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MindMap Gallery Oral-dental and alveolar surgery mind map
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Oral-dental and alveolar surgery mind map
This is a mind map about dental and alveolar surgery, including impacted tooth extraction, tooth extraction, healing of tooth extraction wounds, complications of tooth extraction, etc.
Edited at 2023-12-07 15:30:37
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Oral-dental and alveolar surgery mind map
- Valentine's Day marketing campaign
This Valentine's Day brand marketing handbook provides businesses with five practical models, covering everything from creating offline experiences to driving online engagement. Whether you're a shopping mall, restaurant, or online brand, you'll find a suitable strategy: each model includes clear objectives and industry-specific guidelines, helping brands transform traffic into real sales and lasting emotional connections during this romantic season.
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- Outline
Dental and alveolar surgery dental and alveolar surgery
tooth extraction exodontia
Indications
Indications for tooth extraction are relative With the development of oral medicine, the indications for tooth extraction are constantly changing.
Dental lesions
periapical disease
periodontal disease
Broken tooth
Fracture of 1/3 of the root is generally an indication for tooth extraction. The broken 1/3 of the root tip can be observed after treatment
Misaligned teeth
Extra teeth
Impacted teeth, impacted teeth
Retained deciduous teeth
treatment needs
Lesional tooth
jaw fracture
Preoperative evaluation and contraindications
Preoperative examination and evaluation
History collection and general condition assessment
Oral examination and tooth assessment
Preoperative imaging studies
Effects of systemic diseases on tooth extraction and contraindications to tooth extraction
Contraindications to tooth extraction are relative
heart disease
2% lidocaine is suitable However, it should not be used if there is conduction block above second degree.
Susceptible groups: patients with heart valve damage
Pathogenic bacteria: viridans Streptococcus (group A hemolytic Streptococcus)
Drug of choice: Penicillin (resistant strains can develop after 24 hours and can still exist after 2 weeks) Patients who have used penicillin within 14 days or are allergic to penicillin can use macrolide antibiotics, such as erythromycin
Standard preventive medication: Amoxicillin capsules (2g for adults, 50mw/kg for children) orally administered 1 hour before surgery
If multiple teeth need to be extracted, they should be extracted at once
Contraindications to tooth extraction or postponement of tooth extraction
Myocardial infarction within 6 months
Frequent attacks of angina pectoris recently (need to be stable for more than 3 months)
Heart function level III-IV or symptoms such as orthopnea, cyanosis, jugular venous distension, and lower limb edema; congestive heart failure
People with heart disease and high blood pressure should first control their high blood pressure and then have their teeth extracted
Uncontrolled arrhythmia, patients with a history of third- or second-degree type II atrioventricular block, bibundle branch block, and Aspen syndrome (sudden loss of consciousness combined with heart block)
hypertension
The drug is preferably lidocaine
If the blood pressure is higher than 180/100mm/Hg (24/13.3kPa), it should be controlled first before tooth extraction.
The blood pressure of elderly patients with hypertension should be controlled at 163/90mm/Hg before surgery.
Hematopoietic system diseases
Anemia: If the hemoglobin is 80g/L and the hematocrit is above 30%, teeth can be extracted.
Leukemia: Acute leukemia is a contraindication to tooth extraction Leukopenia: total white blood cell count >4*10^9/L Neutrophils>(2-2.5)*10 ^9/L Neutrophils <1*10^9/L avoid tooth extraction and surgery (patients have poor anti-infection ability)
malignant lymphoma
Performed when platelet count is higher than 100×10^9/L Hemophilia (deficiency of coagulation factor VIII) Factor VIII ≥ 30% can be removed Major surgery factor VIII ≥ 60%
Control primary disease Try to reduce trauma Tooth extraction wound packing with hemostatic drugs
diabetes
During tooth extraction, fasting blood sugar should be controlled at 8.88mmol/L (160mg/dl) Blood sugar during type I diabetes surgery 100-200mg/dl
For diabetic patients receiving insulin therapy, tooth extraction is best performed 1 to 2 hours after breakfast.
Hyperthyroidism
It can be performed only when the resting pulse is below 100 beats/min and the basal metabolic rate is below 20%. Do not add epinephrine to anesthetics
kidney disease
All types of acute kidney disease should postpone tooth extraction In the compensatory stage of renal function, that is, the endogenous creatinine clearance rate is >50%, the serum creatinine is <132.6μmol/L (1.5mg/dL), and there are no clinical symptoms, then there is no problem in tooth extraction.
hepatitis
Tooth extraction should be postponed during acute hepatitis
For patients with chronic hepatitis whose liver function has been significantly damaged, a coagulation function test should be performed before surgery. For those with abnormality, sufficient amounts of vitamin K and vitamin C, as well as other hepatoprotective drugs, should be given starting 2 to 3 days before surgery.
pregnancy
It is safer to perform tooth extraction or surgery during the 4th to 6th month of pregnancy
menstrual period
Postpone tooth extraction
acute stage of infection
malignant tumor
In patients with malignant tumors, simple tooth extraction may cause tumor growth and spread, and should be considered a contraindication. Generally it should be removed together with the tumor.
