Approach to Dentistry - Oral and Maxillofacial Surgery


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Approach to Dentistry - Oral and Maxillofacial Surgery

  1. 1. <ul><li>Um Al Qura University </li></ul><ul><li>Faculty of Dentistry </li></ul>Department of Oral &Maxillofacial surgery
  2. 2. Introduction to Oral and Maxillofacial surgery <ul><li>Dr. Mahmoud El Sayed Khalifa </li></ul><ul><li>Assistant prof &consultant of Oral &Maxillofacial Surgery </li></ul>
  3. 3. Oral and Maxillo - facial surgery <ul><li>Oral= mouth </li></ul><ul><li>Maxillo= Jaw </li></ul><ul><li>Facial =Face </li></ul>
  4. 4. Aims of the Course <ul><li>The Oral and Maxillofacial Surgery covers the medical and surgical management of diseases and disorders affecting the oro-facial region. </li></ul><ul><li>The teaching program covers the wide range of oral and maxillofacial surgical and non surgical procedures, stressing the need for both dental and medical knowledge </li></ul>
  5. 5. Oral &Maxillofacial surgery <ul><ul><li>Include: </li></ul></ul><ul><ul><ul><ul><li>1- Pain and anxiety with Local & General anesthesia element </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2-Basic oral surgery element </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3- Maxillofacial element </li></ul></ul></ul></ul>
  6. 6. Pain and anxiety <ul><li>Methods of pain control </li></ul><ul><li>- Removal of the cause </li></ul><ul><li>1- Local Anesthetic agents </li></ul><ul><ul><li>2- Sedation </li></ul></ul><ul><ul><li>Inhalation sedation </li></ul></ul><ul><ul><li>Antianxiety agents </li></ul></ul><ul><ul><li>Intravenous sedation </li></ul></ul><ul><ul><li>3- General anesthesia </li></ul></ul>
  7. 7. Local Anesthesia <ul><li>Definition </li></ul><ul><li>A reversal temporary cessation of painful impulses from a particular region in the body </li></ul><ul><li>Mechanism of Action </li></ul><ul><li>LA agent penetrate the nerve cell membrane and block receptor site that control the influx of Na + associate with membrane depolarization </li></ul><ul><li>Local Anesthesia Agents </li></ul><ul><li> Ethers </li></ul><ul><li>Amides </li></ul>
  8. 8. Anesthesia in Children <ul><li>Topical Anesthesia (TA) </li></ul><ul><li>Local Anesthesia (LA) </li></ul><ul><li>General Anesthesia (GA) </li></ul>
  9. 9. L A Techniques <ul><li>Mandible </li></ul><ul><ul><li>Infiltration </li></ul></ul><ul><ul><li>Nerve bloke </li></ul></ul><ul><li>Maxilla </li></ul><ul><li>Infiltration </li></ul><ul><li>Nerve bloke </li></ul>
  10. 10. <ul><li>Mandibular Tooth Anesthesia </li></ul><ul><li>Papillary injection </li></ul><ul><li>Intraligamentary injection </li></ul>
  11. 11. <ul><li>TECHINIQUES </li></ul><ul><li>Maxillary Primary and Permanent Molar Anesthesia </li></ul><ul><li>Maxillary Primary and Permanent Incisor and Canine Anesthesia </li></ul><ul><li>Infraorbital block injection </li></ul><ul><li>Nasal palatine block </li></ul>
  12. 12. <ul><li>Complication of LA </li></ul><ul><li>Localized complications </li></ul><ul><li>Systemic complications </li></ul><ul><li>Management of Complication </li></ul><ul><li>Prevention </li></ul><ul><li>Management </li></ul>
