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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

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Oral Surgery

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  1. Oral Surgery V-Day +1 – 02/15/08

  2. For Older Patients • Maxillary K9’s • Always surgical!

  3. When is pinch grasp used? • Use pinch grasp to make sure you are not fracturing the buccal and lingual bone.

  4. 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

  5. Maxillary Extractions • First molar • Strong buccal and strong lingual movement • Seat the beaks as much as you can, expand the bone, tear the fibers

  6. Alternative to bite block for support? • Mandibular sling grasp supports the muscles of the jaw and the TMJ

  7. Thinnest v. Thickest Mnd Bone: • Thickest bone in mandible: • Buccal of mandibular thirds • Thinnest bone in mandible: • Lingual of the thirds

  8. 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

  9. What happens from osteoradionecrosis? It kills the endothelial cells in the bone – an irreversible process

  10. Osteoradionecrosis • Most common Jaw: • Mandible • Cause: • Death of the endothelial cells • Length: • Permanent • Treatment: • Hyperbaric oxygen

  11. Hyperbaric Oxygen • Concept of ‘dives’ … • 1hr at 2atm • Stimulates growth of endothelial cells and mucosa • Each dive is 30min • Give the patient 20-40 dives before you: • 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.

  12. 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!

  13. 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)

  14. 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.

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