Minor Oral Surgical Procedures -Stoma 2014, lecture by dr arun george
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Transcript of Minor Oral Surgical Procedures -Stoma 2014, lecture by dr arun george
Minor oral surgeries…
Dr Arun George MDSMaxillofacial Surgeon India
Like every proffessional man I am very much indebted to my seniors and colleagues who taught me the practice of oral and maxillofacial surgery…..
Pre Surgical Care…………
Stress Reduction Morning Apointment Pre Medication Vocal, Music, Aroma Eye contact on communication Deep Breathing Pain less local anaesthesia Hypnosis
So that you guys don’t end up like this !!!
“Minor oral Surgery
is defined as a surgical procedures which can be comfortably completed by a dentist in not more than 30 minutes”
over view of Minor oral Surgeries
Endodontic Surgeries Surgery & Maxillary Sinus Biopsy Incision & Drainage Preprosthetic Complicated Exodontia Recent advances in minor
surgery
Simple things may not be so simple !...
Surgery is a discipline
based on principles
that evolved from both basic
research and centuries of
trial & error
Apicoectomy & Curettage
ENDODONTIC SURGERY YES (OR) NO
THE CONCEPT IS WAIT AND WATCH – NO HURRY IF YOU HAVE A GOOD APICAL SEAL
Indications of Apicoectomy
Apical anomaly Accessory canals Perforations
Broken instruments Periapical granuloma/ Cyst Draining sinus tract/ non responsive to RCT Extension of RC sealent or cement
Indications
Broken instruments
Open Apex
Periapical granuloma/ Cyst
Dilaceration Calcified canal
Extension of RC beyond the apex
Apicoectomy & Curettage
Maxillary Sinus
Maxillary Sinus Acute Fistula
Chronic Fistula
Oro antral Communication
Is an unnatural communication between oral cavity and the maxillary sinus
Nose blowing Clinical diagnosis for OAF Displace cotton wool Never let the oral fluids to go inside
the sinus
Oro antral Communication Management Protocol Newly created or Chronic Less than 2mm go in for a primary
closure 5mm – Closure with reduction of the
socket walls Give acrylic splint If larger – approximation of the wound by
use of flaps for coverage.
Flaps
Buccal Advancement Palatal Combination of Buccal and Palatal Buccal Pad of Fat Tongue Temperomyofascial Flap
Buccal Advancement flap
CHRONIC OAF Antral Wash Antibiotics Decongestant
Spontaneous healing observed for smaller fistulas
Acrylic plate
Palatal Flap
Caldwell- Luc Operation- •George Caldwell - 1893 [Newyork] •Henry Luc – 1897 [Paris]
Indications : Removal of displaced teeth, foreign body from sinus Post traumatic Hemorrhage Chronic Sinusitis Along the closure of OAF associated with chronic sinusitis
Impacted Third molar
Diagnostic and Ablative
Biopsy
Biopsy
Punch Incisional Excisional
Incisional Biopsy
wedge incision
10 % formalin, 10 times volume, 24 hrs time period,
TAKE BIOPSY SPECIMEN ALONG WITH NORMAL TISSUE MARGIN
Excisional Biopsy
Temperomandibular Joint
INTERNAL DERANGMENT Localized disturbance & uncoordinated
movement between the disc and the head of the condyle
Disc displacement with reductionWith out reductionAdhesionsAlterationVarious arthritis
MANAGEMENT Medical (muscle relaxant, anti depressent ) Functional correction of the occlusion Soft Splint Arthrocentesis & lavage ( release of the
adhesion ) Arthroscopic surgery Open joint surgery
DiscectomyMeniscoplasty
1991- Nitzen
Single Puncture Arthrocentesis
Space Infections
Incision & Drainage
Abscess don’t wait for the sun set
. EMPIRICAL ANTIBIOTIC
THERAPY *
CULTURE AND SENSITIVITY * APPROPRIATE ANTIBIOTIC THERAPY
REMOVAL OF THE CAUSE ( teeth if odontogenic ) *
SUPPORTIVE THERAPY * PHYSIOTHERAPY (to improve mouth opening)
Hiltons Method Anesthesia Stab Incision with
11no blade Burst all the locules with sinus
forceps Abscess I & D only fluctuant,
Rubber drain- 24 hrs Ribbon Gauze wth
whiteheads varnish i/o
High frenal Attachment
High frenal Attachment- Complications
Denture displacement
Mid line Diastema Orthodontic
relapse
Laser Frenectomy Z- plasty- for broad frenum and
short vestibule
Cross Diamond Excision- For excess tissue
V-Y type of incision – For lengthening
“Tongue Tie”
Early Vs Delayed surgery
Z Plasty - Frenoplasty
Impacted Canines….
Impacted canines Position assessment – Tube shift
technique (Clark’s rule)- SLOB Field & Ackerman classification (1935)
Labial positionPalatal position Intermediate positionUnusual position
Cone Beam CT
Canine Impaction Palatal
Surgery Before Prosthodontics
Soft tissue Hard Tissue
Treatment Plan ?????Pre prosthetic????
Spacing
Periodontally Compromised
Low socio economic status
Not willing for Orthodontic & Orthognathic
Deans Alveoloplasty/ Intraseptal
Technique is to correct gross maxillary overjet
Severe Dentoalveolar proclination Spacing
Intraseptal Alveoloplasty with Repositioning of the Labial Cortical
Plate
Post op After 7 days
Deans Alveoloplasty
Pre Op Post treatment
Congenitally Missing Central Incisor
De cortication
Denture-induced fibrous inflammatory hyperplasia
Benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture.
Benign hyperplasia of fibrous connective tissue
Corticotomy- Assisted orthodontics
Cortical Cuts weakens the bony resistance, Allowing the orthopedic movement of dentoalveolar segments there by improving the facial profile and lip competence
Surgical Aids to Orthodontics
1891
Kole called it enblock tooth movement
Corticotomy-facilitated orthodontic treatment was 66% more rapid than without surgery
Shortens the FOT Prevents relapse Indicated in young adults Gives good result in
periodontally compromised patients
corticotomycorticotomy
corticotomycorticotomy
. Bony cuts 2mm depth till reaching the cancellous bone, After a period of 3 weeks corticotomy on the labial side, Relapse is less with corticotomy
Abnormally Huge Sialolith
Trans Oral Sialolithotomy
Grow @ 1mm a year
“A good surgeon knows how to do surgery and an excellent surgeon knows when to do it”
Recent Advances in Minor Oral Surgery
Simple things may not be so simple !...
Definition•A PROCESS OF NEW BONE FORMATION
BETWEEN THE SURFACES OF BONE SEGMENTS GRADUALLY SEPARATED BY INCREMENTAL TRACTION.
Distraction
1992, McCarthy
1951- Ilizarov
Chin & Toth (1996): Kisnisci et al and Iseri et al (2002)
Orthodontic tooth movement rate= 1mm a month
Dentoalveolar Distraction movement rate= 1mm a day
Orthodontic movement Vs Distraction
Buccal cortex removed with extracted premolar
After 10 days
After 30 days
Surgical Tooth Retraction
Vertical Alveolar Distraction
Vertical Alveolar Distraction
For any queries
The Dental Horizon , Muvattupuzha, Kerala, India
http://www.facebook.com/groups/craniofacial1/