  13. 13. Topics to be covered <ul><li>Basic oral sugery </li></ul><ul><li>Medical Problems Relating to Oral and Maxillofacial </li></ul><ul><li>Surgery Emergency and Collapse in the Dental Surgery </li></ul><ul><li>  Exodontia (general consideration) </li></ul><ul><li>  Extraction of Teeth and Roots </li></ul><ul><li>  Surgical Principles and Techniques Surgical Removal of Impacted,Unerupted, Partially Erupted Teeth  </li></ul><ul><li>Complications of Tooth Removal </li></ul><ul><li>Surgical endodontics </li></ul><ul><li>Pre- prosthetic surgery </li></ul><ul><li>Oral implantology, Replantation & TransplantationOral, </li></ul><ul><li>Face, and Neck infections + Antibiotic therapy </li></ul><ul><li>Maxillary sinus Involvement </li></ul><ul><li>Cysts of the jaw </li></ul><ul><li>Tumors of the oral cavity </li></ul><ul><li>TMJ Involvement </li></ul><ul><li>Affections of Salivary glands </li></ul><ul><li>Types & principles of biopsy </li></ul><ul><li>Differential diagnosis </li></ul><ul><li>Advanced oral and Maxillofacial surgery </li></ul><ul><li>Fractures of the mandible </li></ul><ul><li>Fractures of Middle third of the facial skeleton </li></ul><ul><li>Reconstruction of soft and hard tissues </li></ul><ul><li>Distraction ontogenesis </li></ul><ul><li>Cleft lip and Palate </li></ul><ul><li>Dentofacial Deformities </li></ul><ul><li>Complications of Oral Surgery </li></ul><ul><li>G A </li></ul><ul><li>Perspective of general anaesthesia </li></ul><ul><li>General anaesthesia for Dentistry </li></ul><ul><li>Intravenous sedation </li></ul><ul><li>Nitrous oxide sedation </li></ul><ul><li>Resuscitation guidelines </li></ul>
  14. 14. SURGICAL PROCEDURES <ul><li>Extened from simple tooth extraction to tumor resection and orthognathic surgery </li></ul>
  15. 15. Exodontia <ul><li>Uncomplicated Exodontia </li></ul><ul><li>Complicated Exodontia </li></ul>25/05/11
  16. 16. Patient evaluation <ul><li>Goals of Physical Examination </li></ul><ul><li>To determine patient's ability to physically tolerate the dental treatment </li></ul><ul><li>To determine patient's ability to psychologically tolerate the dental treatment </li></ul>25/05/11
  17. 17. Uncomplicated Exodontia Simple Extraction 25/05/11 Closed extraction Conventional extraction Intra-alveolar extraction
  18. 18. Indications for removal of teeth <ul><li>Sever caries </li></ul><ul><li>Pulpal necrosis not amenable to endodontic treatment </li></ul><ul><li>Sever periodontal disease with excessive bone loss </li></ul><ul><li>Orthodontic reasons </li></ul><ul><li>Malopposed or malpositioned teeth </li></ul><ul><li>Supernumerary teeth </li></ul><ul><li>Cracked teeth </li></ul><ul><li>Preprosthetic extractions </li></ul>25/05/11
  19. 19. Indications for removal of teeth <ul><li>Impacted teeth </li></ul><ul><li>Teeth associated with pathologic lesions </li></ul><ul><li>Preradiation therapy </li></ul><ul><li>Teeth involved in jaw fractures </li></ul><ul><li>Esthetics </li></ul><ul><li>Economics </li></ul>25/05/11
  20. 20. Contraindications for the removal of teeth <ul><li>Systemic contraindications </li></ul><ul><li>Local contraindications </li></ul>25/05/11
  21. 21. Systemic contraindications <ul><li>Uncontrolled or poorly controlled medical conditions: diabetics, Leukemia , cardiac disease ;end stage renal disease </li></ul><ul><li>Severe bleeding diathesis as hemophilia ,or platelet disorder </li></ul><ul><li>Pregnancy is a relative contraindication? Safe in the second trimester </li></ul><ul><li>Patients on special medications: corticosteroids, immunosuppressive, or chemotherapy </li></ul>25/05/11
  22. 22. Local contraindications <ul><li>Post-irradiation </li></ul><ul><li>Tooth in tumour mass </li></ul><ul><li>Tooth in Facture line </li></ul><ul><li>Sever pericoronitis </li></ul><ul><li>Acute infection and acute dento-alveolar abscess </li></ul>25/05/11
  23. 23. Introduction for dental implants
