Oral Surgery
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Transcript Oral Surgery
Oral Surgery
V-Day +1 – 02/15/08
For Older Patients
Maxillary K9’s
Always surgical!
When is pinch grasp used?
Use pinch grasp to make sure you are
not fracturing the buccal and lingual
bone.
Maxillary Extractions
Use buccal and palatal motion
Emphasize the side that you can expand
easiest
Buccal
is typically thinner
First primolars
Don’t rotate
Mostly traction
Traction
means pull
Also can use buccal and lingual motion
often
Maxillary Extractions
First molar
Strong buccal and strong lingual
movement
Seat the beaks as much as you can,
expand the bone, tear the fibers
Alternative to bite block for
support?
Mandibular sling grasp supports the
muscles of the jaw and the TMJ
Thinnest v. Thickest Mnd Bone:
Thickest bone in mandible:
Buccal of mandibular thirds
Thinnest bone in mandible:
Lingual of the thirds
Mental Foramen Problems
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
Most common Jaw:
Cause:
Death of the endothelial cells
Length:
Mandible
Permanent
Treatment:
Hyperbaric oxygen
Hyperbaric Oxygen
Concept of ‘dives’ …
1hr at 2atm
Each dive is 30min
Give the patient 20-40 dives before you:
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:
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
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:
Be sure you know 3 things:
How much radiation was given?
Where was the radiation given?
Was the jaw shielded from the radiation?
(upper
and lower)
Shielding Goals
You’re OK if:
Total dose value lower than 3500 and
not shielded
Shielded jaws
NOTE: Date is insignificant… don’t need
to know the date.