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