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OS and Pain Management 2 > Instrumentation_sutures > Flashcards

Instrumentation_sutures Flashcards

1
Q

WOODSON NO. 1

A
  • For interdental papillas, attached gingiva,
    crestal periodontal fibers
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2
Q

MOLT NO. 9
(2)

A
  • Pointed end for interdental papilla
  • Broad end for free alveolar mucosa
    elevation and flap retraction
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3
Q
  • Push stroke
A
  • Most common technique used, especially when combined with rolling/lifting component
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4
Q
  • Rolling/lifting
A
  • Good for interdental papilla
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5
Q
  • Pull stroke
A
  • Not used too often as it tends to tear and shred periosteum
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6
Q

Seldin retractor
(2)

A
  • Great for tongue retraction, and flap retraction
  • Not used as a periosteal elevator (blunt ends)
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7
Q

Minnesota retractor
(2)

A
  • Cheek, flap retractor
  • Workhorse of retractors in OMS
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8
Q

RETRACTING

A
  • Wieder retractor, a.k.a. “Sweetheart” retractor
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9
Q

CONTROLLING HEMORRHAGE
* Hemostat
(4)

A
  • Crile, Kelly, Halstead (a.k.a. “mosquito”)
  • Straight or curved
  • Handle with locking device once vessel is clamped
  • Also used for removing granulation tissue or small root tips
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10
Q

CONTROLLING HEMORRHAGE
* Burnisher

A
  • Any flap instrument for compressing bone around a nutrient vessel
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11
Q

ADSON FORCEPS
(4)

A
  • Three teeth opposed
  • Stabilize tissue while passing suture needle
  • Not good for grasping needle
  • Used on skin
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12
Q

BROWN FORCEPS
(4)

A
  • Multiple serrated tips
  • Grasping keratinized mucosal edges
  • Good for grasping needle
  • Not for skin or fine tissue
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13
Q

GRASPING TISSUE
* Allis tissue forceps
(2)

A
  • Grasping and manipulating large portions of tissue that are going to be removed from the
    body
  • I.E. epulis fissuratum, lesions, bone
  • Not for grasping tissue that will remain
  • Too much trauma from beaks
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14
Q

REMOVING BONE
* Rongeurs
(4)

A
  • Most commonly used for alveoloplasties
  • Will crush/cut lips if not paying attention
  • A relatively atraumatic means of removing bone
  • Quick cut, does not create heat like a handpiece and bur
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15
Q

Rongeurs
Types:
(2)

A
  • Side cutting
  • End cutting (Blumenthal Rongeurs)
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16
Q

REMOVING BONE
* Chisel and Mallet
(5)

A
  • Cleanest means of removing bone
  • Can create traumatic forces to TMJ/jaw without proper support
  • Mallet: occasionally with nylon face to decrease noise/trauma
  • Unibevel - bone removal
  • Bibevel - splitting teeth
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17
Q

REMOVING BONE
* Bone file
(3)

A
  • Used for final smoothing of small areas of sharpness
  • Pull stroke is the action stroke
  • Crosscut or parallel grooves
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18
Q

REMOVING BONE
* Handpiece:
(4)

A
  • MUST NOT EXHAUST AIR INTO OPERATIVE FIELD
  • Electric vs Nitrogen powered
  • Completely sterilizable
  • High speed and torque
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19
Q

AIR EMPHYSEMA
(4)

A
  • Air-driven handpiece during surgical extraction
  • Possible for air embolus
  • Possibly requires airway protection
  • ABX to prevent secondary infection
  • Resolves 3-7 days
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20
Q
  • Air-driven handpiece during surgical extraction
    (2)
A
  • Sudden edema
  • Crepitus to area
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21
Q
  • Possible for air embolus
    (1)
A
  • Air forced through venous system
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22
Q

REMOVING BONE
* Burs
(4)

A
  • Carbide
  • One time use, then throw away
  • # 6 or #8 for bone removal or grooves
  • # 702 or #703 for sectioning teeth/contouringalveolus/troughing
  • # 703 has larger radius versus #702
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23
Q

REMOVING BONE
(3)

