third molars - 4 Flashcards
What are the basic principles of surgical removal of third molars?
Risk assessment - good planning and medical history
Aseptic technique
Minimal trauma to hard and soft tissues
What are the steps of surgical removal of third molars?
- Anaesthesia
- Access
- Bone removal as necessary
- Tooth division as necessary - apices accounted for
- Debridement
- Suture
- Achieve haemostasis
- Post-op instructions
What are the different methods of anaesthesia for surgical removal of third molars?
Local anaesthetic
IV sedation and LA
General anaesthetic
How is access to third molars gained?
Raising a buccal mucoperiosteal flap
Possibly raising a lingual flap - depends on surgeon and the clinical situation
Give 4 principles of flap opening
Maximum access with minimal trauma
Larger flaps heal just as quickly as smaller ones
Use scalpel in one firm continuous stroke
Minimise trauma to dental papillae
How is reflection carried out for surgical removal of third molars?
Raise flap at base of relieving incision
Free the anterior papillae before proceeding with reflection distally to avoid tears
Reflect with periosteal elevator firmly on bone
Raise in 1 piece
Name 4 instruments that can be used in reflection during surgical removal
Mitchell’s trimmer
Howarth’s periosteal elevator
Ash periosteal elevator
Curved Warwick James elevator (raises papillae)
Rake retractor
Minnesota retractor
What 4 principles of surgical removal relate to retraction
Access to operative field
Protection of soft tissues
Flap design facilitates retraction
Atraumatic/passive retraction - rest firmly on bone and be aware of adjacent structures
What instrument is used for surgical bone removal and why?
Electrical straight handpiece with saline cooled bur
Air driven handpieces may lead to surgical emphysema
Saline avoids necrosis of bone
Round or fissure SS and tungsten carbide burs
How is bone removal carried out in surgical removal?
Buccal aspect of tooth onto the distal aspect of the impaction
Creates a deep, narrow gutter around the crown of the tooth
Bone removal should allow correct application of elevators on the mesial and buccal aspects of the tooth
Start distally and move mesially
What happens after bone removal in surgical removal?
The operator must assess the possibility of removing the tooth in its entirety with elevators or a combination of elevators and forceps
If not possible and adequate bone has been removed, the tooth should then be sectioned
How is tooth division most commonly carried out?
The crown of the tooth is sectioned from the roots and the crown and roots are elevated as individual items
Sometimes further separation of the roots with a bur is required following elevation of the crown and each root is elevated as an individual item
How is a crown sectioned horizontally?
When sectioning to remove entire tooth, section above the CEJ leaving some crown behind to allow orientation and elevation
When carrying out coronectomy, section below the CEJ
When is a crown sectioned vertically and why?
Where the roots are separate
This allows removal of the distal portion of the crown and the distal root, followed by elevation of the mesial portion of the crown and mesial root
How is physical debridement carried out?
Bone file or handpiece to remove sharp bony edges
Mitchell’s trimmer or Victoria curette to remove soft tissue debris
