oral surgery in childrendental.subharti.org/pedodontics_lectures/oral_surgery.pdfprinciples of...

Oral surgery in children

Dr. Himanshu Kapoor

Dr. Himanshu Kapoor, Subharti Dental College, SVSU

SURGERY: Branch of medical science which treats injuries , trauma , or diseases by

manipulation or operation

Differences

Small oral cavity

Lack of patient co-

operation

Jaws are in growing

phase

Abundant blood supply

Bone is porous , more

malleable


ORAL SURGICAL PROCEDURES IN CHILDREN

1. EXTRACTION

2. IMPACTION

3. FRENECTOMY

4. APICOECTOMY

5. CYST

6. FRACTURE


DEFINITION

” Extraction is defined as complete, painless removal of tooth or tooth root with minimal trauma to surrounding investing structures, so that the wound heals uneventfully and there will be no post operative prosthetic problems”.


INDICATIONS FOR EXTRACTION


CONTRA INDICATIONS

FOR

EXTARACTION


ABSOLUTE

CONTRA INDICATIONS

1) LOCAL :-


2) SYSTEMIC


RELATIVE CONTRA INDICATIONS

1). LOCAL :-


SYSTEMIC CONTRA INDICATIONS


EVALUATION OF TEETH REMOVAL

• Access to Tooth

• Mobility of Tooth

• Condition of Crown


RADIOGRAPHIC EVALUATION

• Condition of the Tooth.

• Condition of the Bone.

• Relationship with associated Vital structures.


RADIOGRAPHIC INDICATIONS


TYPES OF EXODONTIA

• Intra-alveolar extraction also called as Closed extraction. Where tooth is luxated and elevated out of socket with elevators and forceps.


• Trans-alveolar extraction in this method an incision is placed and mucoperiosteal flap is reflected for proper accessibility, bone cutting is done either with a chisel and mallet or a bur. Sutures are placed to approximate wound margins.


PRINCIPLES OF EXTRACTION

• Intra-alveolar or Closed method

1. Forcep blade should be placed below the C.E. junction on sound root portion with apical thrust.


2. Mechanical principles:

1.) Expansion of bony socket


2) use of lever and fulcrum to elevate the tooth.


3). Use of wedge or wedges within root or socket.


4). Traction towards least resistance.

TRIANGULAR ELEVATOR IN ROLE OF WHEEL-AND-AXLE MACHINE, USED TO RETRIEVE ROOT FROM SOCKET.


PRINCIPLES FOR DECIDUOUS TEETH

EXTRACTION • Gentle and Judicious use of elevators

• Beak of the forceps should be carefully placed, so that it should not injure the hidden permanent tooth bud.


ORDER OF EXTRACTION

• To prevent bleeding from socket of extracted teeth obscuring the field of operation distal most tooth is first extracted.

• Maxillary teeth should be extracted before mandibular to prevent falling of debris or totth material in to socket.

• Canine should not be left last as alveolus may get fractured due to its length.


FORCES DURING EXTRACTION

• Apical force: to wedge the forceps firmly in the periodontal ligament space. this does not actually move the tooth but expands the bony socket

• Buccal force: Expands the buccal cortical plate. • Lingual force: Expands the lingual cortical plate. • Rotational force: Teeth with single conical roots

can be extracted by this method. it causes internal expansion of the bony socket.

• Tractional force: These are forces applied finally to remove the tooth completely out of socket.


RULES FOR APPLICATION OF FORCEPS

• Correct forceps for particular tooth should be selected.

• Grasp the forceps at the far end of handles.

• Long axis of the beaks of the forceps should be parallel to the long axis of the tooth.

• Beaks should be firmly grasped on sound root structure, not on enamel of crown.

• Beaks should not impinge on adjacent teeth.


FORCES APPLIED FOR DIFFERENT

TEETH • MAXILLARY:

• Incisors: labial-lingual-labial with mesial rotation.

• Cuspids: labial-lingual-labial with mesial rotation.

• First premolar: buccal-palatal-removal in buccal direction.

• Second premolar: buccal-palatal-removal in buccal or palatal direction.

• Molars: buccal-slight palatal and distal rotation.


MANDIBULAR:

• Anteriors: labial-lingual-slight mesial to distal

force and removal in labial direction.

