OS 1 PART 2

ESSENTIALS IN EVAL OF TOOTH REMOVAL

1. ACCESS TO TOOTH

2. MONILITY OF TOOTH

3. CONDITION OF CROWN

BASIC REQUIREMENTS OF EXODONTIA

1. Good Radiograph

2. Adequate Anesthesia

3. Complete Instrumentation

4. Sufficient Illumination

5. Efficient Assistant

6. Suction Apparatus

3 FUNDAMENTAL REQ OF A GOOD EXTRACTION

1. Adequate ACCESS & VISIBILITY of the surgical field

2. UNIMPEDED pathway of removal

3. CONTROLLED force to luxate & remove tooth

PURPOSE OF RADIOGRAPHIC EVALUATION

1. CONDITION OF TOOTH

2. CONDITION OF BONE

3. RELATIONSHIP WITH ASSOCIATED VITAL STRUCTURES

INDICATIONS FOR DENTAL RADIOGROPH

1. Attempted extraction

2. Grossly decayed tooth

3. Root canal treated

4. Supernumerary

5. Impacted

6. Root stumps

7. Fractured teeth

TWO MAJOR TECH OF EXTRACTION

1. OPEN

2. CLOSED

3. STOBIE

OTHER NAME OF CLOSED TECH

1. Routine extraction

2. Forcep technique

3. Intra-alveolar

OTHER NAME OF OPEN TECH

1. Complex extraction

2. Complicated extraction

3. Surgical extraction

4. Flap technique

5. Trans-alveolar

INDICATION FOR EXO (SECONDARY DENTITION)

1. Caries

2. Pulpal necrosis

3. Periodontal disease

4. Orthodontic reasons

5. Prosthetic reasons

6. MALPOSED

7. CRACKED

8. IMPACTED

9. Supernumerary

10. Assoc. with pathologic lesion

11. Radiation Therapy

12. Teeth along bone fracture

13. Retained Teeth → cong. missing teeth

14. Severe tooth loss = erosion, abrasion, attrition, abfarcation

15. Esthetic

16. Financial contraint

TWO TYPES OF CONTRAINDICATION:

1. ABSOLUTE

2. RELATIVE

LOCAL ABSOLUTE CONTRAINDICATIOM

1. HEMANGIOMA

2. TEETH LOC IN TUMOR

SYSTEMIC ABSOLUTE CONTRAINDICATION

1. LEUKEMIA & LYMHPMA

2. HYPERTHYROIDISM & THYROTOXICOSIS

3. SEVERE UNCONTROLLED DIABETES MELLITUS

4. SEVERE UNCONTROLLED CARDIAC DISEASE

5. TOXIC GOITER

LOCAL RELATIVE CONTRAINDICATION: STABC LAATA

1. Severe Pericoronitis around Impacted 3rd Molar

2. Therapeutic Radiation

3. Active Infection with Uncontrolled Cellulitis

4. Bleeding disorder

5. Cardiac disease

6. Liver disease

7. Acute Pericoronitis around impacted Mandibular 3rd Molar

8. Acute Dentoalveolar abcess

9. Teeth close proxi with → Vital struc

10. ANUG

SYSTEMIC RELATIVE CONTRAINDICATION: STABC LAATA

1. Mild / Controlled Diabetes Mellitus

2. Taking Blood Thinner

3. Taking Variety of medication

4. Hepatic Cirrhosis

5. Jaundice

6. Rheumatic Heart Disease

7. Nephritis

8. Syphilis

9. Pregnancy

10. Addison’s Disease / Corticosteroid dease

11. Fever of unexplained origin

12. Senility

13. Debilitating Disease

14. Neuro dev / pysch disorder

15. Severe Bleeding Diatheses

INDICATION FOR EXO (PRIMARY)

1. Retained Primary teeth

2. Infection in periapical area

3. Ankylosed Primary

4. Excessively carious

5. Excessive decay → devitalization

6. Excessive decay → impossible pulpo

7. Supernumerary teeth'

8. Traumatic Injury → vertical cracks

9. Root fracture → subseq infection

10. Sinus Opening → mucoperiosteal memb

11. Ectopically positioned tooth

12. Impacted teeth

13. Ortho purposes

CONTRAINDIC EXO (PRIMARY TEETH)

