Minor Oral Surgery Principles
&
Exodontia
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacad...
Principles
surgery

of

minor

oral

 Diagnosis and treatment planning
 Basic necessities for surgery.
 Pain and anxiet...
 Delivery of the tooth, root or other lesion
 Decontamination and debridement
 Principle of drainage
 Dead space manag...
DEVELOPING A SURGICAL DIAGNOSIS AND
TREATMENT PLANNING
The decision to perform surgery should be the culmination of
severa...
 Patient information and data should be
organized into a format to reach a proper
diagnosis and form a decision concernin...
BASIC NECESSITIES FOR SURGERY
Two principles requirements are
 Adequate visibility
 Assistance
Adequate visibility: This...
Adequate access
 Patients ability to open their mouths wide but
also require surgically created exposure.
 Retraction of...
Instruments for retraction







Bowdler Henry rake retractor.
Ward’s double ended 3rd molars
Lack’s tongue depresso...
Adequate light
 Background illumination – colour
corrected fluorescent lamps – 400-500
lux intensity.
 Main sealing moun...
A surgical field free of fluids
 High volume suctioning with a small tip
 Wet gauges
 Cotton and
 Sponge
Competent ass...
Pain and anxiety control
• Local anaesthesia
• Sedation
• General anaesthesia

www.indiandentalacademy.com
Principle of Asepsis
Asepsis is the exclusion of micro-organisms from the
operative field to prevent them entering the wou...
INCISIONS
An incision can be described as a sharp wound
produced by a surgical scalpel.
Basic principles of incisions
1st ...
2nd principle: is that a firm, continuous
stroke should be used when incising.
Long continuous strokes are preferable to
s...
3rd principle: The surgeon should be careful to
avoid cutting vital structures while incising.
No patients microanatomy is...
4th principle: Incision
through
surfaces

epithelial
should

be

made with the blade
held perpendicular to
the epithelial ...
5th principle: Incisions in the oral cavity should
be properly placed.
E.g., Over healthy bone, wound edges should
be at l...
Instruments to incise tissue
Scalpel – composed of handle + sharp
blade

Handle

Scalpel blade
www.indiandentalacademy.com
Scalpel motion made by moving
hand and rest and not by moving
entire forearm.

Scalpel is help in a pen-grip and
handle in...
Flap design:
Surgical flaps are made to gain surgical access
to an area or to move tissue from one place to
another.
The t...
Principles of flap design:
Base of the flap should be wider
than apex.
 The length of the flap should
be no more than twi...
 The base of the flap should
excessively twisted or stretched.

not

be

 Flap must have adequate size to provide
necess...
 Flaps should be designed to avoid any injury
to local vital structure in the area of surgery
i.e., lingual and mental ne...
Types of mucoperiosteal flaps

Envelope flap

Three cornered flap

www.indiandentalacademy.com
Types of mucoperiosteal flaps

Four cornered flap

Semilunar flap

www.indiandentalacademy.com
Types of mucoperiosteal flaps

Y-shaped incision flap

Pedical flap

www.indiandentalacademy.com
Tissue Handling
The difference between an acceptable and
an excellent surgical outcome rests on how
the surgeons handle th...
 Soft tissues - protected from frictional heats
or direct trauma from drilling equipments.
 Tissues - moistened or cover...
Hemostasis
 Prevention of excessive blood loss during
surgery is important for preserving a patients
oxygen carrying capa...
Means of obtaining hemostasis:
 Assisting natural hemostatic mechanisms.
 Electro-coagulation.
 Suture ligation.
 Pres...
Bleeding from bone
 Burnishing
instrument.

the

bone

with

 Applying hot packs.
 Bone wax.
 Driving a chisel into th...
Removal of Bone
 The aim is to expose and to remove bony
overlying the tooth, root and other underlying
pathology.
Techni...
Bur technique
 IT is precise, efficient and useful
technique.
 It should be always used with copious
amount of saline ir...
Chisel and mallet technique
 Historical importance and rarely used.
 Less bone necrosis than bur technique.
 Can cause ...
Technique
 Vertical stops / cuts should be placed.
 The bevel of chisel should be towards
the bone which has to be sacri...
Delivery of tooth root / lesion
• After the necessary bone removal the
delivery of the tooth, root or lesion
should be eff...
Debridement / decontamination:
 Careful cleansing to remove the debris.
 Pathological tissue such as tooth follicle or
s...
Dead space management
Dead space is the area that remains
devoid of tissue after closure of the wound.
Created - removal o...
Means of eliminating dead spaces
Multiple layer suturing
Pressure dressing
Surgical packing of the defect
Drains
- Fine su...
Suturing:
Edema control
Edema is an accumulation of fluid in the
interstitial space because of transudation from
damaged v...
Patient general health and nutrition:
Wound healing depends on
 Patients ability to resist inflammation
 Provide essenti...
Thank you
www.indiandentalacademy.com
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Minor oral surgical principles /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Minor oral surgical principles /certified fixed orthodontic courses by Indian dental academy

