Dental Surgery/Minor Oral Surgery
Definition includes all surgical procedures within the oral cavity that can be performed under local anesthesia on an outpatient basis. As a specialized area within OMS all basic principles of this medical discipline apply to Dental/Minor Oral Surgery as well.
the intention to bring healing .the patients agreement to the procedure .Surgical procedure
-each surgical procedure represents an injury and only:
.responsible screening about own skills and abilities
protects from legal action!!!!!
Classification of procedures
The difficulties within each surgical treatment together with the actual demand for surgical skills and experience as well as equipment mark the classification of a surgical procedure: SAC ± Classification S = Simple A= Advanced C= Complex
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 the vestibulum Gingival resection and curretage
Minor surgical technical difficulty .Complications expected .A= Advanced
.simple procedure but with anatomically related risks .Can be performed by a surgically trained dentist in a standard dental clinic
Tooth extractions Removal of retained or impacted teeth Incision of abscess in the alveolar process Flap reflection on the alveolar process 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
and time consuming .Technically difficult surgically.C = Complex
.More difficult procedures.Complications expected .Can be performed by a surgically experienced dentist or oral surgeon under aseptic conditions all complicated procedures in patients with systemic and local risk factors: diabetes cardiac and circulatory problems kidney or liver damage hemorrhagic diathesis breathing problems allergies immune suppression following radiation therapy
. with or without anatomically related risks .
Some indications for tooth extraction
Deep caries Apical ostitis Failure of root canal treatment Root fractures Extremely deep periodontal pockets Acute local infections
with luxating movements at the same time Use high but controlled force
.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.
Tooth extraction Instruments
Forceps Incisors .upper right + upper left + lower 3rd molar .upper + lower molar .upper + lower forceps of smaller size for deciduous teeth
.upper + lower root forceps .upper + lower Canine\ bicuspid .
Tooth extraction Instruments
Elevators Today there exists numerous elevators of different shapes. we can identify 3 groups: 1st> straight elevators 2nd angled elevators 3rd hooked\curved elevators
Elevators Hooked Angled Straight
Root separation Upper molar Lower molar
Seperated roots and crown of lower molar
Loosening of cervical attachment
Finger support upper extraction
Finger support lower extraction
to avoid trauma of TMJ to palpate the bone to sense the tooth movement to stabilize the process
Why is the finger support important? to fixed the mandible ± to maximize the effect of applied force .
1st: 2 vertical incisions covering the alveolar area 2nd: low speed bone cutting and removal with elevator
Removal of remaining roots
Closure by single suture