Transcript Oral Surgery

Oral Surgery
V-Day +1 – 02/15/08
For Older Patients
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Maxillary K9’s
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Always surgical!
When is pinch grasp used?
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Use pinch grasp to make sure you are
not fracturing the buccal and lingual
bone.
Maxillary Extractions
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Use buccal and palatal motion
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Emphasize the side that you can expand
easiest
 Buccal
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is typically thinner
First primolars
Don’t rotate
 Mostly traction
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 Traction
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means pull 
Also can use buccal and lingual motion
often
Maxillary Extractions
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First molar
Strong buccal and strong lingual
movement
 Seat the beaks as much as you can,
expand the bone, tear the fibers
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Alternative to bite block for
support?
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Mandibular sling grasp supports the
muscles of the jaw and the TMJ
Thinnest v. Thickest Mnd Bone:
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Thickest bone in mandible:
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Buccal of mandibular thirds
Thinnest bone in mandible:
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Lingual of the thirds
Mental Foramen Problems
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Generally not an issue, but can be…
If you drop a flap in that area
 Minnesota retractor during a full
thickness envelope flap

What happens from
osteoradionecrosis?
It kills the endothelial cells in the bone
– an irreversible process
Osteoradionecrosis
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Most common Jaw:
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Cause:
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Death of the endothelial cells
Length:
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Mandible
Permanent
Treatment:
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Hyperbaric oxygen
Hyperbaric Oxygen
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Concept of ‘dives’ …
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1hr at 2atm

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
Each dive is 30min
Give the patient 20-40 dives before you:
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Stimulates growth of endothelial cells and mucosa
Saucerization – cleaning out the necrosis until you
get to bleeding bone
End block – take a big chunk of bone out – generally
does not work well
Give patient more dives at the end of treatment
DO ANYTHING YOU CAN TO PREVENT A TOOTH
EXTRACTION on a osteoradionecrosis patient. Cut it
off at the gumline and do a RCT if necessary.
Problem with operating on
osteoradionecrosis patients:
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If we take out a tooth in a radiated jaw,
there are not enough endothelial cells.
We can’t get the lymphocytes to get there
and kill bacteria due to loss of circulation
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Hence, even major doses of antibiotics won’t
help because there is little to no blood supply
to the area
THEREFORE : the bone necroses quickly!
Keys to radiation know-how:
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Be sure you know 3 things:
How much radiation was given?
 Where was the radiation given?
 Was the jaw shielded from the radiation?
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 (upper
and lower)
Shielding Goals
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You’re OK if:
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Total dose value lower than 3500 and
not shielded
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Shielded jaws
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NOTE: Date is insignificant… don’t need
to know the date.