1. Acute infection → stomatitis, acute vincent’s infec

2. Acute dentoalveolar abcess

3. Acute periodontitis / cementitis

4. Acute cellulitis

5. Bleeding disorder

6. Herpetic Stomatitis

7. Malignancy

8. Tooth in “line of fire”

9. Acute / chronic heart disease

10. Cong heart disease

11. Kidney disease

SENSORY INNERVATIONS OF JAW

1. IAN

2. LINGUAL

3. LONG BUCCAL

4. ASAN

5. MSAN

6. PSAN

7. NASOPALATINE

8. GREATER PALATINE

TECH IN ADMINISTRATION OF LA: TINS

1. TOPICAL A.

2. INFILTRATION A.

3. NERVE BLOCK

4. SUPPLEMENTAL INJECTION

SOFT TISSUE INFILTRATION

1. SUB - MUCOSAL

2. SUPRA - PEPERIOSTEAL

3. SUB - PERIOSTEAL

INTRABONY INFILTRATION

1. INTRA-OSSEOUS

2. INTRA-SEPTAL

NERVE BLOCK:

1. PSANB

2. INFRA ORBITAL NB

3. NASOPALATINE NB

4. GREATERPALATINE NB

5. MAXILLARY NB

1. MENTAL NB

2. IANB

3. BUCCAL NB

4. LINGUAL NB

5. MANDIBULAR NB

INDIRECT APPROACH OF MANDIBULAR BLOCK

1. KURT THOMA TECH

2. FISHER 123 TECH

DIRECT APPROACH OF MANDIBULAR BLOCK

1. GOW-GATE MANDI BLOCK (OPEN)

2. VAZIRANI AKINOSI (CLOSE)

INNERVATIONS OF IAN NERVE BLOCK

1. INCISIVE

2. MENTAL

3. LINGUAL

INNERVATIONS OF MANDI BLOCK: ILMAB

1. IAN

2. LINGUAL

3. MYLOHYOID

4. AURICOTEMPIRAL

5. BUCCAL

WHAT ARE THE SUPPLAMENTAL INJECTIONS

1. INTRA - PULPAL

2. INTRA - LIGAMENTARY

USES OF SEDATION DENTISTRY

1. ANXIETY CONTROL → extremely apprehensive patients

2. PT DIFF CONTROLLING MOVEMENTS

3. LONG PROC → phy & emotionally tiring for pt

TYPES OF SEDATION DENTISTRY

1. ORAL

2. INTRAVENOUS

3. INHALATION

4. GENERAL ANESTH

ORAL SEDATION MEDICATION:

1. Lorezapam

2. Alprazolam

3. Hydroxyzine

4. Triazolam

5. Midazolam

6. Oxazolam

7. Z

8. Z

INTRAVENOUS SEDATION MEDICATION: DTM FLP

1. Diazepam

2. Triazolam

3. Midazolam

4. Fentanyl

5. Lorezapam

6. Profopol

INHALATION SEDATION MEDICATION

1. NITROGEN OXIDE

2. SEVOFLURANE

3. HALOTHAN

4. ISOFLURANE

DEGREES OF SEDATION: ACDU

1. Anxiolysis

2. Conscous Sedation

3. Deep Sedation

4. Unconscious Sedation

5 GENERAL STEPS IN CLOSED METHOD

1. LOOSENING of soft tissue attachment from the tooth

2. LUXATION of the tooth with an elevator

3. ADAPTATION of forcep to the tooth

4. LUXATION of the tooth with a forcep

5. REMOVAL of tooth from socket

MODIFICATION FOR TOOTH EXTRACTION (PRIMARY TEETH)

1. Special type of forcep

2. Wide splaying of roots

3. Beak at bifurcation = NO

4. Buccolingual movements APPLIED

5. Rotational = NO for multi rooted

6. Roots of Primary → EMBRACING

7. Blind Exam = NO p.socket

ORDER OF TOOTH EXTRACTION

1. MAXI → MANDI (prevent debris fall)

2. MOST Distal & Posterior (prevent obscure w blood)

3. CANINE = must not be the last to be extracted (tooth socket prone fracture)

6 TECHNIQUE FOR MULTIPLE EXTRACTION

1. LUXATE ALL in one area

2. PRESS BACK cortical bone

3. REMOVE → sharp bone specules

4. REMOVE → granulation tissue

5. SOFT TISSUE FLAP OVERLAP → trim gingiva

6. SUTURES PLACE

“GUIDANCE OF ERUPTION”

SERIAL TOOTH EXTRACTION

“TIMED EXTRACTION” purpose:

1. Relieve crowding & irreg of teeth

2. Allow interrupted teeth to guide themselves into improved position

3. Adjunct for comprehensive ortho therapy

INDICATIONS FOR OPEN METHOD: 14

1. Failure to remove tooth by close

2. Excessive force need

3. Thick dense bone surround

4. Unfavorable root morpho

5. Fracture / caries → root

6. Hypercemengtosis

7. Ankylosis

8. Impacted tooth

9. Sclerosed tooth/bone

10. Close proximity → major vessels & nerves

11. Teeth associated → disease

12. Teeth undergo → RCT

13. Presence of: short clinical crown, severe attrition, heavy dense bone

14. Large pneumatizes MAXI SINUS (maxi root extend)

10 GENERAL STEPS IN EXO (OPEN) : IRRER TICRePa

1. Incise tissue

2. Reflect mucoper. flap

3. Remove bone surrounding

4. Establish→ point of appl (elevator)

5. Remove tooth from socket

6. Trim bone = rounger forcep, bone file

7. Irrigate wound = FLUSH (debris, tooh frag)

8. Control bleeding

9. Reposition FLAP

10. Pack wound

BASIC TYPES OF INCISION in ORAL SURGERY:

1. PARTIAL THICKNESS INC (mucosal flap)

2. FULL THICKNESS (mucoperiosteal flap)

TYPES OF FULL THICKNESS INCISION: ESSSEX P

1. Envelop / Sulcular

2. Sulcular + Vert Releasing

3. Sulcular + 2 Vert Releasing

4. Semilunar Inc

5. Elliptical

6. X-incision & Y-incision

7. Pedicle Incision

3 MAIN TYPES OF PEDICLE FLAP

1. BUCCAL

2. PALATAL

3. PEDICLE BRIDGE

ADVANTAGE OF TRAPEZOIDAL FLAP: ESNEH

1. Excellent access

2. Surgerty >1-2 teeth

3. NO tension

4. Easy approximation

5. Hastens healing

ADVANTAGE OF TRIANGULAR FLAP: AGGE

1. Adeq Blood supply

2. Good Visualization

3. Good Stability & Reapproximation

4. Easily modified

DISADVANTAGE OF TRIANGULAR FLAP:

1. LIMITED ACCES → long root

2. TENSION (retractor)

3. DEFECT (attached)

ADVANTAGE OF ENVELOP FLAP:

1. NO VERTICAL INCISION

2. EASY REAPPROXIMATION

DISADVANTAGE OF ENVELOP FLAP: DGLLPD

1. Difficult reflection (palata)

2. Great Tension = risk tearing

3. Limited Visualization (apicoectomy)

4. Limited Accedd

5. Possible Injury = PALATAL BV

6. Defect → attached

ADVANTAGE OF SEMILUNAR FLAP: SNNE

1. Small incision

2. NO gingival recession (prostho resto)

3. NO periodontium intervention

4. Easy oral hygiene

DISADVANTAGE OF SEMILUNAR FLAP:

1. INCISION → bony lesion

2. SCAR (anterior)

3. Difficult reapprox

4. Limited access

5. Tear

2 IMPORTANT REQ FOR REMOVAL OF ROOT FRAGMENT:

1. ADEQ LIGHT

2. EXCELLENT SUCTION

GUIDE LINE → REMOVAL OF ROOT FRAG

1. CLOSED TECH → root luxated before injury

2. OPEN TECH → not luxated, bulbous root

3. IIRGIATION & SUCTION TECH → loose root fragment

4. ROOT TIP PICKS may also be used

5. DISPLACEMENT of root → maxillary sinus = maxi post teeth

TWO MAIN TECH TO REMOVE ROOT TIP:

1. EXTENSION of TECH (used in single root)

2. OPEN WINDOW

LOCAL COMPLICATION OF TOOTH EXTRACTION: INTERMMEDIATE

FFFOD HTN

1. Failure of Local Anesthesia

2. Failure to remove tooth

3. Fracture → Tooth, Alveolous, Maxilla, Mandibile

4. Oroantral communication

5. Displacement of soft tissue

6. Hemorrhage

7. TMJ dislocation

8. Nerve injury

LOCAL COMPLICATION OF TOOTH EXTRACTION: DELAYED

1. Excessive → Pain, Swelling, Trismus

2. Bleeding

3. Dry socket

4. Mech Dislodgement of Clot

5. Acute Osteomyelitis

6. Infection

7. Oro-antral fistula

8. Failure of socket to heal

9. Nerve damage

LOCAL COMPLICATION OF TOOTH EXTRACTION: LATE

1. Chronic Osteomyelitis

2. Osteoradionecrosis

3. Chronic pain

4. Nerve damage

SYSTEMIC COMPLICATION OF TOOTH EXTRACTION:

1. Syncope / Fainting

2. Hypoglycemia

3. Hyperventilation

4. Fits & Tantrums

5. Myocardial Infarction

6. Addisonian crisis

7. Respiratiry Obstruction

CAUSES OF DRY SOCKET

1. Excessive Trauma

2. Pre-existing infection

3. Disturbance of blood clot

4. Increased Fibrolytic Activity

5. Impaired Local vasc supply

6. Smoking

7. Oral contraceptives

Clinical features of dry socket

1. EXTRACTION within 48-72 hrs

2. unpleasant or foul odor → HALITOSIS

3. Continuous throbbing, excruciating pain

4. Alv socket coverd with → Grayish Necrotic Tissue

5. exposed → ALV BONE