Surgical Techniques Flashcards
(42 cards)
1
Q
what are the basic principles of minor oral surgery
A
- Risk assessment (good planning, medical history, considering anatomical structures)
- aseptic technique
- minimal trauma to hard and soft tissues
2
Q
What are the stages of surgery
A
- Consent
- Surgical pause/ safety checklist
- Anaesthesia
- Access
- Bone removal as necessary
- Tooth division as necessary
- Debridement/wound management
- suture
- Achieve haemostats
- Post-operative instructions
- Post-operative medication
- Follow up
3
Q
What are the two important points of the surgical technique
A
- Administering local anaesthetic - it is important that site you’re operating on has adequate anaesthesia
- Lift a mucoperiosteal flap to give surgical access
4
Q
What are the aims when lifting a flat
A
- maximal access with minimal trauma
- preserve adjacent soft tissues
- consider post operative aesthetics
5
Q
what is a mucoperiosteal surgical flap?
A
- when the periosteum between the bone and mucosa is raised along with the mucosa when creating a flap
6
Q
What are the aims of surgical access
A
- wide-based incision
- use scalpel in one firm continuous stroke
- no sharp angles
- adequate flap size
- flap reflection should be done cleanly
- minimise trauma to the dental papillae
- no crushing
- keep tissues moist
- ensure that flap margins and sutures will lie on sound bone
- make sure wounds are not closed under tension
- aim for healing by primary intention to minimise trauma
7
Q
what are two flap designs
A
- 3 sided flap
- envelope flap
8
Q
describe a 3 sided flap for wisdom tooth removal
A
- distal relieving incision
- crevicular incision around the tooth
- medial relieving incision between 7 and 8
9
Q
what is important to remember when making a flap for removal of a wisdom tooth
A
do not make the distal incision too lingual as it risks damage to the lingual nerve
10
Q
describe an envelope flap for wisdom tooth removal
A
- distal relieving incision
- a crevicular incision that extends to mid way on the 7 or medial end of 7
11
Q
what do you do once you have incised the flap?
A
retract the tissues
12
Q
what are the aims when retracting soft tissues
A
- aim to access the operative field
- protect soft tissues
- ensure flap design facilitates retraction
- retract using a howarth’s periosteal elevator or rake retractor
13
Q
how do you remove bone/ divide teeth or roots
A
- using an electrical straight handpiece with a saline or sterile water cooled bur
- use round or fissure tungsten carbide burs
14
Q
what can happen if you use an air driven handpiece to remove bone
A
can lead to surgical emphysema (air or gas in subcutaneous tissues)
15
Q
what are the uses of elevators
A
- provide a point of application for forceps
- extract a tooth without the use of forceps
- remove retained roots
- loosen teeth prior to forceps
- removal of multiple root stumps
- removal of root apices
16
Q
What is involved in wound management
A
- debridement and curettage
- suturing
17
Q
describe the stages of debridement and curettage
A
- physical: using a bone file or handpiece to remove sharp bony edges. Use a mitchell’s trimmer of victoria curette to remove soft tissue debris
- Irrigation: sterile saline into the socket and under the flap
- Suction: aspirate under the flap to remove debris
- check socket for retained root apices
18
Q
what do we do when suturing
A
- approximate tissues
- compress blood vessels
19
Q
what are the aims of suturing
A
- reposition tissues
- cover bone
- prevent wound breakdown
- achieve haemostats
- encourage healing by primary intention
20
Q
Define the ways that sutures can be categorised
A
- non absorbable
- absorbable
- monofilament
- polyfilament
21
Q
Describe non absorbable sutures and give examples
A
- sutures which must be removed postoperatively
- used if extended retention periods are required (closure of OAF)
- Examples are Mersilk, praline and ethilon
22
Q
Describe absorbable sutures and give examples
A
- used if the removal of a suture is not possible or desired
- holds the tissues together temporarily
- examples are Vicryl and velosorb
23
Q
how do absorbable sutures breakdown
A
Vicryl breakdown via absorption of water into the filaments which causes the polymer to degrade