A
  • Surgical handpiece must be done under copious irrigation
  • Will generate heat and kill superficial bone
  • Thermal necrosis occurs at 47°C
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24
Q

REMOVING SOFT TISSUE FROM BONY DEFECTS
(3)

A
  • Curettes
  • Hemostats
  • Rongeurs
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25
Q

SUTURING MUCOSA
* Needle holder

A
  • 6” or 15 cm
  • Grasping surface on beak is crosshatched (prevent
    needle spinning)
  • As opposed to hemostats which are parallel
  • Needle prone to spin
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26
Q
  • Iris scissors
A
  • Tissue cutting only, do not use for suture cutting
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27
Q
  • Dean angled scissors
    (2)
A
  • Tissue and suture cutting
  • Serrated
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28
Q

Bite block
(2)

A
  • Passively placed
  • Decreases stress on TMJs
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29
Q

Molt mouth prop
(2)

A
  • Ratcheting system to remain open
  • Can severely damage TMJs and teeth
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30
Q

Surgical suction
(2)

A
  • Small orifice
  • Some with wire stylet used to clean tip
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31
Q

DENTAL ELEVATORS
* Uses:
(3)

A
  • Luxate teeth, NOT to remove teeth
  • Minimizes root fractures
  • Requires a fulcrum point
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32
Q

DENTAL ELEVATORS
* Types:
(3)

A
  • Straight
  • Flag/Cryer
  • Pick
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33
Q

DENTAL ELEVATORS
* Crane pick/Cogswell:

A
  • Elevate roots or teeth applied to a purchase point
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34
Q
  • MAGIC STICK!! (E-92)
A
  • Offset shank to aid in luxation force
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35
Q

DELIVERING TEETH
* Forceps

A
  • Primary instrument for tooth delivery
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36
Q

EXTRACTION FORCEPS
* Maxillary Forceps
(2)

A
  • Beaks parallel to handle
  • Palm under handle
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37
Q

EXTRACTION FORCEPS
* Mandibular forceps
(2)

A
  • Beaks almost perpendicular to handle
  • Palm on top of handle
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38
Q

EXTRACTION FORCEPS
(3)

A
  • Beaks adapt to root structure
  • Beak aligned parallel to long axis of tooth
  • Acts as a wedge to expand alveolar bone
39
Q

MAXILLARY FORCEPS
* #150
(2)

A
  • Universal!
  • Single rooted vs multi
    rooted
40
Q

MANDIBULAR FORCEPS
* #151
(2)

A
  • Universal
  • Single and multi rooted
41
Q

MANDIBULAR FORCEPS
(2)

A
  • # 13, Ash, aka Charlene
  • Conical rooted teeth, turning motion effective
42
Q
  • # 23, Cowhorn, aka Michael Jordan(3)
A
  • Molars
  • Beaks enter bifurcation
  • Tooth is elevated by squeezing handles and
    using pumping motion
43
Q

MANDIBULAR FORCEPS
* #17

A
  • Molar
44
Q

What does ‘suture’ mean?

A
  • Any strand of material that is utilized to ligate blood vessels or approximate tissues
45
Q

Primary purpose of suturing
(3)

A
  • Position and secure surgical flaps to their anatomic position
  • Promote optimal healing
  • Hemostasis
46
Q

THE “IDEAL”SUTURE

A
  • Sterile
  • All-purpose
  • composed of material that can be used in any surgical procedure
  • Causes minimal tissue injury or tissue reaction
  • ie, nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic
  • Easy to handle
  • Holds securely when knotted
  • ie, no fraying or cutting
  • High tensile strength
  • Favorable absorption profile
  • Resistant to infection
47
Q

ESSENTIAL SUTURE CHARACTERISTICS
(5)

A
  • Sterility
  • Uniform diameter and size
  • Pliability for ease of handling and knot security
  • Uniform tensile strength by suture type and size
  • Freedom from irritants or impurities that would elicit tissue reaction
48
Q

Initial response (4-7 days)
(2)

A
  • Invokes inflammatory response
  • PMNL, mononuclear cells, fibroblasts
49
Q

