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
301 304 34

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COGSWELL
A B

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Patient Protection

2 1

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Anesthetic Considerations
Patients 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
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NO
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Anesthesia Access Difficulties

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Needle Modification
Better Access to Anesthetic Sites

Max

Mand

Curved Path of Insertion

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IAN Buccally & Superiorly

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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 1/16/2013 Anatomy

Real World
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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

B U C C A L Max
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B U C C A UndercutL Incision Mand

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Lingual Nerve

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Mandibular Mesio-Angular

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Mand Mesio-Angular Survey

Crown Axis 15

Ext Path

Root Axis

Convergent Tooth Outline

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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

Distal Trough

Preserve

Buccal Trough

M-B Root Access

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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
Crown axis Bind Root axis

Ext Path

Cone shaped root outline

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Disto-Angular Sectioning

1st Distal Trough

2d Section Mesial Cusp to Distal CEJ

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Disto-Angular Extraction

Path of Extraction

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Disto-angular Boney Access

Existing Boneline

Distal Trough
Preserve

Buccal Trough
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Access to M-B Line Angle

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Mand Disto-angular Flap

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Mandibular Horizontal
Requires Multiple Sectioning

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Horizontal Impaction Survey

Bind

Crown Axis Root Axis Undercut

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Horizontal Sectioning Sequence

2d
1st

3d
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Seperate Mesial-Distal Roots

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Horizontal Extraction Sequence

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Horizontal Boney Access

Distal Trough

Buccal Trough

Preserve

M-B Access

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Mandibular Flap, Extended

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Mandibular-Wide Roots And Dilacerations

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Mandibular-Wide Roots & Dilacerations Survey

CEJ Root Width

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Mandibular-Wide Roots & Dilacerations Sectioning

PRIMARY

OPTIONAL

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Mandibular - Wide Roots & Dilacerations Boney Access

Distal Trough
Existing Boneline

Preserve

Buccal Trough

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Mandibular-Wide Roots Flap

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Maxillary Impactions
Pell and Gregory Class C Buccal Approach Normally

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Maxillary Survey
Root Axis Convergent Root Outline

Ext Path

Crown Axis Undercut

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Maxillary Impaction Extraction

Ext Path

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Boney Access Maxillary

Buccal Trough Access to M-B Line Angle Preserve

Distal 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 Impactions

Deep 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 1/16/2013 Reduction

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Complications (Cont)
Isolated Maxillary Molars

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Maxillary Molar, Surgical

(ISOLATED)

SEPARATE SECTION

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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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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Complications

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 ?

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