24
Q
Describe a monofilament and give examples
A
- single strand
- pass easily through tissue
- resistant to bacterial colonisation
- proline and ethilon
25
Describe a polyfilament suture and give examples
- several filaments twisted together
- easy to handle
- can cause wicking (oral fluids and bacteria move along the length of the suture and can result in infection)
- Vicryl, velosorb and mersilk
26
where would you place sutures on a 3 sided flap
- 1 suture distal, and 2 sutures buccally
27
where would you place sutures on a envelope flap
- 1 suture distal to 8 and 1 suture distal to 7
28
How do you control haemostasis perioperatively
- use La with a vasoconstrictor
- Artery forceps
- Diathermy
- Bone wax
29
how do you control haemostasis post-operatively
- use pressure
- La infiltration
- Diathermy
- Sutures
30
when removing third molars, what 4 nerves can be damaged
- lingual
- inferior alveolar
- mylohyoid
- buccal
31
When is the lingual nerve at risk and why
- it is above lingual palate in many patients
at risk when
- incision of flap
- raising buccal and lingual flaps
- retraction of flap
- bone removal
- extraction with forceps
32
what are the potential complications of lower third molar removal
- pain
- swelling
- bruising
- bleeding
- trismus
- infection
- dry socket
- paraesthesia
33
why do teeth fracture during surgery?
- thick cortical bone
- root shape
- root number
- hypercementosis
- ankylosis
- caries
- alignment
- poor technique
34
what should you warn the patient about prior to oral surgery
- explain the procedure
- explain any expected complications
- give the patient an idea of what to expect in lay terms
- if adjacent teeth are close then warn of possible damage
- explain post operative complications
35
what are the general surgical principles
- maximal access with minimal trauma
- bigger flaps heal just as quickly as smaller flaps
- wide-based incision
- used scalpel in one firm continuous stroke
- no sharp angles
- adequate flap size
- minimize trauma to the dental papillae
- flap reflection should be down to bone and done cleanly (mucoperiosteal flap)
- no crushing
- tissues kept moist
- ensure that flap margins and sutures will lie on sound bone
- make sure wounds are not closed under tension
- aim for healing by primary intention to minimise scarring
36
Describe the flap technique of extracting a 45 with a fractured crown (root only)
- create a 2 sided flap with a crevicular incision extending from the medial of the 44 (first premolar) to the distal of the 45
- Create a distal relieving incision beginning at the medial of the 6
- Ensure the distal relieving incision extends beyond the junction of the attached and unattached mucosa (not enough access in unattached)
37
describe the bone removal needed when extracting a 45 with a fractured crown
- easiest area of bone to remove is buccally
- create a gutter between the buccal cortex of bone and the buccal surface of the root, being careful not to drill into the root
38
describe the suturing required when extracting a 45 with a fractured root
- would likely need 3 sutures
- first suture at the distal papillae
- second suture at the medial papillae
- third suture at the distal relieving incision site
39
Describe the flap design for extraction of a lower 6 with a broken crown
- a one sided flap with a long crevicular incision extending from the medial of the 4 to the distal of the 7
40
What are the benefits of a long crevicular incision when removing a lower 6
- less swelling and bruising as a one sided crevicular incision does not extend into the attached gingivae which is more vascular and thus would result in more bleeding
- less likely to damage a nerve as there is no distal relieving incision which may come into contact with a nerve
41
describe the bone removal needed when extracting a 46 with a fractured crown
- drill buccal bone so that you can see the furcation of the roots
- separate the two roots to create an application point for elevator
- elevate the roots separately
42
describe the suturing required when extracting a 46 with a fractured root
- suture at mesial papillae of 6
- suture at distal papillae of 6
- suture at papillae between the 4 and 5
