Download - Oral Surgery for General Dentist
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David B. Ettinger MD,DMD
Assistant Professor Oral and Maxillofacial
Surgery
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Caries
Periodontal Disease
Orthodontics
Tooth Fracture
Preprosthetic Preparation
Teeth Associated withPathologic Conditions
Chemotherapy and Radiation
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Involves minor alveolar bone expansion, separation of theperiodontal ligament, and simple coronal forceps delivery of thetooth
Use of appropriate specialized instrumentation Proper elevation of the tooth
Choosing the right forceps in order to be able to grasp the cervical portionof the tooth and position it as apically as possible to try to shift the centerof rotation toward the root
Avoid any traumatic extraction leading to further bone remodelingand ultimately more bone resorption
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Involves techniques to removeteeth other than by simple luxationof the tooth and forceps delivery
Elevation of a mucoperiosteal flap
Ostectomy
Sectioning of the tooth
Luxation and removal of roots Removal of radicular pathologic
condition when present
Debridement of the surgical fieldand removal of sharp bony edges
Wound closure
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Full thickness mucoperiosteal flap Allow for complete visualization of
the operative field Prevent unnecessary trauma to the
adjacent soft tissue whenremoving teeth
Provide an adequate working area
that will allow for the full removalof intrabony pathologic conditionswhen present
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Incisions should be placed overbone not planned for removal
The incision should be longenough to allow for a flapreflection without tearing
The base of the flap should bewider than the reflected free
margin Avoid placing incisions over vital
structures (mental foramen andlingual nerve)
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Sometimes it will be necessary to remove alveolar bone fromthe crown of the tooth or from the retained root to facilitateits removal
Constant irrigation
Must be as conservative as possible
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Active/chronic infection at site
Cyst formation
Tumors
Caries
Preparation for orthognathicsurgery
Preradiation therapy for head andneck cancer
Resorption of adjacent teeth
Tooth in line of fracture
Active periodontal disease arounddistal of adjacent teeth
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COMPLIC TION an additional problem thatarises following a procedure, treatment orillness and is secondary to it. A complicationcomplicates a situation.
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Removal of the wrong tooth Injuries to teeth and adjacent structures Residual root remnants Displacement of teeth or root tips Soft tissue injuries Oroantral communications Swallowing or aspiration of teeth, fragments of teeth, or restorations and
crowns Tissue emphysema Sensory nerve injuries Alveolar Osteitis (dry socket) Infection Trismus, swelling, or pain
Temporomandibular joint problems Hemorrhage Injuries to osseous structures
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Miscommunication betweenreferring dentist and officepersonnel with specialists office
Incorrectly labeled radiographs orreferral slips
Disagreement between dentist and
patient Inadvertent removal
If discovered at time of surgery,tooth should be implantedimmediately and stabilized
Patient should be informed
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Fractures and loosening adjacentteeth
Dislodging large restorations orcrowns
Careful evaluation of surroundingdentition and radiographs should
be done before institutingtreatment
Partially avulsed teeth should berepositioned and stabilized
Crowns should be recemented
Dislodged restorations temporized
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Dilacerated or divergent roots If remnant is 2-3 mm and in close proximity to a vital structure,
risks versus benefits should be considered
Usually small remnants will be of no consequence if not grosslyinfected
Post op radiograph Appropriate follow up
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DISPLACED ROOT TIP THROUGH THINLINGUAL PLATE
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Exposure of maxillary sinus Maxillary sinusitis or chronic
oraoantral fistula Widely divergent roots increase
the chance that the sinus floorcould be removed along with theroot
Less force should be used anddivision of roots should beconsidered if tooth roots in closeproximity with sinus floor
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Treatment dictated by size ofcommunication
Probing not advised
6mm communication must beclosed primarily using a flapprocedure; sinus precautions
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Laceration of the flap Burns
Abrasions
Puncture wounds Subcutaneous emphysema
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Seen less frequently since the useof rotary instruments such as theHall drill
Caused by the inclusion of airunder pressure into thesubcutaneous soft tissue duringremoval of bone or sectioning ofteeth with an air driven dentalhand piece
Rapid onset of swelling Tenderness Can be life threatening or result in
an infection leading to meningitisor mediastinitis
Tx: ice application, antibiotics, andclose monitoring
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Teeth or fragments of teeth,restorations, and crowns
Chest Xray for patients who haveswallowed/aspirated teeth tolocalize it
If aspirated during surgery and
lodged in trachea, methods usedin ACLS, abdominal thrusts, backslaps, Heimlich maneuver
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Can occur with the removal of teeth whose roots are close to theinferior alveolar, lingual, or mental nerve
Horizontally impacted 3rdmolars
Depth of impaction, presence of completely developed roots, use ofrotary instruments, and sectioning of teeth
Division of inferior alveolar nerve is infrequent but pressure and
compression can take place during removal of third molars Proper patient evaluation, correct flap placement, proper use of
rotary instruments, knowledge of anatomy, and informed consent
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One of the more common surgicalcomplications seen postoperatively
Smoking, oral contraceptives,mandibular teeth, experience ofsurgeon, complexity of extraction,
poor oral hygiene Dull throbbing pain on POD 3-5
with complaint of earache,headache, radiating pain, and norelief with analgesics
Malodorous
Extraction site devoid of clot
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Dry socket pastes containingeugenol, guaiacol, chlorobutanol,and balsam of peru are placed ona dressing and placed in thesocket
Dressings replaced every 2-5 daysprn
Obtain imaging if pain persistsbeyond 3 weeks
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Signs and symptoms typicallymanifest 5 days post op
Swelling,trismus,tenderness,erythema, fever, malaise, purulentdischarge
Flap elevation, bone removal, poorsurgical technique, poor oralhygiene, noncompliant patient,periodontal disease,immunocompromised patient
Tx: antibiotics, incision anddrainage, and acquisition ofcultures
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Pressure with a moistened tea bag or gauze pad Bone wax
Cautery
Absorbable gelatin sponges (Gelfoam)
Oxidized regenerated cellulose (Surgicel)
Microfibrillar collagen (Avitene) Absorbable collagen dressings (Collatape, CollaPlug)
Topical thrombin
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Due to lack of supportagainst lateral focesduring exodontia
Bite block
Other hand
Thorough history
Post op instructions
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Disocation of condyle
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