oral surgery volume 1

8/8/2019 Oral Surgery Volume 1

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Oral Surgery

Volume 1


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Dental Surgery/Minor Oral Surgery

Definition

includes all surgical procedures within the

oral cavity that can be performed underlocal anesthesia on an outpatient basis.

As a specialized area within OMS all basic

principles of this medical discipline applyto Dental/Minor Oral Surgery as well.


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Surgical procedure

-each surgical procedure represents an injury

and only:

- the intention to bring healing- the patients agreement to the procedure

- responsible screening about own skills

and abilities

protects from legal action!!!!!


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Classification of procedures

The difficulties within each surgical

treatment together with the actual demand

for surgical skills and experience as well asequipment mark the classification of a

surgical procedure:

SAC Classification

S = Simple A= Advanced C= Complex


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SAC - Classification

S = Simple

- Simple procedure without

anatomically related risks,

- Absence of surgical technical

difficulties

- Lack of compliances

- Can be performed by any

well-trained dentist in a

private dental clinic

Tooth extractions

Incision of alveolar process

abscess

Flap procedure alveolar

process

Root resection upper anterior

region

Biopsy of mucosa

Excision of benign

pedunculated tumors of thevestibulum

Gingival resection and

curretage


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A= Advanced

- simple procedure but withanatomically related risks

- Minor surgical technicaldifficulty

- Complications expected- Can be performed by a

surgically trained dentistin a standard dental clinic

- Tooth extractions

- Removal of retained orimpacted teeth

- Incision of abscess in thealveolar process

- Flap reflection on the alveolarprocess

- Apicoectomy

- Cystectomy

- Removal of peripheral sialoliths

- Mucosal biopsy

- Excision of benign tumors of

the vestibulum and tongue- Free gingival transplants

- Vestibuloplasty

- Gingival excision and curretage


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C = Complex

- More difficult procedures,with or withoutanatomically related risks

- Technically difficult

surgically, and timeconsuming

- Complications expected

- Can be performed by asurgically experienced

dentist or oral surgeonunder aseptic conditions

all complicated proceduresin patients with systemicand local risk factors:

diabetes

cardiac and circulatoryproblems

kidney or liver damage

hemorrhagic diathesis

breathing problems

allergiesimmune suppression

following radiation therapy


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Some indications for tooth

extraction

Deep caries

Apical ostitis Failure of root canal

treatment

Root fractures

Extremely deepperiodontal pockets

Acute local infections


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Tooth extractions

Principles and instruments Proper anesthesia Sever the marginal tissue with a desmotome

Insert the required elevator and loosen the

targeted tooth to mobility grade 2 if possible Apply the beaks of the forceps with proper grip

to both sides of the tooth

Force the tooth axial with push and pull

movements, with luxating movements at thesame time

Use high but controlled force


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Tooth extraction

InstrumentsForceps Incisors - upper + lower

Canine\ bicuspid - upper + lower

molar - upper right + upper left

+ lower

3rd molar - upper + lower

root forceps - upper + lower

forceps of smaller size for deciduous teeth


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Tooth extraction

InstrumentsElevators

Today there exists numerous elevators of

different shapes, we can identify 3 groups:1st> straight elevators

2nd angled elevators

3rd hooked\curved elevators


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Elevators

Hooked Angled Straight


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Root separation Upper molar

Lower molar


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Seperated roots and crown of lower molar


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Loosening of cervical attachment


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Finger support upper extraction


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Finger support lower extraction


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Finger support/Stabilization

Why is the finger support important?

to fixed the mandible

to maximize the effect of applied force- to avoid trauma of TMJ

to palpate the bone

to sense the tooth movement

to stabilize the process


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Remaining RootsRadix relictae


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Removal technique1st: 2 vertical incisions covering the alveolar area

2nd

: low speed bone cutting and removal with elevator


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Removal of remaining roots

Closure by single suture

oral surgery volume 1

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