Oral Surgery Case discussion

Definition: removal of teeth from its socket in the bone. Also referred as “Exodontia”

Indications:

-Grossly carious tooth which cannot be restored

-Acute/chronic pulpitis; which can’t be restored by RCT

-Periodontal diseases; more than half of alveolar bone loss

-Fracture of tooth; root, longitudinal and if the tooth lied on jaw number line

-Bony lesions lies over the tooth; cyst, tumor, OM

-Impacted tooth

-Aesthetic indication

-Crowding

-Supernumerary and malposed teeth

-retained deciduous tooth if permanent successor is present

-If tooth hurting the soft tissue; Upper 3 rd molar damaging the lower 3rd molar gingiva tissue (operculum)
which can lead to pericoronitis.

Contraindication:

GENERAL:

-cardiac diseases (hypertension, RHD)

-Blood disorders (severe anemia, leukemia)

-Liver disease (vitamin k deficiency-bleeding, clotting factor deficiency)

-Pregnancy -1st and 3rd trimesters

-Epilepsy

-Allergic to LA

-High grade fever

LOCAL:

-Acute gingivitis

-acute periodontitis
-acute pericoronitis

-acute cellulitis

-acute osteomyelitis

-malignancy

(ANY ACUTE INFECTION ACCEPT ACUTE PULPITIS IS NOT CONTRAINDICATION OF TOOTH EXTRACTION
BUT IT IS RATHER INDICATION TO EXTRACTION)

Complications:

- fracture of crown, root, alveolar bone, adjacent tooth

-dislocation of TMJ

-trauma to gingiva, lips, tongue, palate

-Intraoperative and post operative hemorrhage

-trismus

-Infection: local/systemic

-Anesthesia related complication

-dry socket

Extraction Movement:

-Primary Movement: along longitudinal axis of root

-Secondary movement: Main extracting movement

-rotatory

-buccolingual or labiolingual

-mesiodistal

-lifting the tooth

-Upper Central and lateral incisor (rotation)

-Upper canine (rotation, some labiolingual may be needed)

-Upper premolar and molar (Buccopalatal movement)

-Lower central and lateral incisor (labiolingual movement

-Lower canine (rotatory and labiolingual

-Lower premolar (rotatory)

-Lower molar (Buccolingual)

Nerve Supply:

MAXILLA:

-PSAN – Molars

-MSAN – Premolars

-ASAN – Canine and incisor

-Sensory supply of palate from greater and lesser palatine nerve

MANDIBLE:

- Lingual nerve

- IAN ; enters mandibular canal

Dental Block

-Supraperiosteal injection

-“Local infiltration”

-teeth affected: any maxillary tooth

-Only can anesthetize 2 or 3 adjacent teeth

-depositing LA is close proximity as possible to the apex of the tooth

-mental nerve block

-Apex of the 2nd mand premolar

-buccal soft tissue from 2nd mand premolar to midline

-ASAN (infraorbital) block

-Inferior to the infraorbital notch

- Teeth affected: Incisors, canines and premolars

-PSAN block

- except mesiobucall root of maxillary 1 st molar

- insert needle at the height of the mucobuccal fold above the max. 2 nd molar

-LAndmarks: mucobuccal fold, maxillary tuberosity and zygomatic process

-IAN block

-most widely used

-all mandibular teeth to midline

-ant. 2/3rd of tongue

-floor of the mouth

-Complication: Infection, patient having tendency to bite tongue and lips

-deposit enters the mandibular foramen underneath the lingula

-Landmarks (external and internal oblique ridges and line of the pterygomandibular raphe)

Principles:

Expansion of bony socket

-specially for forcep extraction

-sufficient tooth structure

-elastic bone (children)

-Multiple small fractures of buccal cortical bone

1. Use of a level and fulcrum

- remove the tooth/root along the path of least resistance basic factor governing the use of
elevators

2. The insertion of wedge between tooth-root and bony socket wall

3. Wheel and axle principle

What we do in extraction?

1. Separation of tooth from alveolar bone with crestal and principal periodontal fibers

-Severing soft tissue attachment (periosteal elevator)

2. Alveolar expansion

3. Bleeding is arrested by pressure pack.

Techniques

a. intra-alveolar extraction (closed technique)

- Forcep technique

-Elevator techique

b. Transalveolar extraction (open method)

INDICATION:

-Intra-alveolar attempt is failed

-Retained roots in proximity with max sinus and not accessible to forcep

-history of difficult or attempted extraction

-Heavily restored tooth

-Geminated / dilacerated tooth

Alveolitis (dry socket)

Treatment: Flushing dry socket to remove food debris that may contribute the pain or infection

Analgesics medicated dressing to cover the exposed bone

Dry socket paste “Eugenol” pain relieving properties

Prothrombine time deficiency

-is a test used to help diagnose bleeding or clotting disorders

-Prothrombin, or factor II, is one of the clotting factors made by the liver.

- Vitamin K is needed to make prothrombin and other clotting factors

- Prothrombin time is an important test because it checks to see if five different blood clotting factors 
Maxillary sinus

- MAxillary perforation

- direct communication between mouth and sinus through the socket from which your tooth was
removed. A blood clot should form in this area to close that opening

Cellulitis is caused by a exogenous bacteria like streptococcus or staphylococcus.

Systemic feature of cellulitis increased body temperature, fatigue, headache and loss of appetite

Describe cellulitis
If yung abcess po is not able to establish drainage through the surface of the
skin or sa oral cavity. Typically produced from a tooth decay doc
More
Cellulitis is caused by a exogenous bacteria like streptococcus or
staphylococcus. Systemic feature of cellulitis increased body temperature,
fatigue, headache and loss of appetite
Bakit di pwede mag perform ng exo pag may maga ang or pus ang tooth? Na nag iinject din
naman ng anesthetic solutions
ang pH po kasi ng anesthesia nasa 3.5 to 5.5 which is acidic po kapag may
inflammation po yung tooth it means po yung tissue is also acidic so hindi po
mag dissociate yung anesthesia

di po effective ang anesthesia po pag inflammed yung tissue

Nganu man?
in case of infection doc the bacteria from the mouth may find their way to the pulp and cause nerve
damage.