Seth Delpachitra - Principles of Dentoalveolar Extractions

1 Cover

2 Title Page Principles of Dentoalveolar Extractions Seth Delpachitra Anton Sklavos Ricky Kumar

3 Copyright Page

4 Foreword

5 About the Companion Website

6 1 Principles of Surgery 1.1 Wound Healing 1.2 Patient Assessment 1.3 Radiographic Assessment 1.4 Informed Consent 1.5 Anaesthesia 1.6 Preparation of Equipment 1.7 The Surgeon's Preoperative Checklist 1.8 Operative Note

7 2 Local Anaesthesia 2.1 Principles of Anaesthesia 2.2 Mechanism of Action 2.3 Common Local Anaesthetic Preparations 2.4 Side Effects and Toxicity 2.5 Basic Oral Anaesthesia Techniques 2.6 Adjunct Methods of Local Anaesthesia 2.7 Troubleshooting

8 3 Basic Surgical Instruments 3.1 Retractors 3.2 Elevators, Luxators, and Periotomes 3.3 Dental Extraction Forceps 3.4 Ancillary Soft Tissue Instruments 3.5 Suturing Instruments 3.6 Surgical Suction 3.7 Surgical Handpiece and Bur 3.8 Surgical Irrigation Systems 3.9 Mouth Props

9 4 Simple Extraction Techniques 4.1 Maxillary Incisors 4.2 Maxillary Canines 4.3 Maxillary Premolars 4.4 Maxillary First and Second Molars 4.5 Mandibular Incisors 4.6 Mandibular Canines and Premolars 4.7 Mandibular Molars

10 5 Surgical Extraction Techniques 5.1 General Principles of Surgical Extraction 5.2 Practical Aspects of Surgical Extraction 5.3 Common Soft Tissue Flaps for Dental Extraction 5.4 Bone Removal 5.5 Tooth Sectioning 5.6 Cleanup and Closure

11 6 Intraoperative Complications 6.1 Lip Burns and Lacerations 6.2 Damage to Adjacent Teeth or Restorations 6.3 Mandible Fracture 6.4 Tooth Aspiration or Ingestion 6.5 Instrument Fracture 6.6 Intraoperative Bleeding 6.7 Oroantral Communication 6.8 Dentoalveolar Fracture

12 7 Third Molar Surgery 7.1 Treatment Planning of Impacted Third Molars 7.2 Difficulty Assessment and Preoperative Workup 7.3 Radiographic Assessment of Inferior Alveolar Nerve Risk 7.4 Surgical Approach to Third Molars

13 8 Management of the Medically Compromised Patient 8.1 Ischaemic Cardiovascular Disease 8.2 Patients with a History of Infective Endocarditis 8.3 Hypertension 8.4 Medication‐Related Osteonecrosis of the Jaws 8.5 Diabetes Mellitus 8.6 Increased Bleeding Risk 8.7 Adrenal Suppression 8.8 The Irradiated Patient 8.9 Hepatic or Renal Impairment 8.10 Pregnancy and Lactation

14 9 Postoperative Care and Late Complications 9.1 Immediate Postoperative Period 9.2 Postoperative Instructions 9.3 Postoperative Medications 9.4 24‐Hour On‐Call Service and Tertiary Hospital Referral 9.5 Management of Late Complications

15 Appendix A: Special CasesA.1 Lone‐standing Upper First Molars A.2 Palatally Impacted Upper Canines A.3 Bulbous Roots (Hypercementosis) A.4 Teeth with Aberrant Root Morphology A.5 Teeth with Extensive Crown Decay A.6 Retained Deciduous Molars

16 Appendix B: Extraction of Deciduous Teeth B.1 Principles of Paediatric Dental Extraction B.2 Techniques of Paediatric Dental Extraction

17 Bibliography

18 Index

19 End User License Agreement

1 Chapter 1 Table 1.1 Comparisons between commonly used oral benzodiazepine sedatives.

2 Chapter 2 Table 2.1 Conversion tables for local anaesthetic and adrenaline in solution.

3 Chapter 3Table 3.1 General principles of elevator use.Table 3.2 Common elevator designs and indications for use. Image source: KLS ...Table 3.3 General principles of dental extraction forceps use.Table 3.4 Common dental extraction forceps designs (American and British patt...Table 3.5 Common suture materials used in the oral cavity, classified by beha...Table 3.6 Characteristics of suture needles and materials.

4 Chapter 5Table 5.1 General steps in surgical extraction.Table 5.2 Situations where surgical extraction methods may be required.