After 4-7 days
* Dependent on type of suture used
(2)

A
  • Plain gut elicits intense response with macrophages and PMNLs
  • Non-absorbable elicits less intense, relatively acellular response
50
Q

All sutures passing through mucous membrane or skin provide a “—” down which
bacteria can gain access to underlying tissue

A

wick

51
Q

How to avoid/limit wicking:
(2)

A
  • Use monofilament material if possible
  • Remove suture as early as possible
52
Q

Suture removal:
* 3-5 days →
* 5-7 days →
* 5-10 days →

A

skin of head and neck
intraoral sites
body/extremities

53
Q

SUTURE TYPES
* According to structure
(1)
* According to behavior in tissue
(1)
* According to origin
(1)

A
  • Monofilament vs multifilament
  • Resorbable vs nonresorbable
  • Natural vs synthetic
54
Q

MONOFILAMENT
(4)

A
  • Suture made of single filament
  • Less inflammatory response
  • Less wicking
  • Requires more ties to assure an
    adequate knot
55
Q

BRAIDED
(4)

A
  • Multifilament
  • Greater inflammatory response
  • Greater wicking
  • Fewer ties for adequate knot
56
Q

ABSORBABLE
(4)

A
  • Plain Gut
  • Chromic Gut
  • Monocryl (Poliglecaprone 25)
  • Vicryl (Polyglactin 910)
57
Q

NON-ABSORBABLE
(4)

A
  • Silk
  • Nylon
  • Prolene (Polypropylene)
  • Steel
58
Q

Gut sutures were derived from the

A

submucosal layer of ovine (sheep) small intestine or the serosallayer of bovine (cow) small intestine

59
Q

Plain gut:
(3)

A
  • Tissue treated with aldehyde solution
  • Tensile strength maintained for 7-10 days
  • Absorption complete within 70 days
60
Q

Chromic gut:
(3)

A
  • Treated with chromium salt
  • Tensile strength maintained for 10-14 days
  • Absorption complete within 90 days
61
Q

ABSORBABLE SUTURE
* Tissue reaction is due to
* Breakdown accomplished by
* Do not place under stresses tissue where
* Used:

A

non-collagenous material
proteolytic enzymatic digestive process
extended approximation is needed
general soft tissue approximation

62
Q

Monocryl (Poliglecaprone 25):
(3)

A
  • Monofilament copolymer of glycolide and e-caprolactone
  • Tensile strength 50-60% at 7 days, 20-30% at 14 days, and lost at 21 days
  • Absorption complete at 91-119 days
63
Q

Vicryl (Polyglactin 910):
(3)

A
  • Braided multifilament coated with copolymer of lactide and glycolide
  • Tensile strength of 75% at 14 days, 50% at 21 days
  • Absorption complete at 56-90 days
64
Q

Absorbed by — – minimal tissue reaction
* Used:

A

hydrolysis
General soft tissue approximation
Not used where extended tissue approximation is required

65
Q

Surgical silk:
(2)

A
  • Braided raw silk spun by silkworms (organic protein called fibroin)
  • Sometimes coated with beeswax or silicone to ease handling/placement
66
Q

Surgical silk:
* Absorbed by proteolysis at — years, can cause acute tissue reaction, and eventual encapsulation by fibrous connective tissue
* Eventually pushed out by body if left in
* Tensile strength remains at – year
* Contraindicated in pts with
* Used:

A

2
1
silk sensitivities
General soft tissue approximation (vermillion border – pts enjoy better as gut suture ends are sharp on tissue)

67
Q

Nylon:
(2)

A
  • Monofilament (Ethilon) polyamide polymer
  • Braided (Nurolon) coated with silicone
68
Q

Nylon:
* Progressive hydrolysis may result in
* Minimal tissue reaction, should not be used where
* — makes it useful in retention and skin closure

A

loss of tensile strength (81% at 1 years, 72% at 2 years, 66%
at 11 years)

permanent retention of tensile strength is
required

Elasticity

69
Q

Prolene (Polypropylene):
(2)

A
  • Monofilament of isostatic crystalline stereoisomer of a liner propylene polymer (permitting
    little or no saturation)
70
Q

