L3 - Complex Exodontia (8/20) Flashcards
(88 cards)
1
Q
describe flap base and whyh
A
base of flap must be BROADER than the free margin
- has to preserve the blood supply
2
Q
size of flap
A
must be adequate size
*flap extends TWO TEETH ANTERIOR AND ONE TOOTH POSTERIOR to the surgical area
or vise versa
3
Q
why need the size
A
- adequate visualization
- adequate access of instrumentatin
- large enough to retract without tension
4
Q
type of flap
A
full thickness – mucoperiosteal
5
Q
make incision where - general
A
over an intact bone
6
Q
describe flap base
A
BROADER than the free gingival margin
7
Q
go over canine eminence?
A
NEVER
8
Q
how far away from bony defect
A
must be at least 6-8 mm away from a bony defect
do not want margin too close tot he bone we will be removing
9
Q
desctibe the vertical releasing incisions *
A
should NOT cross the bony eminence
10
Q
types of mucoperiosteal flaps
A
- envelop
- tytpical - three-cornered
- four-cornered
- type of flap used to cover a large hole
11
Q
indications for SURGICAL extractions
- long list
A
- surgeon perceives a possible need for excessive force to extract a tooth
- when closed technique has failed
- patient with heavy dense bone
- short clinical crowns secondary to bruxism
- hypercementosis
- widely divergent
- close proximity to sinus
- teeth with extensive caries
- severe attrition
12
Q
check what before surgical extraction is an option **
A
LOOK AT X-RAYS
-
13
Q
when will you know a tooth will need surgical extraction?
A
after taking the time to examine the X-rays
14
Q
is it okay to come over the bone with the forceps?
A
YES
15
Q
first force on a tooth?
A
APICAL
16
Q
REMOVE BUCCAL CORTICAL PLATE?
A
you can
- NEED a finger rest
17
Q
purchase point?
A
with bur – to get a point to grab onto
18
Q
when have multi-rooted tooth?
general
A
you can take one root out at a time if you want
elevator in to separate the tooth and remove them
take the crown off?
19
Q
*before you open up what must you do
A
look at x-rays and look at mouth and know your approach before hand
20
Q
oroantral communications prevention
A
surgical removal
this is a sinus perforation
21
Q
oroantral communications diagnosis
A
- examine tooth
- visualization
- nose-blowing
22
Q
treatment of oroantral communications if less than 2mm
A
dont have to do anything about it really
- try to ensure a good blood clot
23
Q
tx for oroantral communications if b/w 2-6 mm
A
pack the socket, and do a figure 8 suture
antibiotics, decongenstants, and sinus precautions like no smoking, nose blowing, sneezing, sucking out of a straw
24
Q
tx for oroantral communications if b/w 2-6 mm
A
pack the socket, and do a figure 8 suture
antibiotics, decongenstants (dont use for awhile), and sinus precautions like no smoking, nose blowing, sneezing, sucking out of a straw
25
tx for oroantral communications if greater than 7
consider flap closure
| - buccal or palatal finger
26
most common injury to adjacent tooth
fracture of existing restoration
27
common injuries to adjacent teeth
fracture of existing restoration
fracture of an adjacent carious tooth
luxating an adjacent tooth
- using elevator as a scoop instead of using it the other way
extracting the wrong teeth
28
how to prevent taking out the wrong tooth
THE TIME OUT METHOD
29
most common complications with tooth being extracted
root fracture - most common
30
root / tooth displacement
complications with tooth being extracted
1. into max sinus
2. into infratemporal space -- maxillary third molar
3. into the sublingual space
4. into the submandibular space
5. down the pharynx
6. aspirated
31
where can maxillary molar be displaced to
the maxillary third molar
32
nerves that can be affected
1. mental
2. lingual
3. long buccal
4. nasopalaatine
5 IAN
33
bite blocks for?
to alleiviate any post op discomfort in the TMJ
34
patients on coumadin INR?
CAN perform an extraction on a patient with an INR of 3.0 or less
(if 2.8 -- single tooth go for it if very invasive then i would be tentative)
35
microfibular collagen uses
avitene
36
microfibular collagen uses
avitene
37
describe dry socket
1. pain 3-4 days post op
2. bad taste
3. headaches
4. bad headache
5. pain radiated to patients ear
38
pain radiating to ear singifies
dry socket
39
details about the vertical releasing incisions
1. should NOT cross a bony eminence (like canine eminence)
2. should NOT end at the facial aspect of the tooth
3. should cross the free gingival margin at the line angle of the tooth (avoid cutting the papilla away)
40
adequate radiogrpahs include?