  24. 24. What is a dental implant? <ul><ul><li>Definition </li></ul></ul><ul><ul><ul><li>an endosteal (within bone) alloplastic biologically compatible material surgically inserted into the edentulous bony ridge </li></ul></ul></ul><ul><ul><li>Osseointegration ” </li></ul></ul><ul><ul><ul><li>Bränemark - late 1980’s </li></ul></ul></ul><ul><ul><ul><ul><li>direct structural & functional </li></ul></ul></ul></ul><ul><ul><ul><ul><li>connection between ordered, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>living bone & surface of a </li></ul></ul></ul></ul><ul><ul><ul><ul><li>load-carrying implant </li></ul></ul></ul></ul>
  25. 25. What are the types of dental implants? <ul><li>Subperiosteal implant </li></ul><ul><li>Transosteal implant </li></ul><ul><li>Endosteal implant </li></ul><ul><ul><li>Plate form Implants </li></ul></ul><ul><ul><li>Root form Implants </li></ul></ul>
  26. 26. Subperiosteal implant
  27. 27. Transmandibular implant
  28. 28. <ul><li>They mimic the root shape of the natural tooth </li></ul><ul><li> (cylinder or screw) </li></ul><ul><li>Installed immediately/ or 3-6 ms. after extraction </li></ul><ul><li>It can be loaded immediately or few month later. </li></ul><ul><li>Enough bone and soft tissue </li></ul>Root form implants
  29. 30. Tumours of the head and neck
  30. 31. <ul><li>Many of the oral lesions may have had an initial lesion that were potentially curable. </li></ul><ul><li>The cure could be predicted if the lesion is diagnosed early and the appropriate therapy is given before the disease reaches advance stages to become incurable </li></ul>
  31. 33. Maxillofacial trauma Management of traumatized patient
  32. 34. Sequel of facial injury Is the patient fully conscious? And able to maintain adequate airway? Semiconscious or unconscious patient rapidly suffocate because of inability to cough and adopt a posture that held tongue forward Obstruction of airway asphyxia Cerebral hypoxia Brain damage/ death
  33. 35. Clinical assessment and diagnosis <ul><li>History of trauma </li></ul><ul><li>(traumatized patients with possible head injury) and facial injuries </li></ul><ul><li>Clinical Examination </li></ul><ul><li>▶ Extroral </li></ul><ul><ul><ul><li>Inspection (assessment of asymmetery, swelling, ecchymosis, laceration and cut wounds) </li></ul></ul></ul><ul><ul><ul><li>Palpation for eliction of tenderness, pain, step deformity and malfunction </li></ul></ul></ul><ul><li>▶ Intra- and paraoral </li></ul><ul><li>bleeding, heamatoma, gingival tear, gagging of occlussion and step deformity and sensory and motor deficiency </li></ul><ul><li>Radiographs </li></ul>
  34. 36. Radiographs <ul><li>Plain radiograph </li></ul><ul><ul><ul><li>OPG </li></ul></ul></ul><ul><ul><ul><li>Lateral oblique </li></ul></ul></ul><ul><ul><ul><li>PA mandible </li></ul></ul></ul><ul><ul><ul><li>AP mandible (reverse Townes) </li></ul></ul></ul><ul><ul><ul><li>Lower occlusal </li></ul></ul></ul><ul><li>CT scan </li></ul><ul><li>3-D CT imaging </li></ul><ul><li>MRI </li></ul>
  35. 39. Teaching strategies <ul><li>- lectures </li></ul><ul><li>- tutorials </li></ul><ul><li>- Student seminars </li></ul><ul><li>- Problem-based learning scenarios </li></ul><ul><li>- Computer aided learning </li></ul><ul><li>- Clinical skills </li></ul>
  36. 40. Methods of assessment <ul><li>- Coursework </li></ul><ul><li>- Continuous assessment ( Quiz ) </li></ul><ul><li>- Written examination (MCQ's, SAQ's,) </li></ul><ul><li>- Clinical examination ( in year 5 & 6 ) </li></ul><ul><li>- Clinical scenarios </li></ul><ul><li>- Case presentation </li></ul><ul><li>- Oral examination. </li></ul>
  37. 41. Thank you