Dental surgery

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Dental surgery

  1. 1. A TOOTH EXTRACTION (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.
  2. 2. TYPES OF EXTRACTION Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps. rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
  3. 3. Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic.
  4. 4. POST-EXTRACTION HEALING Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. Bleeding is common in this first hour, but its likelihood decreases quickly as time passes, and bleeding has usually stopped after 24 hours. The raw open wound overlying the dental socket takes about one week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about one to two months. Final closure of the socket with bony remodelling can take six months or more.
  5. 5. COMPLICATIONS Infection Prolonged bleeding Swelling Bruising Sinus exposure and oral-antral communication Nerve injury Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). Dry socket (Alveolar osteitis) Bone fragments Trismus Loss of a tooth
  6. 6. HISTORY Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations.
  7. 7. Dental Pelican Tooth Keys Dental Forceps
  8. 8. In Europe, from the Middle Ages all the way until the 19th century, dental procedures were performed by either general doctors or even barbers. Most of the time these barbers would keep their dentistry practice simple, restricting themselves to tooth extractions linked with tooth infection and the lessening of pain. The thought of cutting hair and pulling out teeth is a rather interesting one though.
  9. 9. Before the 18th century, this often involved tying a string around the tooth; a drum might be played in the background to distract the patient, getting louder as the moment of extraction grew nearer. To advertise their services as ‘tooth-pullers’, many barber- surgeons hung rows of rotten teeth outside their shops. In 1727, the poet John Gay, wrote: His pole, with pewter basins hung, Black, rotten teeth in order strung, Rang’d cups that in the window stood, Lin’d with red rags, to look like blood, Did well his threefold trade explain, Who shav’d, drew teeth, and breath’d a vein.
  10. 10. Dentistry, as we understand it today, did not emerge as a licensed profession until the end of the 19th century. That said, one need not suffer in the past with a toothache as long as a barber-surgeon was at hand. For little cost and a lot of pain, the rotten tooth could be extracted and put on display in front of the barber’s shop.
  11. 11. MODERN INSTRUMENTS Tooth extraction forceps Tooth Extraction Forceps are primary instruments to remove the tooth from the socket. The main function of forceps is expansion of the bony socket by the wedge shaped beaks of the forceps and movement of tooth with the forceps. Forceps are also used to pull out the tooth from the socket. Forceps look like tweezers and have a firm grip which allows the dentist to exert sufficient force. The forceps allow the tooth to be held firmly and yet the dentist will be able to move it back and forth before it is plugged out.
  12. 12. Mandibular Extraction Forceps The tooth needs to be pulled out from the roots and for that the forceps are just the rightly designed instruments. They can also maneuver themselves into any part of the mouth in the most effortless of ways. If the dentist wants to perform a non-surgical simple tooth extraction or closed or intra- alveolar tooth extraction then they will certainly need forceps.
  13. 13. Dental Elevators In case of teeth that are deeply entrenched and embedded in the gums then the use of the forceps is just not enough. In that case what is needed are Dental Elevator tools that need to be used along with the forceps. Dental Elevator tools can act as levers and these are put between the tissues and in between the teeth. Elevators are used for luxation of teeth. Elevators are frequently used to mobilize the teeth. The main function of dental elevators is to luxate multirooted teeth prior to forceps application. They are used to luxate and remove the teeth which can’t be engaged by the beaks of the forceps like the impacted teeth, malposed teeth or badly carious teeth. Dental elevators can also be used to remove fractured root stumps or apical tooth tips.
  14. 14. Scalpels for incision in case of Surgical Tooth Extraction In case of surgical tooth extraction which is also known as open tooth extraction, apart from dental elevators and forceps, instruments are required for giving incision and bone cutting. In case of surgical tooth extraction, tooth is damaged to such an extent that nothing is visible above the gums. For giving incision that is for making cut on the soft tissues, scalpel is used. Scalpel is used to cut directly through gum tissue down to the bone. Scalpel has 2 parts that are blade and blade handle. After giving the incision, flap is raised to expose the tooth.
