dr. partridge---oral-surgery-hints-for-the-general-dentist

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ADMINISTRATIVE

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ADMINISTRATIVE

3rd Edition August 2011

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Oral Surgery Tips for the General Dentist

user

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MEDICAL EMERGENCIES Equipment, Supplies, Medications

Emergency Protocol and Procedures

Staff Training and Documentation

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Automated External Defibrillator

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Personal Protective Equipment

Infection Control

vs.

OSHA

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Patient Management Style

Based 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 Patients

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RADIOGRAPHS CURRENT: No more than 6 to 12 months old

DIAGNOSTIC: Clarity and Accuracy

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Evaluate and Plan the Procedure

Assess/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 Attack”

Simple vs. Complex

Sequence of procedures

Plan Sectioning of Teeth

Boney Access Opening

Flap Design

Closure, Sutures

Prepare Appropriate Instrumentation

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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” Elevators

301

34

304

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COGSWELL

A B

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Patient Protection

1

2

3

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Anesthetic Considerations

Patient’s 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 -

YES NO

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Anesthesia Access Difficulties

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Needle Modification

Better Access to Anesthetic Sites

Curved Path of

Insertion

IAN – Buccally & Superiorly

Max Mand

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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 Real World Anatomy

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Mandibular Boney Access

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Troughing Impacted Teeth

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Flap Design Considerations

Determined 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

Undercut

Incision

Max Mand

B

U

C

C

A

L

B

U

C

C

A

L

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Lingual Nerve

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Mandibular Mesio-Angular

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Mand Mesio-Angular Survey

Root

Axis

Crown Axis

Convergent Tooth Outline

15°

Ext

Path

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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

Preserve

M-B Root

Access

Distal

Trough

Buccal

Trough

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Mandibular Mesio-angular Flap

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Mandibular Disto-Angular

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Pre-Op Survey of Tooth

15°

Root axis

Crown axis

Ext

Path

Cone shaped

root outline

Bind

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Disto-Angular Sectioning

Section Mesial

Cusp to Distal

CEJ

Distal

Trough

1st 2d

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Disto-Angular Extraction

Path of

Extraction

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Disto-angular Boney Access

Distal

Trough

Buccal

Trough

Preserve

Existing Boneline

Access to M-B

Line Angle

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Mand Disto-angular Flap

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Mandibular HorizontalRequires Multiple Sectioning

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Horizontal Impaction Survey

Root

Axis

Undercut

Crown

AxisBind

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Horizontal Sectioning Sequence

1st

2d

3d

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Seperate Mesial-Distal Roots

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Horizontal Extraction Sequence

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Horizontal Boney Access

Preserve

Distal

Trough

Buccal

TroughM-B Access

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Mandibular Flap, Extended

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Mandibular-Wide RootsAnd Dilacerations

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Mandibular-Wide Roots& Dilacerations Survey

CEJ

Root Width

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Mandibular-Wide Roots& Dilacerations Sectioning

OPTIONAL

PRIMARY

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Mandibular - Wide Roots& Dilacerations Boney Access

Existing Boneline

Buccal Trough

Distal Trough

Preserve

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Mandibular-Wide RootsFlap

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Maxillary Impactions Pell and Gregory Class C

Buccal Approach Normally

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Maxillary Survey

Ext

Path

Convergent

Root Outline

Undercut

Root Axis

Crown Axis

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Maxillary Impaction Extraction

Ext

Path

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Boney Access Maxillary

Distal

Trough

Preserve

Access to M-B

Line Angle

Buccal Trough

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Flap Design Maxillary

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Surgical Closure

Soft Tissue is Critical for Healing Prepare Boney Surfaces

Align and Secure Tissues

Surgical Stent prn

Suture Selection

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Infection Prevention

Sterile Technique

Extract Entire Tooth, Roots

Curettage; Fragments, Debris, Granulomas

Irrigation, Irrigation, Irrigation

Antibiotics NOT Normally Indicated

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Infection Treatment

I & 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 Considerations

Third Molar in Occlusion

Exostosis

Small Obicularis Oris

Limited Opening

Compromised Buccal Space

Strong Gag Reflex

Exceptionally Anxious Patient

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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 Teeth

May be Extremely Brittle and Ankylosed >2 yrs

Crown and Root Weakened by Tooth Reduction

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Complications (Cont)Isolated Maxillary Molars

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Maxillary Molar, Surgical

(ISOLATED)

SECTION

SEPARATE

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-up

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Oral Antral Management

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Oral Antral Management

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Complications 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 Cement

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Using Surgical Handpieces

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Gas Driven Handpiece, Hall Drill Compressed Nitrogen

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Impact Air Surgical Handpiece

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Piezosurgery Handpiece

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Questions ?