Complicated Extraction, Study notes of Dental surgery

Download Complicated Extraction and more Study notes Dental surgery in PDF only on Docsity! Principles of flap design, development, management Flap  Outlined by surgical incision  Carries its own bld supply  Allows surgical access to underlying tissues.  Can be replaced in the original position.  Can be maintained w/ sutures and is expected to heal. Design parameters of soft tissue flaps  Base should always be broader than the free margin to preserve an adequate bld supply.  Flap should be of adequate size - Visualization of the area. - Insertion of the instruments: rest on intact bone. - Reflection w/o tension. - Soft tissue heals across the incision, not along the length of the incision, and sharp incisions heal rapidly than torn tissue. - Envelope flap: the length of the flap to be of adequate size, the length of the flap in the anteroposterior dimension usually extends two teeth anterior and one posterior to the area of surgery. - W/ relaxing incision : the incision should extend one tooth anterior and one tooth posterior to the area of surgery.  Should be a full-thickness mucoperiosteal flap - Periosteum is the primary tissue responsible for bone healing. - Replacement of the periosteum in its original position hastens that healing process. - Torn, split and macerated tissue heals more slowly.  Flap must be made over intact bone that will be present after surgical procedure is complete - If buccocortical plate has been eroded, the incision must be at least 6-8mm away from it.  Flap should be designed to avoid injury to local vital structures in the area of the surgery - Lingual N, Mental N, Greater palatine A.  Vertical releasing incision is usually made on the anterior  end of the envelope flap; it should not cross any bony prominences.  Vertical releasing incisions should cross the free gingival margin at line angle of a tooth and should not be directly on the facial aspect of the tooth nor directly in the papilla. Types of mucoperiosteal flap  Envelope / sulcular incision  Three cornered flap  Four cornered flap  Semilunar incision  Y incision  Pedicle flap  Ochsenbein-Luebke Techniques of developing a mucoperiosteal flap 1. Incise the soft tissue to allow reflection of the flap. 2. The blade is held at a slight angle to the teeth and the incision is made posteriorly - anteriorly in the gingival sulcus by drawing the knife toward the operator. 3. One smooth continuous stroke is used while keeping the knife blade in contact w/ bone thruout the entire incision. 4. If a vertical releasing incision is made, the tissue is apically reflected, w/ the opposite hand tensing the alveolar mucosa so that the incision can be made clearly thru it 5. Reflection of the flap begins at the papilla. 6. If a three cornered flap is used, the initial reflection is accomplished w/ the sharp end of the woodson elevator on the first papilla only. 7. Retractor is held perpendicular to the bone tissue while resting on sound bone & not trapping soft tissue bet the retractor & bone. 8. Flap should be held w/o tension. 9. The retractor should not be forced against the soft tissue in an attempt to pull the tissue out of the field. Principles of suturing Fxn of sutures  Coapt wound margins  Aids in hemostasis  Help hold soft tissue flap over bone  Aid in maintaining a bld clot in the alveolar socket Armamentarium  Needle holder- 15cm in length and has a locking hande  Suture needle- small 3/8 or 1/2 circle w/ a reverse cutting edge  Suture material - resorbable / non-resorbable. 3 types of resorbable sutures 1. Gut - From submucosa of sheep intestines or the serosa of beef intestine - Susceptible to rapid digestion by proteolytic enzymes produced by inflammatory cells. - + basic chromium salts ➫ chromic gut. - Plain gut : 5days / chromic gut : 7-9days 2-3. Polyglucolic acid and polyglactin -Do not enzymatically breakdown. -Undergo slow hydrolysis ➫ being resorbed by macrophages -Have the advantage of being less stiff than gut sutures & are more likely to remain tied. Commonly used non-resorbable sutures in oral surgery  Silk, nylon, polyester, polypropylene.  Mono / Multifilament -Multifilament form increases the strength of the suture,but also increases suture abrasiveness and is more likely to allow bacteria to "wick" into the wound  When an envelope flap is returned to its position, sutures are placed thru the papilla only  When approximating the tissues, the suture is passed first the mobile(facial) tissue  The needle should enter the surface of the mucosa at a right angle, to make the smallest possible hole in the mucosal flap  The minimal amt of tissue bet. the suture and the edge of the flap should be 3mm  Sutures should not be tied too tightly- no blanching or obvious ischemia of wound edges  The knot should be positioned so that it does not fall over the incision line - it should be at the side  To make the suturing of three cornered flap easier, elevate a small amt of fixed tissue so that the suture can be passed thru the entire thickness of the mucoperiosteum  When three cornered flap is repositioned, the first suture is placed on the occlusal end of the vertical releasing incision. Different suturing tech  Horizontal mattress  Figure of eight  Interrupted sutures  Locking continuous suture  Non-locking continuous suture