Oral & Maxillofacial Surgrery

8/13/2019 Oral & Maxillofacial Surgrery

1/98


2/98

SCOPE of OMS

Major OMS:

Hospital procedureswhich include:

Rx Fractures

Pre-prosthetic: tuberosity reduction, implants,

vestibuloplasty (extending vestibule)

Re-constructive surgery: orthognatic, facialdeformities.

Administer general anesthesia


3/98

GENERAL PRINCIPLES OF

SURGERY A. Wound Healing:

1. Primary: clean incision + sutured to get

good approximation.2. Secondary: not tightly sutured early

granulation tissuescar

3. Tertiary: wound excised extensively to

remove devitalized tissues and debrisgranulation tissuehealing (scar)

Depends on good nutrition (Vitamin C),

medical condition, blood supply.


4/98


SURGERY B. Infection: control and isolation, culture &

sensitivity test to choose specific antibiotics.

C. Nutrition: very important, knowledge of thephysiology of nutrition, fluid balance , electrolytecontent (Na, K, Cl, CO3 )

D. Body fluid & electrolytes: physiology ofwater balance, urinary out put, shifting betweenvarious fluid and electrolyte compartments like

Cell &Tissues


5/98


SURGERY E. Diagnostic Workup:

Cardiac function (Heart murmur, HBP)

Respiratory function (asthma, COPD)Hematology: Bleeding & Coagulation times

Medial History: diabetes, stomach ulcers,cirrhosis, kidney function

Drug history: coumadin (blood thinner)

Systemic disease: immunosupresson(steroid)


6/98

EVALUATION OF PATIENT

A. General

1. History:

Reviewed verbally with patientDrug allergies (penicillin)

Chief complaint + History of Present Illness(symptoms & duration, what exacerbates pain,

history of similar episodes)

2. Extra & intra oral exam


7/98


3. Diagnostic Aids:

X-rays Photos before/after

Sialographs Biopsy

Diagnostic nerve blocks

Transillumination (sinuses, nose)

Lab tests (CBC)Bacterial stains (Gram stain +/- )

KOH fungi Viral Ab studies


8/98


4. Hospitalization:

Considerations:

Medically compromised: un-controlleddiabetes, hemophilia, HBP, MI, CVA)

Difficulty & Extent of Procedure

Special patients: emotionally disturbed,physically handicapped.

Cost: base room rate, OR fee, anesthesia,Lab tests, consultant fees


9/98


Hospitalization (cont)

Dental Emergency

Infection: Increase temperature (> 101 F)

Increased sweating dehydration

Decreased BP, cold, pale IV therapy

Increased WBC count (.> 20,000)

Compromised airway

No response to oral antibiotics


10/98


Hospitalization (cont)

Dental Emergency:

Bleeding: Uncontrolled (hemangioma,

hemophilia)

Monitor:

Pulse Blood pressure

Hematocrit (HCT)

Hemoglobin (Hb)

Patients orientation.


11/98

Hospital Arrangements &

Orders A. Procedures for Admission

1. Tell patient what will occur; blood drawn,

I.V. started, probable length of hospital stay.

2. Give following info to hospital:

Patients name, address, age, insurance etc

Admitting diagnosis & procedure planned

Preferred date of admission

Need for special equipment (drills saws

Physical exam 48 prior to admission)


12/98

ADMISSION ORDERS

1. General & Nursing Orders:

Diagnosis

Patients condition

Allergies

Diet

Activity (bed rest)Specific problems


13/98

ADMISSIONS ORDERS

2. Laboratory Tests:

Hematocrit, Hemaglobin, CBC

Urine analysisChest x-ray (general anesthesia)

E. K. G. (Electro-cardio-gram)

Blood glucose level

Prothrombin Time (PT-liver function, clotting)

Partial Thromboplastin Time (PTT), plateletcount.


