Minor Oral Surgical Principles (NXPowerLite) / orthodontic courses by Indian dental academy

Minor Oral Surgery Principles Minor Oral Surgery Principles &&

ExodontiaExodontia INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

Principles of minor oral surgery

Diagnosis and treatment planningBasic necessities for surgery. Pain and anxiety controlAseptic techniqueIncisionsFlap designTissue handlingHemostasisMeans of promoting wound hemostasisRemoval of bonewww.indiandentalacademy.com

Delivery of the tooth, root or other lesionDecontamination and debridementPrinciple of drainageDead space managementSuturing principles and methodsPost surgical care of wound and edema

controlPatient general health & nutrition.

DEVELOPING A SURGICAL DIAGNOSIS AND TREATMENT PLANNING

The decision to perform surgery should be the culmination of several diagnostic steps.

The initial stepPresurgical evaluation: collection of accurate and pertinent data.

- Patient interviews

- Physical

- Laboratory and

- Imaging examination

Patient information and data should be organized into a format to reach a proper diagnosis and form a decision concerning surgery which is either indicated as not.

Surgeons should be thoughtful observers, should note all aspects of its outcome to advance their surgical knowledge and to improve future surgical results.

BASIC NECESSITIES FOR SURGERY

Two principles requirements are Adequate visibility

Assistance

Adequate visibility: This depends on 3 things Adequate access

Adequate light

A surgical field free of blood and others fluids

Adequate access

Patients ability to open their mouths wide but also require surgically created exposure.

Retraction of tissues away from the operative field provides much of the necessary access.

Proper retraction also protects tissues from

accidental injury e.g., cutting instruments.

Bowdler Henry rake retractor. Ward’s double ended 3rd molars Lack’s tongue depressor Kilner’s cheek retractor Laster’s retractor for upper 3rd molar

Instruments for retraction

Adequate light Background illumination – colour

corrected fluorescent lamps – 400-500 lux intensity.

Main sealing mounted lamp (luminare) – high intensity.- Focused at the centre of the surgery

– 40,000-100,000 lux.- Periphery of the surgery - 8,000 –

15,000 lux.

A surgical field free of fluids High volume suctioning with a small tip Wet gauges Cotton and Sponge

Competent assistance: A trained and competent assistants provides invaluable help

during surgical procedures.

The assistant should be sufficiently familiar with the procedures being performed to anticipate surgeons needs.

Pain and anxiety control

• Local anaesthesia

• Sedation

• General anaesthesia

Principle of AsepsisAsepsis is the exclusion of micro-organisms from the operative field to prevent them entering the wound. Preoperative surgical scrub

4% chlorhexidine 10% Povidine Iodine

Patients preparationDetergents – 10% povidine iodine in 10%

alcohol. – 0.5% chlorhexidine – Alcoholic solution

Mouth washPovidine iodineChlorhexidinewww.indiandentalacademy.com

INCISIONS

An incision can be described as a sharp wound produced by a surgical scalpel.

Basic principles of incisions

1st principle - A sharp blade of the proper size should be used.

Bone and ligamental tissues dull blades more rapidly than does buccal mucosa.

2nd principle: is that a firm, continuous stroke should be used when incising.

Long continuous strokes are preferable to short interrupted ones.

Mucoperiosteal incision should be firm

that penetrates the mucosa and periosteum with the same stroke.

3rd principle: The surgeon should be careful to avoid cutting vital structures while incising.

No patients microanatomy is exactly the same.

Avoid unintentional cutting of large vessels or nerves.

For e.g., Incision in the mandibular buccal sulcus and lingual area - prevent the inadvertent cutting of facial and lingual vessels.

4th principle: Incision

through epithelial

surfaces should be

made with the blade

held perpendicular to

the epithelial surface.

5th principle: Incisions in the oral cavity should be properly placed.E.g., Over healthy bone, wound edges should be at least 6-8mm away from the defect.

Incision should lie at the line angles of the teeth and not at the facial surfaces nor in the papilla.

Instruments to incise tissue Scalpel – composed of handle + sharp blade

Handle Scalpel blade

Scalpel motion made by moving hand and rest and not by moving entire forearm.

Scalpel is help in a pen-grip and handle in supported against slipping.

Flap design:Surgical flaps are made to gain surgical access to an area or to move tissue from one place to another.

The term flap indicates a section of soft tissue.

Basic principles of flap designs –

- Prevent - flap necrosis

- flap dehiscence

- flap tearing

Principles of flap design:

Base of the flap should be wider than apex.

