Transcript Chapter 25
25 Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery • Branch of dentistry that focuses on diagnosis and treatment of diseases, injuries, and malformations 2 Oral and Maxillofacial Surgery Team • • • • Surgeon Receptionist and business staff Dental assistant Nurse anesthesiologist or anesthesiologist 3 Scalpel Setup 4 Retractors • Tissue • Cheek and lip • Tongue 5 Tissue Retractors 6 Tongue and Cheek Retractors 7 Mouth Prop 8 Hemostats • Multiple uses – Retract tissue – Remove small root tips – Clamp blood vessels – Grasp loose objects 9 Needle Holders • Similar to hemostat • Function similar to hemostat 10 Surgical Scissors 11 Surgical Aspirating Tips 12 Surgical Curettes 13 Surgical Chisel and Mallet 14 Surgical Bone File 15 Rongeurs 16 Periosteal Elevators 17 Elevators • Loosen and remove teeth, retained roots, and root fragments • Types – Apical – Root tip picks 18 Extraction Elevators 19 Root Tip Picks 20 Extraction Forceps • Used to remove teeth from alveolar bone • Hinged with various handles and beak styles 21 Asepsis in Oral Surgery • Infection control is critical • Increased risk of exposure to blood in surgery 22 Patient Considerations • Review – Medical records – Dental records – Referring dentist notes – Radiographs – Treatment options – Patient consent – Financial arrangements 23 Oral Surgery Procedures • Uncomplicated extractions – Removal of permanent or primary teeth that have erupted into the oral cavity – Also known as routine or simple extractions 24 Simple Extraction Setup 25 Oral Surgery Procedures • Multiple extractions and alveoplasty – Multiple extractions are performed to prepare patient for partial or dentures – Bone and soft tissue of the edentulous ridge is contoured and smoothed 26 Multiple Extractions Setup 27 Oral Surgery Procedures • Extractions of impacted teeth – Tooth may be partially or fully covered by tissue or bone – Tooth has not erupted into the oral cavity – Extraction is difficult due to depth, position, or angulation of tooth in bone 28 Problems Caused by Impacted Wisdom Teeth Impacted Three roots Impacted Two roots Wisdom teeth (# 3 above) develop inside the bone. Crowns form first, then the roots. If the jaw grows long enough, the wisdom teeth can erupt and be used. If the jaws are not long enough by age 16, wisdom teeth stay trapped (impacted) inside the bone. 29 Problems Caused by Impacted Wisdom Teeth Gum infected Impacted wisdom teeth can cause: (A) Infection of the gums over or around them (B) Infection in the bone around them (C) Destruction of the next tooth 30 Problems Caused by Impacted Wisdom Teeth (D) Destruction of the bone by formation of a cyst Looking down on the biting surfaces of the lower teeth (E) Other teeth pushed out of line (arrows) 31 Removal of Boney Impaction • Handpieces and surgical burs required to gain access (A) (B) (D) (C) (E) Irrigation syringe (F) 32 Oral Surgery Procedures • Biopsy procedures – Total or partial removal of tissue from suspicious areas for microscopic examination and diagnosis – Three types • Excisional, incisional, exfoliative 33 Incisional Biopsy Top view • Removal of small section of lesion and a small border of normal tissue • Used when lesions are larger than 1 cm Normal tissue Lesion Incision Side view Lesion Normal tissue Incision 34 Excisional Biopsy Top view • Complete removal of lesion including border of normal tissue • Performed on smaller lesions Normal tissue Lesion Incision Side view Lesion Incision Normal tissue 35 Exfoliative Cytology • Smear biopsy – Nonsurgical procedure • Removal of a layer of cells from surface of lesion 36 Exfoliative Cytology • Cells spread on a glass slab for microscopic examination • Often done in addition to other forms of biopsies 37 Oral Surgery Procedures • Dental implant surgery – Method for replacing missing teeth – Screw or framework placed into jaw bone – Tooth shaped restoration is screwed into framework 38 Oral Surgery Procedures • Treatment sequence for implants – Patient meets with restorative dentist – Referral to oral surgeon – Diagnostic consultation – Decision on treatment plan – Stages of treatment depend on technique used 39 Dental Implant 40 Oral Surgery Procedures • Types of implants – Subperiosteal – Endosteal – Mini Implant 41 Postoperative Patient Care • Given verbally and written • Lists expectations, what to do, and what to avoid 42 Postsurgical Complications • Alveolar osteitis (dry socket) – Cause is loss of blood clot from extraction site – May be the result of insufficient blood supply, infection, or trauma – Occurs three to five days following surgery 43 Treatment of Dry Socket • Irrigate tissue with warm saline solution • Pack extraction site with iodoform gauze • Rx: analgesic and antibiotics • Procedure repeated every one to two days 44 Treatment for Alveolitis 45 Temporomandibular Joint Disease • Muscles, bones, and joints of mandible fail to function properly 46 Temporomandibular Joint Disease • Signs and Symptoms – Pain around ear – Tenderness of the masticatory muscles – Popping and clicking noise when opening and closing the mouth 47 Temporomandibular Joint Disease • Signs and Symptoms – Crepitus or tinnitus – Limited movement of mandible – Trismus – Headaches or neckaches 48 Temporomandibular Joint Disease • Diagnosing – Dental and medical history – Examination of joint – Radiographs – Dental study casts 49 Temporomandibular Joint Disease • Treatment – Application of ice and heat – Learning to rest jaw – Medications – Stress management – Physical therapy – – – – – – Occlusal splinting Orthodontics Steroid injections Arthrocentesis Arthroscopic surgery Open joint surgery 50 Hospital Dentistry • Trauma • High risk patients • Patients with mental or physical disabilities • Extensive surgeries 51 Advanced Chairside Functions • Suture removal – Hold tissue in original position – Prepare patient and equipment – Examine site – Consult with dentist – Remove with care to avoid trauma or infection 52 Advanced Chairside Functions • Types of Sutures – Simple – Continuous simple – Sling – Continuous sling – Mattress 53