Oral Surgery Volume 1
Transcript of Oral Surgery Volume 1
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Oral Surgery
Volume 1
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Dental Surgery/Minor Oral Surgery
Definition
includes all surgical procedures within the
oral cavity that can be performed underlocal anesthesia on an outpatient basis.
As a specialized area within OMS all basic
principles of this medical discipline applyto Dental/Minor Oral Surgery as well.
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Surgical procedure
-each surgical procedure represents an injury
and only:
- the intention to bring healing- the patients agreement to the procedure
- responsible screening about own skills
and abilities
protects from legal action!!!!!
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Classification of procedures
The difficulties within each surgical
treatment together with the actual demand
for surgical skills and experience as well asequipment mark the classification of a
surgical procedure:
SAC Classification
S = Simple A= Advanced C= Complex
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SAC - Classification
S = Simple
- Simple procedure without
anatomically related risks,
- Absence of surgical technical
difficulties
- Lack of compliances
- Can be performed by any
well-trained dentist in a
private dental clinic
Tooth extractions
Incision of alveolar process
abscess
Flap procedure alveolar
process
Root resection upper anterior
region
Biopsy of mucosa
Excision of benign
pedunculated tumors of thevestibulum
Gingival resection and
curretage
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A= Advanced
- simple procedure but withanatomically related risks
- Minor surgical technicaldifficulty
- Complications expected- Can be performed by a
surgically trained dentistin a standard dental clinic
- Tooth extractions
- Removal of retained orimpacted teeth
- Incision of abscess in thealveolar process
- Flap reflection on the alveolarprocess
- Apicoectomy
- Cystectomy
- Removal of peripheral sialoliths
- Mucosal biopsy
- Excision of benign tumors of
the vestibulum and tongue- Free gingival transplants
- Vestibuloplasty
- Gingival excision and curretage
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C = Complex
- More difficult procedures,with or withoutanatomically related risks
- Technically difficult
surgically, and timeconsuming
- Complications expected
- Can be performed by asurgically experienced
dentist or oral surgeonunder aseptic conditions
all complicated proceduresin patients with systemicand local risk factors:
diabetes
cardiac and circulatoryproblems
kidney or liver damage
hemorrhagic diathesis
breathing problems
allergiesimmune suppression
following radiation therapy
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Some indications for tooth
extraction
Deep caries
Apical ostitis Failure of root canal
treatment
Root fractures
Extremely deepperiodontal pockets
Acute local infections
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Tooth extractions
Principles and instruments Proper anesthesia Sever the marginal tissue with a desmotome
Insert the required elevator and loosen the
targeted tooth to mobility grade 2 if possible Apply the beaks of the forceps with proper grip
to both sides of the tooth
Force the tooth axial with push and pull
movements, with luxating movements at thesame time
Use high but controlled force
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Tooth extraction
InstrumentsForceps Incisors - upper + lower
Canine\ bicuspid - upper + lower
molar - upper right + upper left
+ lower
3rd molar - upper + lower
root forceps - upper + lower
forceps of smaller size for deciduous teeth
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Tooth extraction
InstrumentsElevators
Today there exists numerous elevators of
different shapes, we can identify 3 groups:1st> straight elevators
2nd angled elevators
3rd hooked\curved elevators
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Elevators
Hooked Angled Straight
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Root separation Upper molar
Lower molar
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Seperated roots and crown of lower molar
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Loosening of cervical attachment
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Finger support upper extraction
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Finger support lower extraction
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Finger support/Stabilization
Why is the finger support important?
to fixed the mandible
to maximize the effect of applied force- to avoid trauma of TMJ
to palpate the bone
to sense the tooth movement
to stabilize the process
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Remaining RootsRadix relictae
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Removal technique1st: 2 vertical incisions covering the alveolar area
2nd
: low speed bone cutting and removal with elevator
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Removal of remaining roots
Closure by single suture