Third Molars - L4

Question 1

for surgical removal of 8’s, what is needed?

Answer 1

• Anaesthesia
• Access
• Bone removal as necessary
• Tooth division as necessary
• Debridement
• Suture
• Achieve haemostasis
• Post-op Instructions

Question 2

types of anaesthesia that can be used for surgical removal of 8s?

Answer 2

• LA
• IV Sedation & LA
• GA

[Depends on Pt & difficulty of XLA]

Question 3

Key points in surgical removal of 8s when gaining ACCESS?

Answer 3

• Access to tooth gained by raising buccal mucoperiosteal flap
• MAX ACCESS with minimal trauma
• Large flaps heal just as quickly as small ones
• scalpel in 1 firm continuous strokes
• MINIMISE TRAUMA TO PAPILLAE

Question 4

Surgical Removal: Reflection

Answer 4

Question 5

Surgical Removal: Retraction

Answer 5

Question 6

Surgical Removal: Bone removal

Answer 6

• electrical straight handpiece with saline cooled bur
• AIR DRIVEN HANDPIECE = EMPHYSEMA
• Round/fissure stainless steel & tungsten carbide burs
• Protection of soft tissues

Question 7

Goals of surgical bone removal?

Answer 7

• intention to create a DEEP, NARROW gutter around crown of wisdom tooth
• bone should be removed to allow application of elevators

Question 8

If tooth cannot be removed with bone removal, what happens?

Answer 8

Tooth division

Question 9

what is tooth division during surgical removal?

Answer 9

• most commonly crown is sectioned from roots to be removed separately

Question 10

Debridement in surgical removal?

Answer 10

Physical:
- bone file/handpiece to remove sharp edge
- mitchell’s trimmer

Irrigation:
- Sterile saline into socket & under flap

Suction:
- Aspirate under flap to remove debris

must irrigate under flap & removal of all DEBRIS before repositioning it

Question 11

Purpose of suturing in surgical removal of teeth?

Answer 11

• Approximate tissues
• Compress blood vessels
  Aims:
• reposition tissues
• cover bone
• prevent wound breakdown
• haemostasis

Question 12

when is coronectomy carried out and what is it?

Answer 12

• alternative to surgical removal of ENTIRE tooth where appears to be increase risk of nerve damage with full removal
• crown removed with deliberate intention to leave root

Question 13

Coronectomy main points?

Answer 13

• flap design to gain access
• horizontal cut of crown 3-4mm below CEJ
• elevate/lever crown off without mobilising roots
• Pulp left in place
• untreated

Review pt

Question 14

what must you warn a pt for a coronectomy in regards to the roots?

Answer 14

• IF root is mobilised during crown removal, entire tooth must be removed
• leaving roots could result in infection
• can get slow healing/painful socket
• roots may migrate upwards and require XLA

Question 15

key points regarding maxillary 8s?

Answer 15

• generally easier to remove
• bayonet/upper 8s forceps
• support tuberosity with thumb+finger