extraction of maxillary anterior dentition, alveolectomy, gingivectomy
Post on 14-Jun-2015
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Extraction of Maxillary Anterior Dentition, Alveolectomy, Gingivectomy
Preoperative 2D rendering.
Pt was referred by UW Kaiser clinic.
Plan is for extraction of maxillary dentition, Alveolectomy, and gingivectomy.
#28 to be removed at later date per patient.
Patient profile: note extruded position of anterior complex and supporting alveolar bone
Anterior view
Excessive vertical overlap as a result of anterior complex extrusion
This slide and next:• Green line denotes improved gingival margin and incisal
position. • Patient will require wax-up to determine final vdo and tooth
position.• However proper prosthetic tooth position will be
IMPOSSIBLE without adequate Alveolectomy. ~ 3-4mm to compensate for superior tooth position and ~ 1- 2mm for acrylic base thickness
New anterior view with teeth digitally moved superiorly by about 3-4mm
Yellow arrows indicate direction the anterior complex needs to be shifted.
The green line approximates the outline of a wax rim assuming the vdo will have remained the same
Full thickness approach.
Crevicular incision around the buccal of the teeth
Next two slides:
Using an opposing thumb or finger as a fulcrum allows for controlled elevation of a full thickness flap.
Note curvilinear vertical release begins a few millimeters distal to the end of the surgery site (tooth #5).
Continual use of throat pack
1.improves patients comfort 2. minimizes heme accumulation in the back of the throat3. Reduces risk of aspiration of bone, tooth, and tissue
Use of gauze to quickly strip full thickness flap from the alveolus
Create a vertical corticotomy around The mesial and distal of the roots. This creates a good purchase point for elevators
Remove buccal alveolar bone
Use surgical handpiece with 557 surgical bur
Counter-clockwise rotation with apically directed pressure to dilate socket.
Thumb and forefinger provide stabilization of beaks on root surface
Clockwise rotation with apically directed pressure to dilate socket.
Thumb and forefinger provide stabilization of beaks on root surface
Correct hand position. Middle finger provides attenuation of grip pressure applied to forceps.
All roots removed intact
Planned Alveolectomy
Piezo-electric handpiece and saw tip
Alveolectomy incision
Separating sectioned alveolus
Sectioned alveolus
Rounding corners of the surgery site
Removing excess tissue
Untensioned primary closure. Note wound margin eversion.
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