Before radiotherapy, the affected teeth located in the irradiated area should be extracted or treated at least 7-10 days before radiotherapy. Teeth should not be extracted within 3 to 5 years after radiotherapy, otherwise it may cause osteoradionecrosis When a tooth must be extracted, efforts should be made to reduce trauma and antibiotics should be given before and after surgery to prevent infection.
long-term anticoagulants
For those who have been taking antiplatelet drugs for a long time, such as low-dose aspirin, if the risk of stopping the drug is considered to be greater than the risk of bleeding after tooth extraction, the drug can usually not be stopped before tooth extraction. If it is necessary to stop the drug, it should be started 3 to 5 days before the operation. After the operation, hemostatic agents such as iodoform sponge can be placed in the tooth extraction wound, and the patient can be left under close observation for 30 minutes until there is no movement or bleeding. If there is no active bleeding the next day after surgery, you can resume taking platelet inhibitory drugs.
For patients who have been using heparin for a long time, if the drug is stopped, the drug effect will disappear after 5 half-lives. Usually, surgery can be performed 6 hours after intravenous injection of heparin and 24 hours after subcutaneous injection.
When using warfarin, discontinuation should be done at least 3 to 5 days before surgery, usually 1 week before surgery. If stopping the drug may lead to thrombosis and the drug cannot be stopped, the international normalized ratio of prothrombin time should be controlled at 1.5~2 before tooth extraction can be considered.
Long-term adrenocortical hormone therapy
The most dangerous period for crisis is about 20 hours after surgery.
Such patients should cooperate with a specialist before tooth extraction and rapidly increase the dosage of corticosteroids before surgery.
mental illness
Cooperation issues
Preoperative preparation
Patient preparation
Surgeon's preparation
patient position
When extracting the maxillary teeth, the patient's head should be tilted back so that when the mouth is opened, the plane of the maxillary teeth forms an angle of approximately 45° with the ground plane, and the patient's upper jaw is approximately at the same level as the surgeon's shoulders. Facilitates upper arm exertion and avoids fatigue
When extracting mandibular teeth, the plane of the mandibular teeth should be parallel to the ground when the patient opens his mouth wide, and the mandible should be at the same height as the operator's elbow joint or slightly lower.
Preparing the surgical area
For oral rinse or gargle before surgery, 0.05% chlorhexidine solution/1:5000 potassium permanganate solution can be used
Disinfect the tooth extraction area with 1% iodophor
Instrument preparation
tooth extraction instruments
dental forceps
Structure: handle, joints and beak
type
Usage: Method: shake, twist, pull
Teeth erect
Structure: blade, handle, rod
type
According to shape: straight, curved and triangular
The width and function of the pressing blade: dental elevator, root elevator and apical elevator
working principle
Leverage principle
wedge principle
wheel and axle principle
use
Grip method: Hold with the palm of your hand to produce greater power; Finger grip method, the feeling is more acute
horizontal insertion method
Complete tooth: cut from the mesial and distal axial angles of the affected tooth, with the top of the alveolar process as the fulcrum
Stumps and broken roots: can be cut from the side with higher cross section
Vertical insertion method:
Precautions for use
Never use adjacent teeth as a fulcrum unless the adjacent teeth also need to be extracted at the same time
Except for the extraction of impacted teeth or the need for buccal bone removal, the buccal bone plate at the level of the gingival margin should generally not be used as a fulcrum.
The lingual bone plate at the level of the gingival margin should not be used as a fulcrum
Pay attention to protection during operation. It must be protected with fingers to prevent the tooth ejector from slipping and damaging adjacent tissues.
The force must be controlled, violence must not be used, and the direction of force used to lift the blade must be accurate.
curette
effect
explore
Remove foreign matter
Scrape away diseased tissue
No scraping of the alveolar condition
Acute inflammation: pus (otherwise the infection may spread easily)
Do not scratch after deciduous teeth are extracted (there are permanent tooth germs underneath)
gum separator
Oral power system
Basic steps for tooth extraction
anaesthetization
Separate the gums
The gingival separator is inserted into the gingival sulcus close to the tooth surface and reaches the top of the alveolar process.