14/98

ADMISSIONS ORDERS

Lab tests (con):

ESR (erythrocyte sedimentation rate-infection)

Vital signs: pulse, respiration rate, BP,Temperature

Chem-12 or S.M.A.-12: includes liver function

tests, albumin, total protein, calcium,phosphorous, alkaline phosphatase, serumcholesterol.


15/98

Other Admission Procedures

Medications: dose and frequency

Informed Consent Form:

Discuss surgery & risks.Separate form for general anesthesia.

Prior to surgery:

Review record to ensure patient saw allappropriate consultants.

Evaluate lab results.

Write pre-operative notes in chart


16/98

Other Admission Procedures

Pre-operative Notes:

Discuss patients condition

State abnormal findings in medical history &physical exam; plans to deal with them.

Record & evaluate lab tests

Stating plans for surgical procedures


17/98

RADIOLOGIC AIDS for OMS

Panoramic Radiograph (Panorex)

Screeningfor pathologic lesions

Diagnosis & Rx Plan impacted third molars

Observe TMJ, Sinuses, Sialography

Waters view:View para-nasal sinuses, bones of mid face

Best for mid facial fractures


18/98

RADIOLOGIC AIDS for OMS

Sub-mental vertex view:

Dx facture of base of skull

Dx fracture of zygomatic process, mandible

Townes view: Visualizing condyle

Lateral oblique view: Body & ramus

Mandibular occlusal view: symphysis area

Cervical spine series: neck fractures

TMJ views


19/98

PRINCIPLES of OMS

A. TISSUE HANDLING:

1. Use of Flaps:

Access to & visibility of deep structuresBone removal

Prevent soft tissue damage

2. Types of Incisons:

Linearenvelope(no vertical component)

Releasing(vertical component)

Semi-lunar


20/98


21/98

PRINCIPLES of OMS

4. Re-positioning of Flap:

Incision clean, sharp, perpendicular to

wound

Flap margins over solid bone

For dento-alveolar surgery releasing incison

should end in inter-proximal areas.


22/98

PRINCIPLES of OMS

5. Principles in Working with Bone:

Use burs, chisels, rongeurs, files

Complicated by:

sharp edges

exposed bone (pain, delayed healing)Devitalzation of bone necrosis

Infection necrosis


23/98

PRINCIPLES of OMS

B. Aseptic Technique:

Prevent pathogenic extra oral bacteria from

getting into wound

Sterilization of instruments

Thorough hand washing

Patients face washed and draped.


24/98

PRINCIPLES of OMS

C. Wound Care:

Mechanically remove calculus & dead tissue

Irrigation to wash away bone chips & debrs

Elimination of dead space prevented by:

Closing wound inlayers

Pressure bandages

Draining hematomas


25/98

SUTURE MATERIALS &

TECHNIQUES Needle Type: mostly curved, and triangular

(cutting)

Suture diameter: Intraoral 3-0or 4-0

Suture material:

Black silk: inexpensive, easy to see intraoral,

and removed in 7 daysGut:(sheep intestine) Resorbable, light tan

color

Nylon: not soft or pliable, mainly used onskin


26/98

BIOPSY TECHNIQUE

INDICATIONS:

Confirm clinical diagnosis

Distinguish benign from malignant An ulcer that persists for more than 2

weeks in spite of removal of local irritantfactors MUST be examined histologically

Persistent white lesions biopsied anddiagnosed as Hyperkeratosis MUST befollowed closely and biopsied if changes

occur.


