corner flaps
3- and 4-corner flaps
27
what does the vertical release provide that the envelope flap by itself doesn't?
greater access with a shorter sulcus incision
28
edentulous envelopes are made through a scar at the \_\_\_. what should you be careful of in this area? how long is the edentulous envelope? where does it reflect?
* crest of the ridge (no vital structures) * need to be careful of the mental nerve, which may have "migrated" towards the crest due to atrophy of the bone * can be as long as required * can reflect buccal or lingual (need to be careful of thin, fragile lingual tissues)
29
what is a semi-lunar flap used for?
apical surgery (limited root access)
30
what is the palatal Y flap used for? where are the releasing incisions placed?
* tori removal * releasing incisions anterior to cuspid at the junction of the greater palatine artery and nasopalatine artery
31
in developing a mucoperiosteal flap, you should use a no.\_\_\_ blade with a ___ grasp. the sulcus incision is from ___ to \_\_\_. the blade should be at what angle toward the tooth? use a ___ to reflect the flap at the anterior papilla and move from front to back. use the flat end of a ___ to finish the reflection and to retract the flap initially, then use a ___ to hold the flap.
* 15 * pen * posterior to anterior * slight angle (dulle easily) * no. 9 molt periosteal elevator * elevator * retractor (rest it on bone to avoid tearing or trapping soft tissue)
32
how should you reflect tissue on a 3-corner flap?
start at anterior papilla pushing apically, then reflect crestal mucosa moving posteriorly
33
what are some reasons you suture a flap?
* coapt wound margins * control bleeding (hemostasis) * cover the bone to avoid necrosis
34
when suturing a flap, why should you avoid tension on the flap?
to avoid retraction of wound edges, exposure of bone, and delayed healing
35
what are the two resorbability types of suture material?
digestion (enzymes) and hydrolysis
36
what are the two sources of suture material?
natural or synthetic
37
what are the two filament types of suture material, and what are the characteristics of each?
* unifilament (monofilament) - smooth surface, easy handling, reduces tissue trauma * multifilament - easier to tie, attracts bacteria (braided) and can be a source of infection
38
what are common resorbable/natural sutures used in dentistry?
plain and chromic gut
39
what are common resorbable/synthetic sutures used in dentistry?
dexon, vicryl, PDS (polydioxanone)
40
what are common non-resorbable/natural sutures used in dentistry?
silk
41
what are common non-resorbable/synthetic sutures used in dentistry?
nylon, polypropylene (prolene), ethibond, mersiline
42
what is the basic suturing technique?
* needle pass at right angle to mucosa * pass through papilla, 3-4mm bite; don't suture across an empty socket * pass through mobile flap first (buccal), pick up needle and pass thorugh fixed mucosa (lingual) * don't tie too tightly - approximate wound edges
43
a prudently used ___ extraction technique may be more conservative and cause less operative morbidity compared with a ___ extraction
* open (surgical) * closed
44
what is the technique for surgical extraction of single rooted teeth?
* provide adequate visualization: reflect flap * determine need for bone removal 1. try to reseat forceps 2. grasp a bit of buccal bone over root and remove along with root 3. try straight elevator pushing it down the PDL; protect elevator from slipping with finger rest 4. surgical bone removal over area of tooth
45
describe bone removal over the area of a tooth
* crestal bone * bone over root surface (width of root and 1/2-2/3 length of the root) and remove with straight elevator forceps * purchase point made in root at most apical portion deep enough for tip of elevator
46
what should you do following tooth removal?
* smooth sharp bone edges * debride and irrigate wound * replace flap and palpate (repeat above if not smooth) * suture
47
the surgical extraction of multirooted teeth is the same surgical technique used for single rooted teeth except what?
the tooth may be divided to convert multirooted tooth into 2 or 3 single rooted teeth
48
what is the surgical extraction technique if the crown is present?
want the crown to stay attached to one root, or split the crown and have it attached to both
49
what is the surgical extraction technique if the crown is missing?
just divide the roots and extract them
50
what are the steps of a surgical extraction of a mandibular molar?
* envelope flap, direct visualization * remove crestal bone around the neck of the tooth * tooth sectioned buccolingually (mesial and distal halves) * luxate with straight elevators * remove with lower forceps or elevators
51
what are two pointed elevators that can be used to elevate and remove roots?
crane pick and cryer elevator
52
what are some considerations prior to extracting maxillary molars?
* divergent roots, dilacerations * proximitry to sinus * severe caries * bulbous roots/hypercementosis * immediate implant placement
53
how should you extract a maxillary molar if the crown is intact?
* +/- flap * divide tooth into thirds through the furcations, keep crown on the palatal root if possible * section off other roots * remove palatal root first to get greater access to other roots
54
how should you extract a maxillary molar if the crown is not present?
* +/- flap * split roots * remove buccal root first so you can greater access to palatal root
55
what are some possible complications from a molar extraction?
* injury to IA, mental, or lingual nerves * tooth/root into sinus * oroantral fistula * sinusitis * tooth into infratemporal space
56
what are the 2 requirements for the removal of root tips?
excellent light and excellent suction (also irrigation)
57
if the apical 1/3 of a root is fractured, which extraction technique should you use (closed or open)? what does closed and open refer to?
either
58
what are complications that can arise from the removal of root tips?
sinus, nerve, mylohyoid
59
describe the open (surgical) technique for the removal of root tips
* envelope flap +/- releasing incision * two types: * removal of buccal bone over root of tooth * open window technique
60
when is it justifiable to leave a root tip?
* root must be small, 5mm or less * root tip deeply embedded in bone, not superficial * tooth is not infected * risks of surgery are greater than benefit
61
what are considerations in treatment planning for multiple extractions?
* full or removable partial dentures, immediate dentures, interim dentures * implant restoration, socket grafting, immediate placement of implant * soft tissue surgery, tuberosity reduction, alveoloplast, undercuts or exostoses * surgical guide for implants
62
should maxillary or mandibular teeth be extracted first? why
* maxillary * LA has a more rapid onset and disappearance * during extraction, amalgam, fixed crowns, bone chips, etc. can fall into empty sockets of the mandible
63
when extracting multiple teeth, should you start anterior and work posterior, or oppose? is there an exception?
* opposite - start posterior and work toward the anterior * exception is that you always want to extract the canine last because it has the longest root and is sometimes difficult to remove; having adjacent teeth removed allows the socket to expand easier
64
what is the extraction sequence for FMX?
* maxillary posterior * maxillary anterior * maxillary canine * mandibular posterior * mandibular anterior * mandibular canine
65
soft tissue reflections should not made on more than one ___ at a time
quadrant
66
when extracting teeth, all teeth in the quadrant should be luxated with a ___ and then extracted with \_\_\_
* elevator * forceps
67
what should you do to the empty sockets after extraction?
compress them if you are not planning to place an implant
68
after repositioning soft tissue following extractions, what should you do?
* palpate the ridge for bone irregularities/spicules, alveoloplasty as needed, area irrigated, soft tissue redundancy removed/trimmed * suture with no overlap of soft tissue; interrupted or continuous sutures with removal in 1 week if needed

Oral Surgery I (13 decks)

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