  15. 15. Chisel and osteotomes for cutting or splitting bone in Surgical Tooth Extraction Chisels are unibevelled instruments for cutting the bone and osteotomes are bibevelled instruments which split the bone. Chisels are used to remove chips of bone in case of surgical tooth extractions and to split the tooth in difficult tooth extractions.
  16. 16. Mallet It is made of steel, lead or wood and is similar to a hammer. It is used for giving controlled taps on the chisel or osteotome.
  17. 17. Dental drill and burs for splitting tooth and bone cutting It is a quicker method of bone removal by drilling the bone at high speed. Burs are rotary instruments that cut the bone. They are made of either stainless steel or carbide. They are available in different lengths, shapes and sizes. They aid in bone removal or splitting the tooth during surgical removal of teeth. Hand piece and burs can also be used to round off the sharp margins after tooth extraction. Irrigation should be done during drilling with copious amount of saline solution. There should be as less damage to the alveolar bone during the surgical tooth extraction as possible.
  18. 18. Rongeur Forceps, Bone file, Bone cutter Rongeur Forceps are used to nibble sharp bony margins after simple or surgical tooth extraction. Rongeur forceps have curved handles and have spring action. Bone file as the name suggests is used to smoothen any bony margins present in the surgical field. Bone cutter is similar to Rongeur forceps and is used to trim sharp bony margins after tooth extraction.
  19. 19. Sutures or stitches after tooth extraction procedure Stitches are given to approximate the margins. The two basic types of suture materials are resorbable suture material which the body is capable of breaking down easily and the non- resorbable sutures. Resorbable suture material includes gut, polyglycolic acid and copolymer of glycolic and lactic acid. Non-resorbable suture material includes silk, nylon, polyester and polypropylene sutures. Non-resorbable sutures can be monofilamentous, multifilamentous or can be both.
  20. 20. Suction apparatus, Suction tubing and Suction tip Suction apparatus, Suction tubing and suction tip are used to maintain a clear surgical field during surgical tooth extraction.
  21. 21. The ability to control pain is a critical part of all dental procedures. Throughout history, dental professionals have used a variety of methods for dental procedures, from herbal remedies to local anesthetics and nitrous oxide, to create a comfortable and trusting environment for the patient.
  22. 22. With pain-dulling practices starting as early as 2250 BC, the evolution of dental anesthesia has come a long way to help make some of the most invasive oral procedures possible.
  23. 23. 2250 BC: A Babylonian clay tablet reveals the remedy for pain of dental cavities. The cement that was used was made by mixing henbane seed with gum mastic.
  24. 24. 1000 BC: In India, wine is used to produce insensibility.
  25. 25. 1540: Valerius Cordus of Germany introduces synthesized sweet vitriol, now more commonly known as ether.
  26. 26. 1564: Ambroise Pare of France obtains local anesthesia by compression of nerves.
  27. 27. 1779: Humphry Davy announces the anesthetic properties of nitrous oxide and notably calls it laughing gas.
  28. 28. 1842: Morton begins the use of ether in dental and oral procedures.
  29. 29. 1844: After demonstrating nitrous to Dr. Horace Wells, traveling showman Gardner Colton gives nitrous oxide to Wells and another dentist, Dr. Riggs, for wisdom tooth extraction.
  30. 30. 1846: Dr. Horace Wells demonstrates the use of nitrous oxide for tooth extraction. Since the patient claimed he still felt pain during the experience, it was not considered a successful demonstration.
  31. 31. 1853: The hollow needle and hypodermic syringe are invented.
  32. 32. 1877: Sister Mary Bernard of the US is considered the first nurse anesthetist.
  33. 33. 1884: Carl Koller expounded the value of cocaine for local anesthesia.
  34. 34. 1894: H.J. Carlson discovers that ethyl chloride produced a sound sleep in some dental patients.
  35. 35. 1904: Procaine, or more commonly known as Novocaine, is discovered.
  36. 36. 1915: D.F. Jackson uses carbon dioxide absorber for general anesthesia.
  37. 37. 1931: The American Association of Nurse Anesthetists (AANA) is organized by Agatha Hodgins.
  38. 38. 1942: Curare, an arrow poison once used by South American Indians, is first used and starts the “Age of Anesthesia.” South American Indian preparing curare
  39. 39. 1943: Lidocaine is synthesized and used as a dental anesthetic in minor surgery.
  40. 40. 1956: Halothane, which is still used today, is used clinically for the first time.
  41. 41. 1967: Synthesized pancuronium, Pavulon, is first used clinically.
  42. 42. 1981: Forane is approved for general use in the United States.
  43. 43. 1990: Propofol (Diprivan) Sedative, a hypnotic is introduced into clinical use in the United States after showing success in Europe for many years.
  44. 44. 1992: Desflurane is introduced and used clinically.

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