Lesson 1Setting selection rationale: criteria for office, ambulatory surgery centre, or hospital operating room useThis section outlines criteria for choosing office, ambulatory surgery centre, or hospital operating room, considering patient comorbidities, anaesthesia needs, infection risk, resource availability, and emergency preparedness to ensure safe, efficient care across Canada.
Office setting indications and limitationsWhen to use an ambulatory surgery centerHospital operating room indicationsAssessing medical risk and ASA statusEmergency preparedness and equipment needsLesson 2Flap design options for mandibular molar surgery: envelope, triangular, and vertical releasing incisions with pros/consThis section analyzes flap design principles for mandibular molar surgery, comparing envelope, triangular, and vertical releasing incisions, with emphasis on blood supply, access, tension control, and how each design affects postoperative pain and ridge preservation.
Biologic principles of mucoperiosteal flapsEnvelope flap indications, pros, and consTriangular flap design and clinical usesVertical releasing incisions and limitationsFlap tension management and repositioningLesson 3Anaesthesia level decision: indications for local anaesthesia alone, local with IV sedation, or general anaesthesiaThis section reviews patient, procedure, and systemic risk factors guiding anaesthesia choice, comparing local anaesthesia alone, local with IV sedation, and general anaesthesia, including monitoring needs, airway considerations, and medico-legal documentation.
Assessing patient anxiety and medical comorbiditiesIndications for local anesthesia aloneWhen to add IV sedation to local anesthesiaCriteria for choosing general anesthesiaMonitoring, recovery, and documentation needsLesson 4Formulating the final diagnosis: chronic periapical infection with buccal cortical thinning and proximity to inferior alveolar nerveThis section explains how to synthesize clinical, radiographic, and CBCT data to confirm chronic periapical infection, assess buccal cortical thinning, and evaluate the relationship to the inferior alveolar nerve for safe surgical planning and prognosis.
Key clinical signs of chronic periapical infectionRadiographic and CBCT features of cortical thinningMapping proximity to the inferior alveolar nerveDifferential diagnosis and endodontic vs surgical careRisk stratification and prognosis documentationLesson 5Ridge preservation techniques: socket graft materials (autograft, allograft, xenograft, alloplast), membrane types, and choice considerations given infection and cortical defectsThis section examines ridge preservation after infected molar extraction, comparing socket graft materials and membrane types, timing in the presence of infection and cortical defects, and decision pathways to maintain volume for future implant placement.
Assessing socket walls and defect morphologyAutograft, allograft, xenograft, and alloplast choicesResorbable versus nonresorbable membranesTiming of grafting in infected extraction sitesStrategies to maintain ridge width and heightLesson 6Tooth sectioning strategies: root separation patterns for mandibular molars, instrumentation, and minimizing torque on nerveThis section covers root morphology assessment, ideal root separation lines for mandibular molars, bur and instrument selection, controlled sectioning sequences, and strategies to reduce torque transmission and mechanical stress near the inferior alveolar nerve.
Radiographic evaluation of root morphologyDesigning root separation patterns by molar typeInstrumentation choice for precise sectioningTechniques to minimize torque on the nerveManaging fractured roots and difficult segmentsLesson 7Bone removal and access techniques: osteotomy planning, use of rotary instruments vs piezoelectric surgery, minimizing cortical lossThis section details preoperative osteotomy design, selection and sequencing of rotary versus piezoelectric instruments, irrigation and cooling strategies, and methods to minimize cortical plate loss while ensuring adequate access and visibility for safe tooth removal.
Principles of osteotomy design and planningChoosing rotary versus piezoelectric devicesHandpiece control, irrigation, and heat reductionPreserving buccal and lingual cortical platesIntraoperative assessment of access and visibilityLesson 8Debridement of periapical lesion: curettage technique, removal of granulation tissue, culture/biopsy indicationsThis section describes systematic debridement of periapical lesions, including curettage technique, removal of granulation tissue, management of cystic lesions, and when to obtain cultures or biopsies to guide antimicrobial therapy and histopathologic diagnosis.
Instrumentation for periapical curettageStepwise removal of granulation tissueHandling cystic and fibrous lesionsIrrigation protocols and hemostasisIndications for culture and biopsy samplingLesson 9Managing proximity to the mandibular canal during extraction: gentle traction, controlled apical curettage, and use of intraoperative CBCT or navigationThis section focuses on identifying high-risk canal proximity, using gentle traction and luxation, controlled apical curettage, and indications for intraoperative CBCT or navigation systems to avoid nerve injury and manage unexpected canal exposure safely.
Preoperative mapping of the mandibular canalAtraumatic luxation and traction techniquesControlled apical curettage near the canalUse of intraoperative CBCT and navigationManagement of suspected nerve exposureLesson 10Soft tissue management and closure: primary closure vs open healing, use of collagen membranes, suturing techniques to maintain ridge contourThis section addresses soft tissue handling around extraction and graft sites, comparing primary closure versus open healing, use of collagen membranes, flap advancement, and suturing techniques that protect grafts and preserve ridge contour and keratinized tissue.
Criteria for primary closure versus open healingFlap advancement and releasing techniquesUse of collagen membranes for coverageSuture selection and tension controlPostoperative soft tissue remodeling review