Prolene (Polypropylene):
* Does not adhere to tissues and is useful as a
* — tissue reaction
* Not subject to degradation or weakening, and maintains
* Used:

A

“pull-through” suture (subcuticular closure)
Minimal
tensile strength for up to 2 years
high tension areas (fascia), contaminated wounds, skin closures

71
Q
  • Sutures were originally manufactured ranging in size from #1 to #6
    (3)
A
  • # 1 being the smallest
  • A #4 suture would be roughly the diameter of a tennis racquet string.
  • The manufacturing techniques, derived at the beginning from the production of musical strings,
    did not allow thinner diameters.
72
Q

Size refers to the

A

diameter of the suture strand and is denoted as zeroes.

73
Q

The more zeroes characterizing a suture size, the

A

smaller the resultant strand diameter
* 4-0 or 0000 is larger than 5-0 or 00000

74
Q

The smaller the suture, the

A

less tensile strength of the strand.

75
Q

COMPONENTS OF SURGICAL NEEDLE
(3)

A
  • Attachment end
  • Body
  • Point
76
Q
  • Attachment end
    (2)
A
  • Swaged end permanently attached to material
  • Eyed →need to thread suture material
77
Q

Chord length

A
  • Straight line distance between the point of
    the curved needle and swage
78
Q

Needle length

A
  • Distance between point to end along needle
79
Q

Radius

A
  • Distance between center of the circle to
    body of needle
80
Q

Diameter

A
  • Gauge or thickness of the needle
81
Q

Cutting
(3)

A
  • Needle body is triangular
  • Sharpened cutting edge on inside
  • Easy to tear through tissue if too forceful
82
Q

Reverse cutting
(2)

A
  • Needle body is triangular, inverted
  • Less tear through
83
Q

Taper
(2)

A
  • Rounded needle body
  • Limited tear through
84
Q

SUTURING TECHNIQUE

A
  • Grasp needle with holder below the swage
  • Ratchet one to two “clicks”
  • Insert needle 90° to tissue
  • Turn wrist to continue to pass through tissue
  • Attempt to not grasp needle point with instrument
  • Will dull tip and tear through tissue with continued use
  • Pass through loose tissue first, then though stable tissue
  • Grasp tissue gently (do not crush wound edges)
85
Q

Now there should be two ends to the suture through the tissue
(2)

A
  • One with the needle at end
  • One without needle, considered the tail
86
Q

In non-dominant hand, secure/hold the suture needle
(1)

A
  • Make sure to hold securely in hand that needle does not touch
    nonsterile environment or patient’s facial anatomy
87
Q

Place empty instrument in between suture ends
* Should be over the

A

incision line

88
Q

SURGICAL KNOT

A
  • First throw is forward and a “double”
  • Second throw or Reverse throw is single and
    “squares” the knot
  • Finish with another squared knot:
  • Single forward throw and single reverse throw
89
Q

SIMPLE INTERRUPTED SUTURE

A
  • Maintains strength and tissue position if
    one portion fails
  • Requires more time and suture material
  • Has minimal holding power against stress
90
Q

HORIZONTAL MATTRESS SUTURE

A
  • Tension suture
  • Rapid
  • Minimizes number of sutures needed
  • Less suture material used
91
Q

FIGURE OF EIGHT SUTURE
(3)

A
  • Tension suture
  • Brings tissue into good apposition
  • Good to secure socket dressings
92
Q

SIMPLE CONTINUOUS SUTURE
(5)

A
  • Easy for linear long span wounds
  • Involves one diagonal pass and one
    perpendicular pass
  • Uses less material vs multiple interrupted
  • Provides minimal tension-holding
  • Prone to failure if one portion fails
93
Q
  • Easy for linear long span wounds
A
  • I.e. alveoloplasty full thickness
    mucoperiosteal flap approximation
94
Q

LOCKING CONTINUOUS SUTURE
(3)

A
  • Greater tissue stability vs simple running
  • Uses more suture material vs simple
    running
  • More stable in the event of a partial failure
    or breakage

OS and Pain Management 2 (10 decks)

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