The length of the flap should be no more than twice the width of the base.

Axial blood supply should be included in the base of the flap.

The presence of a sinus must be taken into account when flaps are designed.

The base of the flap should not be excessively twisted or stretched.

Flap must have adequate size to provide necessary access and visualization of the required area.

Flaps should be a full thickness flap i.e.,

mucoperiosteal flap.

The margins of the flap should be at least 6-8mm away from any present / future defect that will remain after surgery.

Flaps should be designed to avoid any injury to local vital structure in the area of surgery i.e., lingual and mental nerves.

Releasing incision should be used only when necessary and not routinely.

Overextension of a flap in the vertical dimension should be avoided.

Types of mucoperiosteal flaps

Envelope flap Three cornered flap

Four cornered flap Semilunar flap

Y-shaped incision flap Pedical flap

Tissue HandlingThe difference between an acceptable and an excellent surgical outcome rests on how the surgeons handle the tissue.

Toothed forceps or tissue hooks.

Tissue should not be retracted over aggressively.

When bone is cut, copious amount of irrigation is used.

Soft tissues - protected from frictional heats or direct trauma from drilling equipments.

Tissues - moistened or covered with a damp sponge – prevent desiccation.

Only physiologic substances should come in contact with living tissue.

The surgeon who handles tissue gently is rewarded with wounds that heal with fewer complications and grateful patients

Hemostasis Prevention of excessive blood loss during

surgery is important for preserving a patients oxygen carrying capacity.

Decreased visibility that uncontrolled bleeding creates.

Hematomas : Place pressure on wounds Decrease vascularity. Increase wound tension. Acts as culture media potentially the

development of a wound infection www.indiandentalacademy.com

Means of obtaining hemostasis:Assisting natural hemostatic mechanisms. Electro-coagulation.Suture ligation.Pressure packing.Vasoconstructive substances.Use of Hemostatic agents

- Turpentine or tannic acid

- Thrombin and Russell viper venom

- Oxidized regenerated cellulose (Surgicel)

Bleeding from bone

Burnishing the bone with a small instrument.

Applying hot packs. Bone wax. Driving a chisel into the bone.

Removal of Bone

The aim is to expose and to remove bony

overlying the tooth, root and other underlying

pathology.

Techniques of bone removal:

a. Bur technique.

b. Chisel and mallet technique.

Bur technique IT is precise, efficient and useful

technique. It should be always used with copious

amount of saline irrigation to avoid thermal trauma (necrosis of bone).

Round bur Straight fissure bur

Chisel and mallet technique Historical importance and rarely used.Less bone necrosis than bur technique.Can cause inadvertent fracture of the bone.Jaw bone should be supported while using this technique.Quick, clean method for removing young elastic bone

provided the instrument is sharp and used skillfully.Contraindicated in sclerotic bone and in thin atrophic

mandible.

Technique

Vertical stops / cuts should be placed.

The bevel of chisel should be towards the bone which has to be sacrificed.

Delivery of tooth root / lesion

• After the necessary bone removal the delivery of the tooth, root or lesion should be effected.

• Granulation tissue, by cystic lining or lesion should be removed.

Debridement / decontamination:

Careful cleansing to remove the debris.

Pathological tissue such as tooth follicle or sinus tracts, is excised.

Sharp bony edges are filed. Flaps are trimmed of all necrotic tissues or

tags. Tooth chips and loose pieces of bone are

removed. Thorough irrigation.

Dead space management Dead space is the area that remains

devoid of tissue after closure of the wound.

Created - removal of tissues in depth

- not suturing in multiple layers

This dead space is usually filled with blood

or serum and subsequently become

infected.www.indiandentalacademy.com

Means of eliminating dead spacesMultiple layer suturing

Pressure dressing

Surgical packing of the defect

Drains

- Fine superficial drains

- Larger superficial drains

- Deep drains (tube drains)

- Vacuum drains

Suturing:

Edema controlEdema is an accumulation of fluid in the interstitial space because of transudation from damaged vessels and lymphatic obstruction by fibrin. Two variables:

- Amount of tissue injury.- Amount of loose connective tissue.

Controlled by - Minimizing tissue damage- Ice application- Systemic corticosteroids

Patient general health and nutrition:Wound healing depends on

Patients ability to resist inflammation

Provide essential nutrients

Thank you

For more details please visit www.indiandentalacademy.com

Minor Oral Surgical Principles (NXPowerLite) / orthodontic courses by Indian dental academy

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