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regarding surgery : I think This summary for the summer semester (practicalinfo) will help U in the clinic:

*For tooth extraction in maxilla :the head should be 45-60 degree.The pt mouth should be 8cm below the shoulder level.

*For tooth extraction in mandible , the head should be up-right position.The height should be 16 cm below the level of operators elbow.

________________________________#operator position:

In all teeth U should stand in front of the patient in the right side, except:if the operator is right handed> the exception is the lower right> the operator

should stand posteriorly to the patient in the right sideif the operator is left handed> the exception is the left side> the operator

should stand posteriorly to the patient in the left side________________________________

FORCEPS:Upper forceps : no angle (straight) btw the handle and the peak

Lower forceps: right angle btw the handle and the peakNotch= molar

For post teeth in the maxilla specially the max 3rd molar = Bayonet forceps*Bayonet forceps: the peak and the handle are in the same level and have

additional part ( curve/ angle) to reach post teeth in maxilla.Mand teeth=2 roots = 1 bifurcation area in each side = 2 notches (1 buc+ 1

ling(Max teeth = 3 roots = 1 bifurcation area =1 notch buccaly.

Mand: Rt and Lf forceps are the same.Max: there is diference btw Rt and Lf bcz we have one notch ( buccaly(

*the concave part of max forceps handle should face the palm of the hand._________________________________

*the top of the peak:if it Closed completely then its for the roots

if their is a Small space then its for tooth with crown*max teeth before Mand teeth*Post teeth before ant teeth*2teeth you should take care of (6+3) bcz of their roots6=divergent root3=long root8

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nerve that branches is 1) posterior superior alveolar nerve that innervatesposterior molars and palatal of 6

*then the maxillary nerve continues and in the fossa it will give many nervesto the nose and face , it will end by exiting from the infraorbital canal and itwill be called 2) infraorbital nerve which branches to (a) middle nerve which

innervates premolars & MB root of 6 (b) anterior superior alveolar nerve which

innervates anterior teeth.Hard palate is innervated by 2 nerves:

)1(the greater palatine which is a branch of maxillary nerve.)2(incisive nerve is a continuation of the naso- palatine nerve which is also

branch of maxillary nerve.Soft palate is innervated by lesser palatine nerve.

Palatal anesthesia:-give LA next to the tooth = btw the middle of the palate and the margin of

the tooth.-bevel of the needle should facing the bone.

Buccal infiltration details:1-central and lateral infiltrations : next to them ( above them(

2-canine: mesial or distal and you can give infiltration above the canine but itis painful

3-premolars : above them4-1st molar is double innervated , give the LA 0.5ml distal and 0.5 ml mesial5-In 7 & 8 : give next to the tooth ( in the book : distal to the zygomatic

buttress. (*Giving LA in the anterior maxilla can be very painful ,you can use topical

anesthesia before putting the needle.**Posteriorly in the maxilla : we need to be aware of the pterygoid venous

plexus ,we need to be very careful when dealing with this area bcz injection ofLA in it will lead to intoxication so we never go very deep in this area to avoid

reaching it ,we also may traumatize these tissues and result in hematoma

which is a collection of bleeding within the tissue.***both greater palatine and incisive nerve innervates palatal mucosa of the

canine****incisive gives the pre- maxilla ( which is from canine to the canine(

Infra orbital nerve block:*example: if we want to extract anterior teeth & premolar-the nerve supply these teeth buccally is infraorbital ,so we can give

infraorbital nerve block instead of infiltration around each tooth.-rare used.*infra orbital nerve:-it's exits through the infra orbital foreman just below the middle of the

inferior orbital rim.

-easily palpated.-2ways to block it:

)1(intra orally)2(extra - orally : immediately through the skin.

Notes:-Giving mandibular nerve block can cause facial palsy to the Pt

( it will subside eventually so don't be panic.(-when we do greater palatine nerve block we anesthetize the

lesser palatine too ,so the soft palate will be anesthetized ,andthere will be a feeling of choking ( it's not A big deal. (

______________________________Regional nerve block technique:(anasthesia to a named nerve(

we can anathematize a group of teeth by one injection

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we use longer needle (infiltration> 20mm, ID block> 35mm(we use it for the man teeth

if U want to extract the teeth U should anesthetize all the nervethat supply the pulp and the gingiva:

*8-5:inferior alveolar nerve block (ID block), lingulay>anesthetize the lingual nerve, buccaly> the long buccal nerve

*4-3:mental nerve block( but our goal is to block the incisivenerve) , lingualy>the lingual nerve, buccaly> the mental nerve

*2-1:cross innervated so we use infiltration for the ant area ofthe manbuccaly and lingualy.

~~~~~~~~~~~*ID nerve block technique:(give whole cartridge, 2mm(

the LA should given btw the ant & the pos border of themandible, U should lock for the pterygomandibulr raphe this

raphe is medial to the ant border of the ramus and the LA mustbe given btw them.

-Uto inject the needle we go to the contra lateral side btw thepremolar and parallel to the occlusal plane and just above it.

~~~~~~~~~~)2(*ID nerve block technique:(give whole cartridge, 2mm(

the LA should given btw the ant & the pos border of themandible, U should lock for the pterygomandibulr raphe this

raphe is medial to the ant border of the ramus and the LA mustbe given btw them.

-Uto inject the needle we go to the contra lateral side btw thepremolar and parallel to the occlusal plane and just above it.

~~~~~~~~~~*mental nerve block:(45 degree with long or short needle just

next to the apices of the premolars btw the root of the premolar(by blocing the mentel nerve U anesthetize also the incisive nerve

which supply the pulp and the mental nerve supply the bucaalpart. So to anesthetize this part lingualy we give infiltration in the

floor of the mouth (few drops(