basic oral cavity surgery principles
primary goal: maintain overall health and function of oral cavity,.
-great healing in the mouth as they have an increased Blood supply, but also worsens visualization
-preserve vessels and nerves
oral surgery suture and needle
-reverse cutting 3/8 of cirlce
-suture material: absorbable 3.0 - 5.0. depends on patient size, condition of tissue and goal of procedure.
-use monocryl down in the clinic but almost lasts too long and still there at two week checkup, can also us vicryl rapide
suture patterns and rule of 3s and what knot and pattern s
Suture patterns
Simple interrupted, Horizontal mattress, Cruciate
Surgeons knot then 2-3 more throws
-dont blanch tissue (have too tight and white)
Rule of 3
3mm from incision/ gum line or at base of papilla
3mm apart3mm apart
3mm ends3mm ends
Knots on buccal surface
-interdental sutures: want to secure the gingava againt the tooth, between the teeth where you lifted away the gingiva with your flaps.
-debride chronic and intact epithelial surfaces
-do not leave denuded bone
factors involved when deciding to remove or not remove a tooth
-tooth status
-periodontal tissues
-owner compliance
-pet compliance
-as compliance decreases the probability of removal increases. (easier to remove then all the at home work/ rechecks)
exodontia (extraction) indications
Retained deciduous teeth
Interceptive orthodontics
Deciduous & permanent
Malocclusion
Periodontal disease
Resorptive lesions
Endodontic disease
Missing teeth
toothanasia ( teeth were usually trying to save)
Provide a healthy & comfortable oral cavity
Strategic teeth
Canine or carnassial (MX PM4 & MN M1)
Esthetic teeth (client wants to keep)
MX & MN incisors
-owner consent
canine tooth roots
1 root: I, C, 1st PM
3 roots: maxillary 4th PM, 1 & 2 molars
2 roots: all others
feline tooth roots
1 root: I, C maxillary 2nd PM
3 roots: Maxillary 4th PM
2 roots: all others
dental radiographs show you
-ankylosis (fused to bone)
-# of tooth roots
-resorption: external or internal
-dilaceration (abnormal angle of tooth root or crown)
dental anesthesia and pain control
-general anesthesia
-local nerve blocks: bupivicane +/- buprenorphine
-post op pain control: gabapentin, meloxicam. buprenorphine
exodontia steps 1
sever the epithelial attachment:
-#11/12 scalpel blade
-small sharp periosteal elevator or dental elevator, all around the tooth hold pressure, stretch and break down periodontal ligament.
insert blade into gingival suculus until contacting alveolar crestal bone
-extend the sulcular incision around the entire tooth
-smooth control, and control on the quadrant
using flaps for visualization when extracting teeth
-MP flaps help you visualize root structures
-buccal alveolar bone removal with high speed drill and bur
-envelope flap, mucoperiosteal flaps
envelope flap
-used for most teeth
Flap release use the periosteal elevator with pressure directed towards bone
Reflect a full thickness mucoperiosteal flap extending flap past the MGJ
Initially extend ½ the tooth mesial & distal to the tooth in question
-dont want to cut through nerve bundles
mucoperiosteal flap
Single releasing & double releasing flaps:
To gain sufficient access to the root surface or to
allow appropriate positioning of the flap without
extending its border into uninvolved areas
Incisions are made at the mesial and/or distal
borders of the flap vertically
Incisions are made at line angles
-dont cut through frenula
-common for lower insicors
A. Wedge
B.B. Wheel & axle
C.C. Lever
for exodontia
-wedge: into peri space, have contact with quadrant, all around the tooth at least 1/2 way down the root until finger loose, before you can put extractors on
-wheel and axle: get under the tooth and rotate it along the area to take the tooth out. have to do after wedge
- lever action: dont use unless it is wobbling with fingers and too motile to move, if stable do not use this you can break the jaw.
alveolar bone removal
-remove 1/3 buccal bone with a round bur
-outline the root
-conservative but remove more if required
-light touch, use lots of water
sectioning teeth for removal
multi-rooted teeth-> section into single rooted segments
-locate furcation with chisel or bur, and section the tooth with high speed drill with tapered cross-cut bur 701L
-start at furcation where the roots meet at buccal aspect -> bur through to lingual aspect.
post exodontia
Alveolar socket curettage: Gently use a small bone curette to remove necrotic debris, DONT CURETTE HEALTHY PL, leave a blood clot
-alveoloplasty: bone file to remove sharp edges, enhances healing
alveolor socket lavage: only if comtaminated, decreases bacterial load, flush with saline or water LEAVE A BLOOD CLOT
closure sutures
-place knots over bone support, secure and NOT TIGHT, debride flap margins, horizontal mattress and simple interrupted pattern.
if an envelope flap= interdental sutures.
maxilla PM4 exodontia complications
-suborbital vessels between roots, if you slip can get hemorrage
-slippage into nasal sinuses
-forcing root tips into nasal sinuses
mandibular exodontia complications
-slippage into MN canal
-large defect in MN
-MN fracture
general exodontia complications
-fractured root tips
-pre, intra and post X-rays
-complete extraction can be very hard with root resorption.
-atomization: AIR EMBOLI, not reccomended
when to leave root tip in when having exodontia complications
-retained tip is ID on rads with no pathology in surrounding bone
-can not find it
-excessive hemorrhage
-important structures are involved
-patient not doing well
-document and inform client
consequenses of leaving root tip in
-resorption of root tip
-extrusion of root tip
-retained intact
-infection
