OS week 4

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Author:
emm64
ID:
216793
Filename:
OS week 4
Updated:
2013-04-30 10:44:28
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OS week
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Description:
complicated exodontia
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  1. Indications for surgical extractions
    • ž Type 1/dense bone
    • ž Short clinical crowns (attrition)
    • ž Hypercementosis & bulbous roots
    • (older patients)
    • ž Widely divergent or dilacerated
    • roots
    • ž Extensive caries (root caries)
    • ž Large restorations
    • ž Retained roots
    • ž Close approximation of maxillary
    • sinus/IAN
    • ž Unsuccessful “closed” (forceps)
    • delivery
  2. Open extraction requirements
    • 1. Surgical hand piece with fissure bur
    • 2. Copious saline irrigation
    • 3. Throat pack and bite block
    • 4. A steady hand!
    • 5. Patience and knowing your limits
    •  Provide for adequate visualization an access-FLAP
    • ž Create sufficient space- TROUGH
    • ž Divide and conquer-SECTION
  3. flap must have base that is broader than ______
    free gingival margin
  4. full thickness flap includes
    • surface mucosa, submucosa and periosteum
    • periosteum primary tissue responsible for bone healing
  5. flap…
    • ž is outlined by an incision
    • ž possesses its own blood supply
    • ž allows easy access to
    • underlying tissues
    • ž can be replaced in the original
    • position
    • ž can be maintained with sutures
    • and is expected to heal
  6. Envelope flap size
    • — - extends 2 teeth anterior and 1 tooth posterior
    • to the area of the surgery
  7. 3-cornered flap with releasing incision size
    • — extends 1 tooth anterior and 1 tooth posterior to
    • the area of the surgery
  8. palatal incision
    • Y: remove torus
    • pedicle flap: mobilizes from one to flill defect from other
  9. semilunar incision
    • avoid trauma to papillae and gingival margin but limited access 
    • used with periapical surgery
    • do not cross major eminences (canine)
  10. vertical releasing incisions should cross the ______ at the _____
    vertical releasing incisions should cross the free gingival margin at the line angle of a tooth and should not be directly on the facial aspect of the tooth or papilla
  11. 2 most important vital structures that can be damaged are both located in the ______
    • mandible:
    • 1. lingual nerve (lingual mandibublar 3rd)
    • —2. mental nerve (apical mandibular premolar) use envelope flap well anterior/posterior
  12. bone flap margin locations
    • ž Solid bone is best
    • ž 6-8 mm from bony defect
    • ž Prevents wound dehiscence
  13. Can you leave a small root fragment?
    • ž Risk of removing> leaving
    • — Not lack of skill or instrumentation!
    • ž Infected
    • ž Apical pathology
    • ž Close to vital structures-displacement
    • — Inferior alveolar nerve
    • — Sinus
    • ž Excessive damage to bone
  14. Multiple extractions
    • ž Envelope flap to
    • expose crestal bone
    • ž Teeth luxated with
    • straight elevator
    • ž Forceps delivery
    • ž Buccal and lingual
    • plate compression
    • ž Removal of bone
    • spicules &
    • undercuts
    • ž Irrigation
    • ž Reposition soft
    • tissue
    • ž Suture
  15. Why suture?
    • ž Keep tissue in place
    • ž Approximate wound edges
    • ž Hemostasis
    • ž May aid in maintaining a blood
    • clot in socket
    • — Not so much

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