• Premolars: buccal with slight mesio-distal rotation.

• Molars: buccal-lingual and removal in buccal direction.

• Third molars: buccal pressure and removal in buccal or lingual direction.


COMPLICATIONS OF EXODONTIA

• A complication is any deviation from normal expected pattern of events

• Fracture of:

• Crown of tooth.


POST OPERATIVELY DAMAGE TO:-


POST OPERATIVE PAIN DUE TO:-

• Acute osteomyelitis


POST OPERATIVE SWELLING DUE TO


TECHNIQUE FOR TOOTH REMOVAL IN CHILDREN

Explain the child : sensations

Procedure

Use elevator to free the attached gingiva from the cervix of the tooth labilally and lingually. Luxate the tooth slightly.


FOR PRIMARY ANTERIORS :

Beak of plier cervically……….slight rotation


FOR PRIMARY POSTERIORS

• Reflection of buccal and lingual gingiva ……beak at the furcation area……………give buccal movement ----normal----buccal ----normal ----then pull .


Inaccessible Root Tips If root tip is hopelessly unattainable through normal

means & will not interfere with normal growth and eruption, leave the root to exfoliate on its own.

Or remove surgically.


• If permanent tooth bud is moved during extraction, reinsert it properly ( buccolingual position ), apply suture to close socket .

• Pulp tests


INDICATIONS FOR EXTRACTION OF PERMANENT FIRST MOLARS

• If first molar extracted before second molar eruption (in gingiva ) – 2nd molar will move mesially and occupy the space .

• If 2nd molar has erupted – mesial tilting ( periodontal disease and orthodontic problems )

• If three molars are diseased – extract all four


IMPACTIONS

• Tooth fails to erupt even after its normal force of eruption due to any physical barrier.

• Prevalence : Permanent maxillary canine

Mandibular II pre molar

Maxillary lateral incisor

Supernumerary tooth


CAUSES

Local • Arch length deficiency

• Thick fibrous gingiva

• Premature loss of primary tooth

• Any pathology

Systemic • Hypopituitarism

• Hypothyroidism

• Genetic

• Cleft palate

• Cleidocranial dystosis


MANAGEMENT

1. NO NEED TO EXTRACT

2. ORTHODONTIC MANAGEMENT

3. SURGICAL REMOVAL


• At birth – labial frenum is attached to alveolar crest.

• But as growth takes place , alveolar process grows in

downward and forward direction - Frenum receedes upward

.

• If it fails …….high labial frenum – midline diastema

FRENECTOMY: Surgical removal of either

labial or lingual frenum. Dr. Himanshu Kapoor, Subharti Dental College, SVSU

APICOECTOMY

• Surgical removal of the apical end of periapically involved teeth /tooth in order to remove the pathology and to achieve a proper hermetic seal


Indications

Tooth / teeth which cannot be obturated by conventional orthograde method .

Broken instrument

Periapically involved teeth involving more than 1/3rd of the total root.

Failure to heal even after endodontic procedure .

Horizontal root fracture ( apical 3rd )


Contraindications

Medically compromised patients

Acute infections

Anatomical landmarks are close to root apex

Intentional Reimplantation


CYSTS IN THE SOFT TISSUES OF THE ORAL CAVITY


MUCOUS CYSTS

Site : lips and cheeks

hard and soft palate.

Appearance: Bluish in color

Elastic consistency

Treatment : Excision .


RANULAS AND DERMOID CYSTS

RANULAS

Site: floor of the mouth

Thin walled , blue-red ,

vesicular prominence

Have viscous fluid

Treatment :

marsupialization

DERMOID CYSTS

Yellowish in color

rubber like consistency

Filled with cheesy yellow

material


FRACTURES IN CHILDREN

• Facial fractures : 5%

• In young children :

• 1. More retruded position relative to the “protective” skull

• 2. The high elasticity of young bones, a thick layer of the adipose tissue covering them contributing to the low incidence of facial fractures


• Relatively larger amount of medullary bone held by a strong periosteal support

• Osteogenic potential of the periosteum leads to rapid and easier healing .

• In # without displacement : careful observation

• Minimally displaced #:crylic splints, circumferential wiring, arch bar or gunning splint


oral surgery in childrendental.subharti.org/pedodontics_lectures/oral_surgery.pdfprinciples of...

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