27/98

BIOPSY TECHNIQUE

INDICATIONS (cont):

To establish type of treatment(in the hospitalall tissues remove teeth etc are sent for grossand histologic description)

Where or How to Biopsy:

Small (< I cm) benign appearing = ExcisionVesiculo-bulluous lesions= Incision (Michel

solution)


28/98

BIOPSY TECHNIQUE

Where & How to Biopsy (cont):

Large ulcers or White lesions

Sample normal into abnormal areas Sample several areas if large lesion

Sample must extend into connective tissue

Pigmented lesions MUST ALL be excised

with wide margins


29/98


30/98

BIOPSY TECHNIQUE

Where & How to Biopsy (cont):

Punch biopsy = skin (small & difficult to

orient for sectioning)

Tissue Handling & Instrumentation:

No tweezers or hemostats to grasp lesionAnesthesia = Do not inject into lesion

Fixative = 10% formalin immediately


31/98

BIOPSY TECHNIQUE

Tissue Orientation:

The pathologist need to cut the lesionperpendicular to the surface to see progressionof the disease process. Thin biopsiesshould be

placed connective tissue side downon a pieceof thick paper before placing into fixative.

The pathologist need know margins(up, downfront, back etc); to see if lesion extends to theedge of what margin.


32/98


33/98

FRACTURES

Classification (4 types)

1. Simple: (Closed)

Dividedbone into two parts, noexternal communication thru skin ormucosa

2. Compound: (Closed) (Mostly children)Incomplete, may extent thru cortical

plate.


34/98

FRACTURES

Classification (cont)

Compound:

Communicate with outside of skin/mucosa Exposed fragments

Comminuted:Multiple fractures of a single bone

Simple or compound


35/98

MAXILLARY FRACTURES

La Fort 1: Simplest Horizontal

Maxillary alveolus containing dentition

separated from upper face

Segment pushed backwards & downwards

X-ray show fracture thru maxillary sinus

Rx: closed reduction, immobilze 57 wks


36/98

MAXILLARY FRACTURES

Le Fort type 1


37/98

MAXILLARY FRACTURES

La Fort 11 Fracture (pyramidal fracture):

Alveolar fracture + across bridge of nose

Fracture near Lacrimal sac, alongInfraorbital ridge, exits around Infraorbitalforamen to wall of sinus and underneathZygomatic process, then to up Pterygoidplates.

Clinical: periorbital edema + ecchymosis,subconjuntival hemorrhage, epistaexis.

Rx: intermaxillary fixation


38/98


39/98

MAXILLARY FRACTURE

La Fort 111

ThruZygomatic arch

Down lateral orbital wallTo Inferior orbital fissure

Along Medial wall of orbit

Over Bridge of nose

ThruPterygmaxillary fissure

Craniofacial disarticulation

Clinical: Epistaxis


40/98


41/98

POST-OP COMPLICATIONS

HEMORRHAGE:

Mostly due to poor clot formation(use tea bag+ pressure)

Remove large exophytic jelly-like clots

Use local anesthesia with epinephrinetocontrol bleeding to facilitate exam

Sutureto control bleeding

If bleeding continuestake to EmergencyRoomfor Blood Tests


42/98


PAIN:

DRY SOCKET (most common)

Loss of clot + inflammation of bone3rdmandibular molar area most common

Pain radiated to ear on ipsilateral (sameside)

Goals of Rx:Clear out local irritants(food)

Apply topical analgesic

Prevent irritants from getting in socket


43/98


PAIN (cont)

Rx Dry Socket:

Do not currette out socketIrrigate socket with saline

Place sedative dressing in socket

Bacteriostatic agent: iodine, bacitracinAnalgesic: benzocaine, eugenol

Change dressing every 2448 hrs


44/98


PAIN (cont)

SEQUESTRUM:

Fragment of tooth or non-vital boneinwound.

Rx: X-rayand surgical removalwith LA


45/98


SWELLING: (due to infection)

Mild infection suppuration (no fever)

Infection

facial planes

cellulitis or pus Infectionbuccal, lateral pharyngeal,

pterygoid, peri-tonsllar,sublingual, submandibular

spaces Rx:

Drainage

Antibiotics (culture & sensitivity test),

systemic support fluids)


46/98


FEVER:

Infectious or non-infectious etiology

Mild temperature elevation= fluid lossoraltered metabolism

Post oral surgery mild elevation of

temperaturedue to transient bacteremia(1224 hrs)

High fever (> 99.8 F)for more than 48 hrs

need aggressive Rx.