1. root apexes
2. morphology
adjacent structure like
- sinus
- IAN
41
Three conditions must be met for a tooth / root fragment to be left in the alveolar process
1. The root fragment must be small <4-5 mm
2. The root must be deeply embedded
3. The tooth involved must NOT be infected
No radiolucency present
42
in order For a surgeon to leave a previously described root fragment in place
The risk of removal must be greater than the benefit
43
Three examples of when the risk of removal would be greater than the benefit
- Large amounts of bone must be removed
- The root tip is close to vital structures
There is a high liklihood the root tip may be displaced
44
If a root tip is left in place what must occur
1. Patient must be informed
2. radiographic documentation is obtained
3. the decision to leave the root tip must be well documented in pt. chart
4. the patient should be placed on a periodic recall schedule
5. the patient should be instructed to contact you if they develop any symptoms
45
multiple extractions sequencing and why
maxillary before mandibular
- aneshetic considerations
- wound contamination (debris)
posterior before anterior
- the 1st molar and canine teeth are removed last
46
teeth that are removed last
1st molar and canine
47
main components / tools to control bleeding
1. gauze packs
2. patient told to expect oozing for 12-24 hours
AVOID
- smoking
- spitting
- sucking through straw
- strenuous exercise
48
pt. told to expect oozing for?
12 -24 hours
49
most pain can be managed with
mild analgesics
50
peak pain usually occurs when?
12 hrs. post-operative
pain rarely persist longer than 2 days
51
diet in post-op
high calori liquid diet
soft diet
adequate hydration
cool foods
52
when can patient rinse
post -op day 2
53
brushing on day of surgery
AWAY from the extraction site
54
max edema/ swelling will occur?
24-48 hours post-op
55
how to control edema
1. elevate head
2. ice packs (20 on 20 off) for the 1st 24 hours
3. 3rd post-op day heat may e applied
56
when can you apply heat
3rd day
57
for infection control consider...
consider antibiotics
58
trismus details
patients MUST be told that this may occur
- most commonly caused by multiple injections
heat packs may be helpful
59
ecchymosis
| onset?
bruising / not dangerous
- usually seen in older patients
- onset usually in 2-4 day post-op
- can last 7-10 days
60
radiographically needs to show what on roots
apex
morphology
*adjacent structures need to see sinus and IAN
61
Cardinal rules of surgery
1. adequate visualization
- light, retraction, and suction
2. unimpeded pathway for removal
3. controlled force (finesse, NOT force)
4. aseptic technique
5. atraumatic handling of tissues
6. adequate hemostasis
62
adequate visualization
light
retraction
suction
63
Post-op instruction headlines
1. activity
2. diet
3. pain control
4. wound care
64
soft tissue injuries include
1. tearing of flaps (most common)
2. puncture injury
3. abrasions
65
tearing of flaps
most common soft tissue injury -- most common injury is to the mucoperiosteal flap
due to
- poor design
- excessive retraction force
66
reasons for puncture injury
inadequate finger rest
67
reasons for abrasions
1. re-tractors can cause
rotary instruments
68
main injuries to osseous structures
1. bone fracture
2. management of fractures
3. tuberosity fractures
69
main cause of bone fracture during extraction?
| most common areas?
excessive force -- common in the maxillary canine and maxillary molar area
- fracture of the maxillary tuberosity
70
excessive force use common in?
the maxillary canine region and maxillary molar area
71
prevention of bone fracture
age
poor morphology
thickness of buccocortical plate
72
if bone is removed with tooth? if bone remains attached?
if it is removed completely with the tooth-- do not attempt to replace it -- no blood supply
if bone is still attacahed to periosteum- there is a high probability that the bone will heal
73
management of tuberosity fractures
splint tooth and return 6-8 weeks for surgical extraction
remove crown and wait for healing (6-8 weeks)
74
tx for dry socket
1. irrigation
2. placement of a medicated dressing
3. change dressing every day or every other day for 3-6 days
75
common etiology causing oro-antral communications
1. removal of maxillary molars and pre-molars
76
risk factors for oro-antral communications
1. divergent roots
| 2. no bone separating roots from sinus
77
sequelae of oroantral communications (what can follow)
1. fistula formation
| 2. sinusitis
78
best method for diagnosing oro-antral communications
nose-blowing test (best method)
79
Control of pain
| - Mild analgesics usually work well T/F
True
80
most common post -op pain meds used
tylenol
tylenol with codeine
NSAIDs
Vicodin
Percocet
81
give first dose of meds when?
before the anesthetic wares off
82
armentarium to control bleeding post - op
1. pressure
2. collagen plug
3. microfibular collagen (Avitene)
4. gelfoam
5. collagen tape
6. surgical
7. topical thrombin
8. bone wax
83
wound dehiscence aka
exposure of bone
84
main signs of dry socket
1. pain radiating to ear
2. bad smell
3. bad taste
4. exposure of bone
5. PAIN STARTS 3-4 DAYS POST OP***
85
bite blocks especially important with?
taking out mandibular teeth and limited the medial movement of the jaw
- place on contra-lateral side
86
medications that can increase risk of post-op prolonged bleeding
he 5 A's
1. ASA / aspirin
2. anticoagulants
3. antibiotics
4. anti-cancer drugs
5. alcohol
87
put tooth back in to control bleeding
yes - can be used as a means to stop bleeding
88
dry socket is complication of
delayed healing and infection
