What are the stages of surgery?
- consent
- surgical pause/safety checklist
- anaesthesia
- access
- (bone removal)
- (tooth divison)
- debridement
- suture
- achieve homeostasis
- POI
- (post-operative medication)
Describe the consent required for oral surgery.
- GA requires written consent
- LA requires verbal consent although it is good practice to obtain written as well
- consent must be obtained using simple language (no jargon)
What is involved in the surgical pause?
- safety checklist
- site marked
- equipment checked
- checked it is the correct patient
- ensure patient knows what procedure is going to happen
Describe surgical access.
- a larger flap gives better visualisation and large flaps heal at the rate as smaller ones
- preserve adjacent soft tissues where possible
- consider post-op aesthetics if in the anterior
- wide base incision is better for circulation
How should you use a scalpel when making an incision?
- one firm continuous stroke
- no sharp angles
- flap reflection should be down to the bone (periosteum)
How should you manage a flap during surgery?
- keep tissue moist
- do not crush tissues
How should flaps be closed?
- using sutures
- flaps should not be closed under tension as this will cause the flap to pull open during healing
Describe a 3 sided flap.
2 relieving incisions mesial and distal to the tooth being extracted
Describe a 2 sided flap.
1 relieving incision mensal OR distal to tooth being extracted (also known as an envelope flap)
What is the role of soft tissue retraction?
- protection of soft tissues
- gain better access to operative field
- flap design facilities retraction
What should be used to retract soft tissues?
- Howarth’s periosteal elevator
- rake retractor
Why are air driven handpieces not used in oral surgery?
May lead to surgical emphysema (air driven into soft tissues, can be life threatening)
What is used for bone removal and tooth division?
- electric straight handpiece with saline cooled bur
- round or fissure tungsten carbide burs
Where do you remove bone during a surgical extraction?
Form a gutter around the buccal side of the tooth
How should you divide a tooth for extraction?
Remove crown and the divide the roots
What are the principals of elevator use?
- avoid using excessive force
- support instrument to avoid injuring soft tissues
- force should be applied away from major structures
- always use under direct vision
- do not use adjacent tooth as fulcrum
What can elevators be used for?
- point of application for forceps
- loosen teeth prior to forceps
- extraction
- removal of retained roots
- removal of root apices
What are the 3 actions when using an elevator?
- wheel and axel
- wedge
- lever
What are the different methods of bone debridement?
- physical
- irrigation
- suction
Describe physical debridement.
- bone file or handpiece to remove sharp bony edges
- Mitchell’s trimmer or Victoria curette to remove soft tissue debris
Describe irrigation used for debridement.
Sterile saline injected into socket and under soft tissue using a blunt needle
Describe suction used for debridement.
Aspirate under socket
What are the aims of suturing?
- compress blood vessel to achieve homeostasis
- reposition tissues
- cover bone
- prevent wound breakdown
- encourage healing by primary intention
Define healing by primary intention.
When tissues are approximated to prevent loss of tissue, should heal with a thin, neat scar
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1 - Indications for extractions2
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2 - Extraction complications19
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3 - Basic surgical technique34
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4 - Analgesia58
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5 - Minor oral surgery techniques (fractured teeth and retained roots)9
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6 - Extraction complications 221
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7 - Post-op compilations 328
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8 - Post-op complications 434
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SDCEP anticoagulant and antiplatelet guidance13