47/98

OMS & DIABETIC PATIENT

OUT PATIENT MANAGEMENT:

Early morningappointments

Short appointment timeHave patient take normal morning dose of

insulin or oral agent+ normal breakfast

Mid morning hypoglycemic (weak,trembling)

Have orange juice available


48/98

Management of Emergencies in

the Dental Surgery A = Airway B = Breathing

C = Circulation

SYNCOPE (fainting):Cause:anxiety, nervousness, hypoglycemia

Made worseby lack of food, fever,infection,

lack of sleepPatient becomeanxious, sweaty, pale,

nauseous


49/98


the Dental Surgery Syncope (cont)

Patient becomes unresponsive (drowsinesstounconscious)

Pulse isweak andslow

Management:

Supine positionincreased blood to headAirwayopen, tilt head backwards

Breathingoxygenby face mask

Circulation

check vital signs Pupils dilated


50/98


the Dental Surgery Syncope (cont)

Management:

Apply cool wet towel to foreheadRemove tight bulky clothing


51/98


the Dental Surgery RESPIRATORY OBSTRUCTION::

Patient trying to breathe but somethingblocking airwaystridor(high pitch) or

crowingnoise

Management:

Heimlich maneuver: quick forceful pressure

on abdomen, below rib cage, upwards Pull mandible forward, insert oropharyngeal

tube

Hemostat, kelly clamp or suction remove object


52/98


the Dental Surgery Respiratory ObstructionManagement (cont)

If object can not be dislodged, place in supine

positionGive oxygen under pressure

Laryngoscopy intubationor tracheostomy

Chest x-ray ASAP


53/98


the Dental Surgery RESPIRATORY ARREST:

Patient is making no effort to breathe,

although airway is clear. Management:

Check mouth for obstructive object

Oxygenvia breathing bagDial 119, continue to breathe for patient

every 3 to 4 seconds


54/98


the Dental Surgery CARDIAC ARREST (Circulatory collapse):

Management: CPR

Dial 119Patient supine on flat hard surface

Start CPR

2 person = 1 breathe : 5 compressions 1 persons = 2 breaths : 15 compressions

Check pupils and pulse


55/98

PAIN CONTROL

DIAGNOSIS & HISTORY:

Ask if painis:

Superficial or deepConstant or intermittent

What relieves and exacerbates pain

Is it sharp, dull, burningUnilateral or bilateral


56/98

PAIN CONTROL

If patient describes pain in a bizarre manneritfeels like bugs are crawling up my face arm, thinkof psychogenic origin.

Psychotic pain mostly occurs in head & neck

Iatrogenic pain = cause by HCW

Be patient, interested Listen carefully

Look for simple causes first

Do meticulous Extra & intra oral exam


57/98

PAIN CONTROL

SOMATIC PAIN:

Caused by noxious stimulus (exogenous,endogenous or spontaneous (no apparent cause)

Warning signof physical injury

Peripheral stimuli interpreted in subcortical

& cortical areasof brain.

Transmitted by pain conducting fibers whenheat, cold, proprioceptive fibers are

extremely stimulated.


58/98

PAIN CONTROL

Methods of Controlling Somatic Pain:

Block conductionlocal anesthetic

Eliminate noxious stimuliAnalgesic drugs

Sedative & consciousness altering drugs

General anesthesiaHypnosis & Acupuncture

Beliefs (cultural, religious etc)


59/98

PAIN CONTROL

PSYCHOGENIC (PSYCHOSOMATIC) PAIN:

Cortical & subcortical areas in the absence ofperipheral impulsesproduce the interpretation

of pain

Patient is calm, smiling, facial expression freeof distress.

Burning sensation& depression go together.Rx: Psychiatric consultation

Establish good relationship and treatdental needs.