  1. 1. Minor Oral Surgery Principles & Exodontia INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Principles surgery of minor oral  Diagnosis and treatment planning  Basic necessities for surgery.  Pain and anxiety control  Aseptic technique  Incisions  Flap design  Tissue handling  Hemostasis  Means of promoting wound hemostasis  Removal of bone www.indiandentalacademy.com
  3. 3.  Delivery of the tooth, root or other lesion  Decontamination and debridement  Principle of drainage  Dead space management  Suturing principles and methods  Post surgical care of wound and edema control  Patient general health & nutrition. www.indiandentalacademy.com
  4. 4. DEVELOPING A SURGICAL DIAGNOSIS AND TREATMENT PLANNING The decision to perform surgery should be the culmination of several diagnostic steps. The initial step Presurgical evaluation: collection of accurate and pertinent data. - Patient interviews - Physical - Laboratory and - Imaging examination www.indiandentalacademy.com
  5. 5.  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. www.indiandentalacademy.com
  6. 6. 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 www.indiandentalacademy.com
  7. 7. 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. www.indiandentalacademy.com
  8. 8. Instruments for retraction      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 www.indiandentalacademy.com
  9. 9. 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. www.indiandentalacademy.com
  10. 10. 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. www.indiandentalacademy.com
  11. 11. Pain and anxiety control • Local anaesthesia • Sedation • General anaesthesia www.indiandentalacademy.com
  12. 12. Principle of Asepsis Asepsis 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 preparation Detergents – 10% povidine iodine in 10% alcohol. – 0.5% chlorhexidine – Alcoholic solution Mouth wash Povidine iodine www.indiandentalacademy.com Chlorhexidine
  13. 13. 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. www.indiandentalacademy.com
  14. 14. 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. www.indiandentalacademy.com
  15. 15. 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. www.indiandentalacademy.com
  16. 16. 4th principle: Incision through surfaces epithelial should be made with the blade held perpendicular to the epithelial surface. www.indiandentalacademy.com
  17. 17. 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. www.indiandentalacademy.com
  18. 18. Instruments to incise tissue Scalpel – composed of handle + sharp blade Handle Scalpel blade www.indiandentalacademy.com
  19. 19. 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. www.indiandentalacademy.com
  20. 20. 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 www.indiandentalacademy.com
  21. 21. 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. www.indiandentalacademy.com
  22. 22.  The base of the flap should excessively twisted or stretched. not be  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 68mm away from any present / future defect that will remain after surgery. www.indiandentalacademy.com
  23. 23.  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. www.indiandentalacademy.com
  24. 24. Types of mucoperiosteal flaps Envelope flap Three cornered flap www.indiandentalacademy.com
  25. 25. Types of mucoperiosteal flaps Four cornered flap Semilunar flap www.indiandentalacademy.com
  26. 26. Types of mucoperiosteal flaps Y-shaped incision flap Pedical flap www.indiandentalacademy.com
  27. 27. Tissue Handling The difference between an acceptable and an excellent surgical outcome rests on how the surgeons handle the tissue.  Toothed forceps or tissue hooks.  Tissue should aggressively. not be retracted over  When bone is cut, copious amount of www.indiandentalacademy.com irrigation is used.
  28. 28.  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 www.indiandentalacademy.com complications and grateful patients
  29. 29. Hemostasis  Prevention of excessive blood loss during surgery is important for preserving a patients oxygen carrying capacity.  Decreased visibility bleeding creates. that uncontrolled  Hematomas : Place pressure on wounds  Decrease vascularity.  Increase wound tension.  Acts as culture media potentially the development of a wound infection www.indiandentalacademy.com
  30. 30. 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) www.indiandentalacademy.com
  31. 31. Bleeding from bone  Burnishing instrument. the bone with  Applying hot packs.  Bone wax.  Driving a chisel into the bone. www.indiandentalacademy.com a small
  32. 32. 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. www.indiandentalacademy.com
  33. 33. 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 www.indiandentalacademy.com
  34. 34. 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. www.indiandentalacademy.com
  35. 35. Technique  Vertical stops / cuts should be placed.  The bevel of chisel should be towards the bone which has to be sacrificed. www.indiandentalacademy.com
  36. 36. 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. www.indiandentalacademy.com
  37. 37. 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. www.indiandentalacademy.com
  38. 38. 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 infected. and subsequently www.indiandentalacademy.com become
  39. 39. Means of eliminating dead spaces Multiple layer suturing Pressure dressing Surgical packing of the defect Drains - Fine superficial drains - Larger superficial drains - Deep drains (tube drains) - Vacuum drains www.indiandentalacademy.com
  40. 40. Suturing: Edema control Edema 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 www.indiandentalacademy.com - Systemic corticosteroids
  41. 41. Patient general health and nutrition: Wound healing depends on  Patients ability to resist inflammation  Provide essential nutrients www.indiandentalacademy.com
  42. 42. Thank you www.indiandentalacademy.com

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