5 Chapter 6Table 6.1 Haemostatic agents that may be used to assist with control of bleed...

6 Chapter 7Table 7.1 Indications for third molar extraction as per the National Institut...Table 7.2 Contraindications for third molar extraction.Table 7.3 Treatment options for third molar teeth based upon presence of symp...Table 7.4 Local and general factors that increase the difficulty of third mol...

7 Chapter 8Table 8.1 Medications associated with the development of MRONJ.Table 8.2 American Association of Oral and Maxillofacial Surgery – Clinical S...Table 8.3 Relative risk of MRONJ based on a C‐terminal telopeptide (CTX) bloo...Table 8.4 Acquired and congenital conditions which affect normal haemostasis ...Table 8.5 Common medications which affect normal haemostasis and increase ble...Table 8.6 Conditions for which corticosteroids are commonly prescribed.Table 8.7 Dose equivalence table for various steroid compositions compared wi...Table 8.8 Considerations in patients with hepatorenal disease undergoing surg...

8 Appendix BTable B.1 Options for space maintenance after deciduous tooth extraction.

1 Chapter 1 Figure 1.1 Phases of wound healing. Figure 1.2 The coagulation cascade. Figure 1.3 Panoramic radiograph: 1. mandible; 2. maxilla; 3. temporomandibul... Figure 1.4 Slices of a serial transaxial CBCT. Figure 1.5 Example consent form for dentoalveolar surgery. Figure 1.6 Clinic room with defined administrative, operative, and hygiene a... Figure 1.7 WHO surgical handrubbing technique. Figure 1.8 Dentist with sufficient sterile and personal protective attire fo...

2 Chapter 2 Figure 2.1 Mechanism of action of a local anaesthetic agent. Figure 2.2 Example preparations of local anaesthetic. Figure 2.3 Buccal/labial infiltration anaesthesia of the maxilla (left) and ... Figure 2.4 Anatomy of the pterygomandibular space and relations of the infer... Figure 2.5 Conventional ‘open‐mouth’ technique. Figure 2.6 Akinosi ‘closed‐mouth’ technique.Figure 2.7 Gow–Gates technique.Figure 2.8 Mandibular long buccal block.Figure 2.9 Mental nerve block.Figure 2.10 Anatomy of nerve supply to the maxilla.Figure 2.11 Greater palatine block.Figure 2.12 Palatal infiltration.Figure 2.13 Nasopalatine nerve block.Figure 2.14 Posterior superior alveolar nerve block.Figure 2.15 Intrapulpal injection.

3 Chapter 3Figure 3.1 Cawood‐Minnesota retractor. Only a gentle finger grip is required...Figure 3.2 Wire cheek retractor. This instrument is most commonly held by th...Figure 3.3 Tongue retractor. This instrument is large and can damage the ant...Figure 3.4 Basic elevator construction.Figure 3.5 Types of forces applicable through an elevator.Figure 3.6 Basic forceps construction.Figure 3.7 Scalpel handle and blade types commonly used in dentoalveolar sur...Figure 3.8 Molt periosteal elevator. Each end has two surfaces: one rounded ...Figure 3.9 Mitchell's trimmer.Figure 3.10 Angled curette.Figure 3.11 Cleoid‐discoid carver.Figure 3.12 Curved artery forceps.Figure 3.13 Basic suturing equipment. Needle holders, forceps, and scissors ...Figure 3.14 Front of a suture packet, detailing suture gauge (3‐0), needle t...Figure 3.15 Frasier suction tip.Figure 3.16 Surgical bur setup with sterile plastic and foot pedal.Figure 3.17 Options for surgical irrigation include use of a Monoject (R) sy...Figure 3.18 Mouth prop. A number of sizes are available.

4 Chapter 4Figure 4.1 Extraction of a maxillary incisor tooth.Figure 4.2 Extraction of a maxillary canine tooth.Figure 4.3 Extraction of a maxillary premolar tooth.Figure 4.4 Extraction of a maxillary molar tooth.Figure 4.5 Extraction of a mandibular incisor tooth.Figure 4.6 Extraction of a mandibular canine or premolar tooth.Figure 4.7 Extraction of a mandibular molar tooth.

5 Chapter 5Figure 5.1 Crestal‐only flap with no relieving incision.Figure 5.2 Two‐sided flap, consisting of a crestal flap with mesial relievin...Figure 5.3 Three‐sided flap, consisting of a crestal flap with mesial and di...Figure 5.4 Vestibular incision used to approach an impacted canine.Figure 5.5 Buccal bone gutter to facilitate removal of a lower molar.Figure 5.6 Decoronation of a tooth.Figure 5.7 Sectioning between roots.Figure 5.8 Sectioning within a single root.