60/98

PHYSIOLOGY OF PAIN

Stimuli neural signals nervous system

Nervous system influenced by pastexperiences, culture, anxietyetc

These brain processes participate in theselection, abstraction & synthesis ofinformation of total sensory input.

Action potential begins in pain receptors

Free endings covered bySchwann cell sheath(no capsule) located in deep epithelium &

lamina propria


61/98

PHYSIOLOGY OF PAIN

Distribution of Receptors:

Skin (MOST) Tendons

Mucous membrane FaciaPeriodontium Veins

Periosteum CT of muscle

Arteries (Least)Ligaments


62/98

PHYSIOLOGY OF PAIN

Coded pattern of nerve impulsesAnterior-lateral Spinal cord

Thalamus (spinothalmic tracts)

Reticular formation (lower Brain)

Different speeds & frequencies

High threshold receptors = small diameterfibers (A-delta & C)

Low threshold receptors = large diameter

fibers (A-beta & C-fibers)


63/98

PHYSIOLOGY OF PAIN

Means for Transmitting Signals

Spatial summation: stimulation of manyfibers in a nerve trunk simultaneously ratherthan of a single fiberintensified effect.

Temporal summation: # of impulses along a

single fiber (10, 30, 100). Stronger theimpulse the greater number of fibersinvolved & greater rate of impulsetransmissionby each fiber.


64/98

Differential Diagnosis of Facial

Pain Most pain DHCW deal with = Odontogenic

Maxillary sinusitis Maxillary molars

Ear infection Mandibular molars

Most Common Causes of Facial Pain:

Caries

Acute or chronic pulpitis

Exposed dentin or cementum

Fractured tooth syndrome

Impacted tooth Gingivitis or periodontitis


65/98


66/98

PERICORONITIS

Mostlyassociated with mandibular 3rdmolar.

Acute infection around crown of tooth withsuppuration around pericoronal flap(operculum)

Rx:

Irrrigate under flap

Rx antibiotics (Penicillin or Clindamycin)Operculectomy

If not treatedinfection can spread thru facialplanes of face & necktrismus, pain,

elevated temperature


67/98


68/98

Facial Spaces & Spread of

Infection LATERAL PHARYGEAL:

Rapid spread of infection

Lies medial to ramusInfection canextent to base of skull & chest

Trismus of Medial Pterygoid Muscle

PERITONSILLAR:

Most commonly involve tonsillar infections


69/98

Routes of Spread of Infections

Hematogenous

Lymphogenous

Facial spaces

Direct extension

All sinuses are in direct communicationwitheach other

Maxillary canine infectionCavenous SinusThrombosis

Mandibular molar infectionsLudwigsangina


70/98

ANESTHESIA

MAXILLARY:

Ant, Mid, Post SAN All Teeth + Bu gingiva

Post SAN DB roots 1st, 2nd, 3rdMolars

Mid SAN M-B root 1stmolar + PMs

Ant SAN Incisors + Canine

Nasopalatine N soft tissue palatal toincisor + canine

Greater Palatine N soft tissue palatal &distal to canine


71/98


72/98

LOCAL ANESTHETICS

ESTERS OF BENZOIC ACID:

Procaine (Novocaine)

AMIDES:

Xylocaine (Lidocaine) 2% + Epinephine1:100,000

Carbocaine (Mepivicaine) 3% (NOepinephrine)

Topical Anesthesia: 2% xylocaine ointment

Ethyl chloride (cold spray)


73/98

CHARACTERISTICS OF LA

Highest Concentration Needed for:

Motor nerves fibers

Pain fibers

Autonomic fibers

LA Results in Order of Loss of Function:

Pain (unmylinated) Proprioception

Temperature Muscle tone(myelinated)

Touch


74/98

MODE OF ACTION OF LA

LOCAL ANESTHETICS:

