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ADMINISTRATIVE3rd Edition August 20111/16/2013 1
Oral Surgery Tips for the General Dentist
user
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MEDICAL EMERGENCIESEquipment, Supplies, Medications Emergency
Protocol and Procedures Staff Training and Documentation
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Automated External Defibrillator
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Personal Protective EquipmentInfection Controlvs. OSHA
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Patient Management StyleBased on Your Personality Be Positive
and Confident Develop a Relaxed Comfortable Style Address the
Dental Fear/Pain Complex
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Know Your Patient
Interview the Patient Review Medical History Examine Dental
Record and Radiographs Clinical Exam of Patient Confirm Diagnosis
and Treatment Plan Use the 5 Minute Rule on New Patients1/16/2013
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RADIOGRAPHSCURRENT: No more than 6 to 12 months old DIAGNOSTIC:
Clarity and Accuracy
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Evaluate and Plan the ProcedureAssess/Anticipate difficulties:
Refer PRN Advise Patient: Informed Consent: Surgical Info and Risks
Alternative or No Treatment Signed Consent Form Dental Plan of
Attack
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Dental Plan of AttackSimple vs. Complex Sequence of procedures
Plan Sectioning of Teeth Boney Access Opening Flap Design Closure,
Sutures Prepare Appropriate Instrumentation1/16/2013 10
Instrument Trays
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150
151
151S
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150
151
151S
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65 (Top)
69
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88L / 88R
23
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Standard Elevators301 304 34
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COGSWELLA B
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Patient Protection
2 1
3
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Anesthetic ConsiderationsPatients Medical History Type and
Duration of Procedure Presence of Inflammation or Infection
Pregnancy
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Needle Modifications
Curved Surfaces (Needles) are Stiffer than Straight Surfaces
Less Deflection Upon Insertion Better Access to Injection Sites
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Needle Modification
-
Curved Needle vs. Bent Needle
YES1/16/2013
NO21
Anesthesia Access Difficulties
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Needle ModificationBetter Access to Anesthetic Sites
Max
Mand
Curved Path of Insertion1/16/2013
IAN Buccally & Superiorly23
Linguala/IAN Alignment
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Hard Tissue Considerations
Tooth Anatomy Location and Angle Boney Access/Reduction
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Pell and Gregory Classification
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Mandibular Molar Anatomy
Textbook Anatomy 1/16/2013 Anatomy
Real World27
Mandibular Boney Access
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Troughing Impacted Teeth
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Flap Design ConsiderationsDetermined by Hard Tissues Location of
Tooth, Tori, Other Degree of Impaction Soft Tissue
Anatomy/Physiology Closure
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Flap Design, Extended(Anterior Releasing Incision)B U C C A
L
B U C C A L Max1/16/2013
B U C C A UndercutL Incision Mand31
Lingual Nerve
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Mandibular Mesio-Angular
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Mand Mesio-Angular SurveyCrown Axis 15
Ext Path
Root Axis
Convergent Tooth Outline
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Mandibular Mesio-angular Sectioning
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Sectioning Mandibular Molars
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Mandibular Mesio-angular Extraction Sequence
1st
2d
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Mandibular Boney Access
Distal Trough
Preserve
Buccal Trough
M-B Root Access
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Mandibular Mesio-angular Flap
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Mandibular Disto-Angular
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Pre-Op Survey of Tooth15Crown axis Bind Root axis
Ext Path
Cone shaped root outline
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Disto-Angular Sectioning
1st Distal Trough
2d Section Mesial Cusp to Distal CEJ
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Disto-Angular Extraction
Path of Extraction
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Disto-angular Boney AccessExisting Boneline
Distal TroughPreserve
Buccal Trough1/16/2013
Access to M-B Line Angle44
Mand Disto-angular Flap
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Mandibular HorizontalRequires Multiple Sectioning
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Horizontal Impaction Survey
Bind
Crown Axis Root Axis Undercut
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Horizontal Sectioning Sequence
2d1st
3d1/16/2013 48
Seperate Mesial-Distal Roots
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Horizontal Extraction Sequence
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Horizontal Boney Access
Distal Trough
Buccal Trough
Preserve
M-B Access
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Mandibular Flap, Extended
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Mandibular-Wide Roots And Dilacerations
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Mandibular-Wide Roots & Dilacerations Survey
CEJ Root Width
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Mandibular-Wide Roots & Dilacerations Sectioning
PRIMARY
OPTIONAL
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Mandibular - Wide Roots & Dilacerations Boney AccessDistal
TroughExisting Boneline
Preserve
Buccal Trough
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Mandibular-Wide Roots Flap
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Maxillary ImpactionsPell and Gregory Class C Buccal Approach
Normally
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Maxillary SurveyRoot Axis Convergent Root Outline
Ext Path
Crown Axis Undercut
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Maxillary Impaction Extraction
Ext Path
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Boney Access MaxillaryBuccal Trough Access to M-B Line Angle
Preserve
Distal Trough
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Flap Design Maxillary
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Surgical ClosureSoft Tissue is Critical for HealingPrepare Boney
Surfaces Align and Secure Tissues Surgical Stent prn Suture
Selection
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Infection PreventionSterile Technique Extract Entire Tooth,
Roots Curettage; Fragments, Debris, Granulomas Irrigation,
Irrigation, Irrigation Antibiotics NOT Normally Indicated
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Infection TreatmentI & D Where Obvious Flap, Curettage, and
Irrigation where Feasible Antibiotics as an Adjunct Only -Febrile
Patient -Immunocompromised Patient F/U Appt< 48 hrs
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I&D Technique
Location, Muco-Gingival Junction Blunt Disection Slight
Compression Irrigation Penrose Drain 2 Silk Sutures F/U in 24-48
hrs Remove in 3-5 Days Antibiotics PRN
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Post Op Instructions WRITTEN & VERBAL Bleeding Swelling Pain
Control Diet Oral Hygiene Limit Physical Activities Emergencies (
POCs )
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Evaluation ConsiderationsThird Molar in Occlusion Exostosis
Small Obicularis Oris Limited Opening Compromised Buccal Space
Strong Gag Reflex Exceptionally Anxious Patient1/16/2013 68
Evaluations (Cont) Maxillary ImpactionsDeep Vault vs. Shallow
Vault
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Evaluations (Cont)Know Your Limits
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Evaluations (Cont)Know Your Limits
ORAL SURGEON!!!
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Complications
Endodontically Treated TeethMay be Extremely Brittle and
Ankylosed >2 yrs Crown and Root Weakened by Tooth 1/16/2013
Reduction
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Complications (Cont)Isolated Maxillary Molars
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Maxillary Molar, Surgical(ISOLATED)
SEPARATE SECTION
EXTRACT
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Maxillary Molar, Surgical(ISOLATED)
SECTION SEPARATE
EXTRACT
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Complications (Cont.)Oral-Antral Opening-
-
-
Check for O-A Opening Check for Fragments in Sinus Surgical
Closure Medications Patient Instructions Follow-up76
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Oral Antral Management
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Oral Antral Management
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Broken Restorations-Examine for Defective Restorations Crowns
-Advise Patient before surgery -Use Caution When Elevating -Use a
Surgical Approach -Replace Broken Restorations with Temps -Replace
Loosened Crowns/Bridges with Temp Cement1/16/2013 79
Complications
Using Surgical Handpieces
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Gas Driven Handpiece, Hall DrillCompressed Nitrogen
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Impact Air Surgical Handpiece
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Piezosurgery Handpiece
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Questions ?
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