minor oral surgical principles (nxpowerlite) / orthodontic courses by indian dental academy

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  • Minor Oral Surgery Principles &Exodontia INDIAN DENTAL ACADEMY

    Leader in continuing dental education www.indiandentalacademy.comwww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Principles of minor oral surgery Diagnosis and treatment planningBasic necessities for surgery. Pain and anxiety controlAseptic techniqueIncisionsFlap designTissue handlingHemostasisMeans of promoting wound hemostasisRemoval of bonewww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Delivery of the tooth, root or other lesionDecontamination and debridementPrinciple of drainageDead space managementSuturing principles and methodsPost surgical care of wound and edema controlPatient general health & nutrition. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • DEVELOPING A SURGICAL DIAGNOSIS AND TREATMENT PLANNINGThe decision to perform surgery should be the culmination of several diagnostic steps. The initial stepPresurgical evaluation: collection of accurate and pertinent data. Patient interviews Physical Laboratory and Imaging examinationwww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Patient information and data should be organized into a format to reach a proper diagnosis and form a decision concerning surgery which is either indicated as not.

    Surgeons should be thoughtful observers, should note all aspects of its outcome to advance their surgical knowledge and to improve future surgical results. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • BASIC NECESSITIES FOR SURGERY Two principles requirements are Adequate visibility

    Assistance

    Adequate visibility: This depends on 3 things Adequate access

    Adequate light

    A surgical field free of blood and others fluidswww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Adequate access

    Patients ability to open their mouths wide but also require surgically created exposure.

    Retraction of tissues away from the operative field provides much of the necessary access. Proper retraction also protects tissues from accidental injury e.g., cutting instruments. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Bowdler Henry rake retractor.Wards double ended 3rd molarsLacks tongue depressorKilners cheek retractorLasters retractor for upper 3rd molar Instruments for retractionwww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Adequate lightBackground illumination colour corrected fluorescent lamps 400-500 lux intensity.

    Main sealing mounted lamp (luminare) high intensity.- Focused at the centre of the surgery 40,000-100,000 lux.Periphery of the surgery - 8,000 15,000 lux.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • A surgical field free of fluids High volume suctioning with a small tipWet gaugesCotton and Sponge

    Competent assistance:A trained and competent assistants provides invaluable help during surgical procedures.

    The assistant should be sufficiently familiar with the procedures being performed to anticipate surgeons needs.

    www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Pain and anxiety control

    Local anaesthesia

    Sedation

    General anaesthesia

    www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Principle of AsepsisAsepsis is the exclusion of micro-organisms from the operative field to prevent them entering the wound. Preoperative surgical scrub4% chlorhexidine 10% Povidine Iodine

    Patients preparationDetergents 10% povidine iodine in 10% alcohol. 0.5% chlorhexidine Alcoholic solutionMouth washPovidine iodineChlorhexidinewww.indiandentalacademy.com

    www.indiandentalacademy.com

  • INCISIONSAn incision can be described as a sharp wound produced by a surgical scalpel.

    Basic principles of incisions

    1st principle - A sharp blade of the proper size should be used.

    Bone and ligamental tissues dull blades more rapidly than does buccal mucosa. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • 2nd principle: is that a firm, continuous stroke should be used when incising.

    Long continuous strokes are preferable to short interrupted ones. Mucoperiosteal incision should be firm that penetrates the mucosa and periosteum with the same stroke. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • 3rd principle: The surgeon should be careful to avoid cutting vital structures while incising.

    No patients microanatomy is exactly the same. Avoid unintentional cutting of large vessels or nerves. For e.g., Incision in the mandibular buccal sulcus and lingual area - prevent the inadvertent cutting of facial and lingual vessels.

    www.indiandentalacademy.com

    www.indiandentalacademy.com

  • 4th principle: Incision through epithelial surfaces should be made with the blade held perpendicular to the epithelial surface. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • 5th principle: Incisions in the oral cavity should be properly placed.E.g., Over healthy bone, wound edges should be at least 6-8mm away from the defect. Incision should lie at the line angles of the teeth and not at the facial surfaces nor in the papilla.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Instruments to incise tissue Scalpel composed of handle + sharp bladeHandleScalpel bladewww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Scalpel motion made by moving hand and rest and not by moving entire forearm.Scalpel is help in a pen-grip and handle in supported against slipping.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Flap design:Surgical flaps are made to gain surgical access to an area or to move tissue from one place to another. The term flap indicates a section of soft tissue. Basic principles of flap designs - Prevent - flap necrosis- flap dehiscence- flap tearing

    www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Principles of flap design:

    Base of the flap should be wider than apex.

    The length of the flap should be no more than twice the width of the base.

    Axial blood supply should be included in the base of the flap.

    The presence of a sinus must be taken into account when flaps are designed.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • The base of the flap should not be excessively twisted or stretched.

    Flap must have adequate size to provide necessary access and visualization of the required area. Flaps should be a full thickness flap i.e., mucoperiosteal flap.

    The margins of the flap should be at least 6-8mm away from any present / future defect that will remain after surgery. www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Flaps should be designed to avoid any injury to local vital structure in the area of surgery i.e., lingual and mental nerves.

    Releasing incision should be used only when necessary and not routinely.

    Overextension of a flap in the vertical dimension should be avoided.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Types of mucoperiosteal flaps Envelope flapThree cornered flapwww.indiandentalacademy.com

    www.indiandentalacademy.com

  • Four cornered flapSemilunar flapTypes of mucoperiosteal flaps www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Y-shaped incision flapPedical flapTypes of mucoperiosteal flaps www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Tissue HandlingThe difference between an acceptable and an excellent surgical outcome rests on how the surgeons handle the tissue. Toothed forceps or tissue hooks.

    Tissue should not be retracted over aggressively.

    When bone is cut, copious amount of irrigation is used.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Soft tissues - protected from frictional heats or direct trauma from drilling equipments.Tissues - moistened or covered with a damp sponge prevent desiccation.Only physiologic substances should come in contact with living tissue.

    The surgeon who handles tissue gently is rewarded with wounds that heal with fewer complications and grateful patientswww.indiandentalacademy.com

    www.indiandentalacademy.com

  • HemostasisPrevention of excessive blood loss during surgery is important for preserving a patients oxygen carrying capacity.

    Decreased visibility that uncontrolled bleeding creates.

    Hematomas :Place pressure on woundsDecrease vascularity.Increase wound tension.Acts as culture media potentially the development of a wound infection www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Means of obtaining hemostasis:Assisting natural hemostatic mechanisms. Electro-coagulation.Suture ligation.Pressure packing.Vasoconstructive substances.Use of Hemostatic agents - Turpentine or tannic acid - Thrombin and Russell viper venom - Oxidized regenerated cellulose (Surgicel) www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Bleeding from bone

    Burnishing the bone with a small instrument.Applying hot packs.Bone wax.Driving a chisel into the bone.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Removal of Bone The aim is to expose and to remove bony overlying the tooth, root and other underlying pathology. Techniques of bone removal:a. Bur technique.b. Chisel and mallet technique.www.indiandentalacademy.com

    www.indiandentalacademy.com

  • Bur technique IT is prec