Lipid soluble + weak organic bases

Converted to water soluble acid saltsDissolved in water for injection

Non-ionized free base penetrates nerve

membrane

Cationic form required for anesthetic

activity within cell


75/98

Mode of Action of LA

Potency increaseswith increased lipid solubility

Cationic formavailable ininjection capsule

Cationic formchanges to free baseoninjection into alkaline buffers in tissue

Free baseenters cellreconverted to cationicformblocks Na channel


76/98

MODE OF ACTION OF LA

Tissue pH should be slightly alkaline tohydrolyze free base from water soluble salt

form

Acidc pH (infection) ionic form pooranesthesia

LA stabilize nerve membrane elevatedmembrane threshold no depolarization

Na channels do not open, Na will not enter

axon


77/98

EXCRETION &

ABSORPTION OF LA PROCAINE:

Hydrolyzedby plasma esterase paraaminobenzoic acid (PABA) diethylaminoethanol

(80% excreted in urine) (3% in urine)

XYLOCAINE (LIDOCAINE):

80%metabolized inLiver by microsomalenzymes

2% Xylocaine: 1cc=20 mgs.

Max adult (70 kg) dose = 300 mg or 15cc

(8 carpules)


78/98


79/98

ACTION OF LA

Concentration of LA= 6x greater than thatneeded to affect CNS

Smallest amount necessary should be used

Aspiration extremely important

Toxicity of LAresults in respiratory arrestbefore cardiac arrest

i f


80/98

Action of vasopressors

(epinephrine) in LA Increase depth & length of anesthesia

Retains LA solution in the area injected bydiminishing blood(vasoconstriction) prolong

anesthesia

Reduces bleedingbetter visibilityof field

Reduces the toxicity of LA by decreasing rapidabsorption into blood

Most common vasopressor used = epinephrine

1:50,000 1:100,000 1:200,000

C f 1 8 l l f


81/98

Contents of 1.8 ml carpule of

2% Xylocaine with epinephrine 36 mg Lidocaine

0.018 mg Epinephrine

NaCl

Na-metabisulfate (preservativetostabilizeepinephrine)

Methylparaben (preservative, cause of allergy)

NaOH(stabilize pH)

T i i & Ad R i


82/98

Toxicity & Adverse Reactions

to LA Majority of toxic reactionsdue to overdose

Urticaria (local edema) + bronchospasm (rare)

Rx Benadryl 10 mg/1 cc + epinephrine1:100,000

Intravascular injection cardiac arrhythmias

Tissue irritation if injected into muscle CNS stimulation then depression & peripheral

cardiovascular depression

Increased salivation

T i i & Ad R i


83/98

Toxicity & Adverse Reactions

to LA Tremors

Convulsions

Coma Hypertension

Tachycardia

Hypotension Paralysis of orbital nerves

Blindness (wrong injection technique)


84/98

Pre-op Medication

Tranquillizer(Valium)

Psycho-sedative(Librium)

Both produce no hang over(barbiturates do)

Both are muscle relaxants + anti-convulant

Both no analgesicproperty

Both show little depression of respiration or heart

Amnesia = IV Valium (not in 1sttrimester) Barbiturates relieve anxiety

Demerol (narcotic) drowsiness + euphoria +elevated painthreshold (Lorfan, Nalline antagonist)

PRINCIPLES OF MINOR


85/98

PRINCIPLES OF MINOR

EXODONTIA A. Reasons for Exodontia:

Pulpalpathology: endodontics not feasible

Peridontalpathology: peridontics not feasble

Trauma: fractured or displaced teeth beyondrepair

Impacted teeth

Orthodonticindications: create spaceProsthodonticindications: path of insertion

Estheticindcations: micro or macrodont

PRINCIPLES OF MINOR


86/98

PRINCIPLES OF MINOR

EXODONTIA B. Contra-indications for Exodontia:

Acuteperiapical infection

Acute periodontal infection ANUG

Osteo-radionecrosis

Uncontrolled Systemic conditions

PRINCIPLES OF MINOR


87/98

PRINCIPLES OF MINOR

EXODONTIA C. Factors re Difficulty Level of Exodontia:

