What are the basic principles before a surgical extraction?
-Risk assessment
-Aseptic technique
-Minimal trauma to hard tissues
Consider: the patient and their medical history, informed discussion, benefits vs risks, minimise trauma to hard and soft tissues to reduce complications of bleeding etc.
What are the stages of oral surgery?
Consent, surgical pause, anaesthesia, access, bone removal if necessary, tooth division as necessary, debridement, suture, achieve haemostasis, post op instructions, post op medication and follow up.
Do big or small flaps heal faster?
They heal the same.
What membranes must you lift when lifting a mucoperiosteal flap?
Mucosa AND periosteum.
What are the steps in gaining surgical access.
- Wide-based incision circulation/perfusion
- Use scalpel in one continuous stroke
- No sharp angles
- Adequate sized flap
- Flap reflection should be down to bone and done cleanly
- Minimise trauma to 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 scarring (more scarring with secondary intention).
What is primary intention wound healing?
Primary intention is the healing of a clean wound without tissue loss. In this process, wound edges are brought together, so that they are adjacent to each other (re-approximated). Wound closure is performed with sutures (stitches), staples, or adhesive tape or glue.
What are the two types of incision for wisdom tooth removal?
3 sided and envelope incisions.
What incisions do you make in a 3 sided incision?
Mesial, crevicular and distal relieving incision.
What incisions do you make in an envelope incision?
Distal and crevicular relieving incision (extending to the 7).
What instruments can we use for soft tissue retraction?
Ash
Bowdler henry rake retractor
Howarth’s periosteal elevator
Rake retractor.
Why do we use soft tissue retraction?
To improve access to operative field
Protection of soft tissues
Flap design facilitates retraction.
What might air driven hand pieces lead to?
Surgical emphysema.
What hand piece do we use for bone removal and tooth division?
Electrical straight hand piece with saline/sterile water cooled bur.
What bur do you use for bone removal and tooth division?
Round or fissure tungsten or carbide burs.
What technique do you use for removing a crown or root of a tooth,
Buccal gutter.
What are the principles of use of an elevator?
- Mechanical advantage
- Avoid excessive forse
- Support the instrument to avoid injury to the patient should the instrument slip
- Ensure applied force is direct away from major structures
- Always use elevators under direct vision
- Never use an adjacent tooth as a fulcrum unless it is to be extracted
- Keep elevators sharp and in good shape. Discard if blunt or bent
- Establish an effective and logical point of application
- Careful debridement after the use of elevators to remove any bone fragments that have been closed.
What are the uses of elevators?
- To provide a point of application for forceps
- To loosen teeth prior to using forceps
- To extract a tooth without the use of forceps
- Removal of multiple root stumps
- Removal of retained roots and root apices.
What are the three basic actions of using elevators?
Wheel and axle (rotate wrist when elevating tooth)
Wedge
Lever.
What are the mechanics of using an elevator that we use at undergrad level?
Mesial, buccal or maybe distal.
What are the three stages of debridement?
- Physical- bone file or hand piece to remove sharp bony pieces. Use Mitchell’s trimmer or Victoria curette to remove soft tissue debris.
- Irrigation- sterile saline into socket and under flap.
- Suction- aspirate under flap to remove debris. Check socket for retained apices.
What are the aims of suturing?
- Reposition tissues
- Cover bone
- Prevent wound breakdown
- Achieve haemostasis
- Encourage healing by primary intention.
What are the two types of sutures?
Non-absorbable
Absorbable.
What are examples of non-absorbable sutures and what are they used for?
Mersilk, prolene and ethlon (nylon). Must be removed after a certain period of time. Used for oro-antral fistula or exposure of a canine tooth.
What are examples of absorbable sutures and what are they used for?
They hold tissue edges together temporarily. If removal of suture not possible or desirable. Vicryl breakdown via absorption of water into filaments causes polymer to degrade. Vicryl rapide or velosorb fast.
