Dentoalveolar Surgery and Exodontia
Dentoalveolar Surgery and Exodontia
This domain tests safe planning and execution of extractions and minor dentoalveolar surgery: impacted teeth, surgical access, and complication control. The exam emphasizes decision-making, risk assessment, and documentation rather than instrument names.
Core rules
- Assess medical status, bleeding risk, anticoagulants, prior radiotherapy, and airway before surgery.
- Classify third molars with Pell–Gregory (ramus and occlusal level) and Winter (angulation); use CBCT when roots overlap the inferior alveolar canal.
- Obtain adequate mucoperiosteal access, remove bone and section teeth deliberately, and avoid blind leverage on adjacent teeth.
- Consider coronectomy for a vital mandibular third molar with high inferior alveolar nerve risk and no active infection.
- Anticipate bleeding, dry socket, infection, oroantral communication, root displacement, nerve injury, and TMJ dislocation.
Worked example
A 26-year-old has a mesioangular mandibular third molar, Pell–Gregory IIB, with roots overlapping the canal. Reasoning: the crown–root relationship and proximity raise inferior alveolar nerve risk; CBCT clarifies the canal; sectioning reduces apical force; if the root is intimately related, coronectomy may be safer than extraction. Postoperative instructions and review are part of the plan.
Traps
Extracting during acute pericoronitis without drainage or airway assessment; ignoring anticoagulation; excessive lingual retraction; missing a root displaced into the lingual space; failing to document nerve risk and consent.