OS Lec # 4 by Mohammad Al-Shantir

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OS Lec # 4 by Mohammad Al-Shantir

Post by Sura on 26/10/2011, 12:59 am


عدد المساهمات : 484
النشاط : 2
تاريخ التسجيل : 2010-09-29

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Re: OS Lec # 4 by Mohammad Al-Shantir

Post by Shadi Jarrar on 31/10/2011, 4:44 am

Oral surgery

Bayonet forceps which design for upper wisdom, as we said we have to do luxation*, one of the advantages of the luxation is facilitate the application of the forceps.

Luxation: dislocation.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier

The target of the curve design of the bayonet is to be parallel to the long axis of the tooth, you have to know the surgical tactile sensation, and this will help you to apply the proper force.

We care about:

1) Tactile sensation

2) Proper force

3) Field visualization (not to work blindly)

Always we have to work in isolated field either by suction or gauze.

The design of the forceps for remaining roots the peaks is closed together, but for teeth the peaks are separated.

We have to prepare the surgical tray and that’s depending of the surgical type like major, minor, simple...etc.

The first step in the surgery is to control and manage the pain.

We have to know contraindication of tooth removal and the case that indicated or not, there is systemic and local condition we have to be aware, never do extraction for patient who are highly compromise like with sever metabolic disease, uncontrolled leukemia and lymphoma, or uncontrolled diabetes, if there is diabetic patient we have to stop the extraction and ask some question about FBS and hemoglobin A1C*.

Hemoglobin A1C: the level of glycelated hematocrit, the normal value (6.1-6.4%).

We are not allowed to treat all patients by now; there is special case need special care.

As we know the half life of the RBC is 120 days.

Uncontrolled leukemia and lymphoma we fear about its complication like uncontrolled bleeding or infection.

Most common bleeding disorder is hemophilia, and the most common inherited disease as bleeding disorder is von willebrand disease, it’s associated to platelet and factor 8.

von Willebrand disease (vWD) is the most common hereditary coagulation abnormality described in humans, although it can also be acquired as a result of other medical conditions. It arises from a qualitative or quantitative deficiency of von Willebrand factor (vWF), amultimeric protein that is required for platelet adhesion. It is known to affect humans and dogs (notably Doberman Pinschers), and rarely in swine, cattle, horses, and cats. There are three forms of vWD, inherited, acquired and pseudo or platelet type. There are three types of hereditary vWD, vWD Type I, vWD Type II and vWD III. Within the three inherited types of vWD there are various subtypes. Platelet type vWD is also an inherited condition.

vWD Type I is the most common type of the disorder and those that have it are typically asymptomatic or may experience mild symptoms such as epistaxis although there may be severe symptoms in some cases. There are various factors that affect the presentation and severity of symptoms of vWD such as blood type.( From Wikipedia)

We are not allowed to treat patient who take anticoagulant drugs and immunocompromized patient.

Local factors that contraindicated for extraction:

1) History of radiation for cancer in the area of the tooth, if we do extraction the patient may have ostionecrosis (loosing bone) and that’s due to the effect of radiotherapy on blood supply (compromise it), we have to treat patients before radiotherapy, we have to put good planning for their treatment (extraction) or we will delay the treatment for 6 months.

2) If there is tumor in the area of teeth, if we do extraction we may disseminate the tumor.

3) Pericoronitis in the area of impacted mandibuler molar, we give the patient course of antibiotic before extraction, other management: extraction of the upper molar, because it may exert pressure (impingement or trauma) of the operculum of the lower one.

In artriti obliterans : calcification in the arterioles duo to radiotherapy.

No blood supplies in the area so any bone healing, if the bone exposed and there is no blood supply...by9eer 3nna ostiomallytis.

Clinical evaluation: we have to know what we are treating, we have to know if there is good mouth opening or not.

Asses the mobility of the teeth, if there is periodontal disease, examine the crown if there is large caries or filling if this present we may expect fracture of the crown during extraction.

Ideally we do scaling before extraction.

Radiographic evaluation of the tooth, we have to know if there is any pathology like periapical radioluscency.

Relation between teeth.

If there is root caries the tooth may fracture during extraction, if there is divergent root, hypercemntosis or dilacerations the extraction will be HARD.

When we do extraction we have to respect the patient and respect the soft tissue.

Always we have to see the radiograph and asses the proximity the roots to the surrounding structure, In the upper arch we care about sinus, in the lower arch there is ID nerve, we care about it when we extract the lower 3rd molar so we have to assess the proximity of root to the NERVE to protect our patient from permanent parasthesia.

Temporary parasthesia: due to inflammation after extraction.

All teeth that endo treated its brittle and it may fracture. When we suspect fracture we have to focus of using elevator. But if we use the elevator in the wrong way we may harm the adjacent filling or structure.

Chair position and operator position: as we know the level of patient mouth must be equal to the level of operator’s Elbow level.

Maxillary teeth extraction: the occlusal plane must be at 60 degree with floor (recline)

Mandibular extraction: dental chair more to the upright position and lower level, occlusal plan must be parallel to the floor.

In maxillary there is 2 point support but mandibular 3 point support, we have to support it because its mobile bone.

In extraction: all teeth we will come to front of patient except:

If you are right handed: lower right posterior (behind the patient)

If you are left handed: lower left posterior (behind the patient)

In the upper teeth, always we start our movement buccaly because the buccal bone is brittle, and the lower except the posterior lower molar the buccal bone is thick but on the other tooth its thinner, so the movement buccopaletally, we do expansion of the alveolar bone then rotational force (for conical root not curved one) and final retraction force when delivering the tooth.

Mechanical principle of extraction depends on elevator and that’s depending on force arm and resistant arm, we have to increase the force arm by the elevator.

Elevator depends on the principle of wheel and axis.

If there is two roots in the sucker one of them extracted and the other remains, we engage the cryer in the root then elevated.

The last step is retraction force when delivery.

We may use lever and effecter arm.

Peaks of the forceps do bone expansion; we have to reduce this expansion.

Center of rotation transmitted apically and that’s give us better:

1-tactile sensation

2-controlled force

We have to do luxation and the best location for luxation is the mesiobuccal point.

We have to apply controlled force not jerky one.

If the center of rotation remains cervicaly the apical 3rd will be fractured that’s due to jerky movement or wrong application of the forceps.

When we are working on the right side we may use bite block to the other teeth to protect TMJ.

When we deliver a force we have to wait to give the time for bone expansion

Done by: Mohammad AL-Shanty
Oral surgery #4
Shadi Jarrar
مشرف عام

عدد المساهمات : 997
النشاط : 12
تاريخ التسجيل : 2009-08-28
العمر : 27
الموقع : Amman-Jordan


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