Number of roots

Length of roots

Hypercementosis

Periodontal disease

Density of bone (condensing ostitis)

Vitality of tooth (tooth brittle) Degree of caries

Relation to sinus, mandibular canal etc

PRINCIPLES OF MINOR


88/98

PRINCIPLES OF MINOR

EXODONTIA D. Mechanics of Tooth Extraction

1. Forceps

Luxation forces perpendicular to long axis oftooth (not pulling along long axis)

Fulcrum close to apex of tooth

High ratio of lever to action arm

Beaks short & concave to adapt to root Place beaks opposite each other at same

level

Beaks parallel to long axis of tooth


89/98

MECHANISM OF


90/98

MECHANISM OF

EXTRACTION 3. Types of Elevators

Straight: most commonly used

Crane pic: off set blade placed in purchasepoint & furcation and used as a lever.

Root elevators(right & left): blades off set

to reach into back of socket.

Cryer elevators(EastWest): (right & left):triangular pointed blades, used primarily on

lower molar roots.

MECHANISM OF


91/98

MECHANISM OF

EXTRACTION 4. Procedures in Minor Exodontia

A. Use opposite hand to:

1. Retract soft tissues for visibility &protection

2. Help guide beaks of forceps into

position

3. Stabilize jaws & apply counterpressure to take stress of neck &

jaw muscles

PROCEDURES IN MINOR


92/98

PROCEDURES IN MINOR

EXODONTIA B. Test for anesthesia& reflect periodontal

attachment.

Use elevator to facilitates placement of beaks

& prevents tearing marginal gingival

C. Place beaks sub-gingivally on cementum.

Handles held in hammer-type grip forapplying forces

PROCEDURES IN MINOR


93/98

PROCEDURES IN MINOR

EXODONTIA D. Extraction forces Initial force directed apically (places

fulcrum point near apex + minimize root

fracture)

Next forcesether buccal-lingual luxationorrotation(incisors + canines)

No pullinguntil tooth is loose

PROCEDURES IN MINOR


94/98

PROCEDURES IN MINOR

EXODONTIA E. WOUND CARE:

Compress buccal plate with finger

Use curette to remove periapical pathology

Pressure applied by patient biting on gauze

Suture only if severe bleeding or marginal

gingiva is torn or loose

PROCEDURES IN MINOR


95/98

PROCEDURES IN MINOR

EXODONTIA F. EXODONTIA FOR DECIDUOUS TEETH Molarshave flared spindly rootswhich

increase risk of root fracture

For maxillary molars the primarydirection of luxation is palatal (buccal inadults). Deciduous molars more palatally

positioned & palatal root is strong.

Caution not to disturb permanent tooth

bud


96/98

EXTRACTION FORCES

MAXILLA LUXATION

Anteriors Labail + Palatal +Rotation

1stPM Buccal + Palatal(no rotation)

2nd

PM Buccal + Palatal +Rotation

Molars Buccal + Palatal(N.B. Palatal delivery fordeciduous molars)


97/98

EXTRACTION FORCES

MANDIBLE LUXATION

Incisors Labial+ Lingual +Rotation

Cuspid Labial+Lingual +Rotation

Premolars Buccal + Lingual +Rotation

Molars Buccal + Lingual

POST EXTRACTION


98/98

POST EXTRACTION

PATIENT INSTRUCTIONS A. Mouth rinses: No rinses for 24 hrs (preventsloosing clotdry socket

B. Pressure dressings: 2x2 gauze over site +

patient bite down. Tea bag (Tannic acid). C. Avoid spitting vigorously

D. Application of Ice: first 24 hrson out side offace (reduces edema)

Application of Heat: after 24 hrs if there is lotsof swelling. Causes increased blood supply.

Di t id ti ll h t ld f d

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Oral & Maxillofacial Surgrery

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