Very loose tooth
Use suitable dental forceps, open the beak, insert into the completely separated gingival sulcus space along the tooth surface, advance to below the high point of the tooth neck, push as far as possible toward the root, and keep the beak parallel to the long axis of the tooth. Clamp the affected tooth and check the tooth position again
Place forceps
Push as far into the root as possible, keeping the beak of the forceps parallel to the long axis of the tooth.
Dislocated tooth
shake
The main ways to loosen teeth
Suitable for flat-rooted mandibular anterior teeth, premolars and multi-rooted molars
Sequence: First, move to the side with greater elasticity, less resistance, and thinner alveolar bone, and then rock the other side along the lip (buccal)-lingual (palatal) direction.
twist
Suitable for conical single root teeth, such as 1-3 on the top and 3-5 on the bottom
traction
Post-extraction examination and treatment of tooth extraction wounds
First check whether the tooth roots are complete, whether the number conforms to the anatomy of the tooth, and whether there are any tears in the gums
Using a curette to explore the extraction socket
Check whether the alveolar bone is broken. If most of the broken bone fragments are attached to the periosteum, they should be reduced. If the broken bone fragments are basically free, they should be removed. Excessively high alveolar septum, bony ridge or alveolar bone wall can cause pain, hinder wound healing, and may affect denture repair, and should be trimmed
Reposition the alveolar socket (reduction is not necessary if dental implants are needed later)
Precautions after tooth extraction
Do not brush your teeth or rinse your mouth within 24 hours after tooth extraction. On the day of tooth extraction, you should eat soft food and the food should not be overheated. Avoid chewing on the affected side; Do not lick the wound with your tongue, Don’t suck repeatedly It is normal for saliva to have blood streaks in the few days after surgery Maintain oral hygiene
Various types of tooth extractions
maxillary central incisors
The tooth root is straight and nearly conical in shape. The alveolar bone on the labial side is more elastic and has a thinner wall than the round side.
Make a twisting action first. If it is firmer, it should be combined with moderate shaking, mainly on the lip side.
straight-line traction
maxillary lateral incisors
The root of the tooth is slightly thin, the sides are slightly flat, and the root tip is slightly curved distally.
Mainly rocking, the torsion amplitude is smaller than that of the central incisors
The traction direction should be downward and forward and gradually toward the distal
Note: prevent root breakage
maxillary canines
The cross section of the tooth root is oval and slightly triangular. The root is thick and is the longest in the mouth. The bony plate on the labial side is thinner.
Use rocking motion toward the lips first, followed by twisting but with a smaller amplitude.
Draw and pull out laterally to the lip
Note: Labial alveolar bone fractures and gum tears are prone to occur
maxillary premolars
Flat root, the cross section is dumbbell-shaped with a wide buccal and palatal diameter; There are more than 4 double roots in the apical 1/3 or 1/2 of the upper roots, and the palatal root is thinner. The upper 5 is mostly a single root, and the buccal wall is thinner than the palatal side.
First, shake slightly to the buccal side. After feeling greater resistance, turn to the palatal side, gradually increase the amplitude, and at the same time pull distally to the buccal side.
Note: It is not advisable to use twisting force to avoid breaking the roots.
On 6
Stronger, with three roots. The roots have large bifurcations. The palatal root is the largest and conical. The mesiobuccal roots are mostly flat, and the distal roots are mostly round and thin. The surrounding bone is solid, slightly thinner on the buccal side, and reinforced by the zygomatic alveolar ridge on the buccal side.
If it is firmer, you can first use your teeth to tighten it, and then use dental forceps to slowly shake it first toward the buccal side and then toward the palatal side.
When it is loosened to a certain extent, pull it out downward, distally, and bucally in the direction of least resistance.
Take the upper 6 palatal lateral roots to prevent pushing into the maxillary sinus
on 7
Most have three roots, but they are slightly thinner than the first molars. There are also cases where two or three roots on the buccal side are completely fused. The surrounding bone is solid and slightly thinner on the buccal side
Same as above 6
Same as above 6
on 8
The tooth roots vary greatly, but most of them are single root or two buccal and palatal roots. They are generally curved distally, with surrounding osteoporosis and maxillary tubercle distally.
If the tooth is erect and force is applied backward, downward, and outward, most of the teeth can be extracted.
Use dental forceps to pull downward and distal to the buccal side while shaking.
Note: Prevent root breakage and maxillary tubercle fractures
undercut
The tooth crown is small, the tooth root is flat and short, and the mesiodistal diameter is small. Mostly taproots, The bony plates on the labial and lingual sides are both thin, especially on the labial side.
The labial and lingual side shakes, mainly the labial side
Pull upward on the lip
Note: Use your left thumb to control the dental forceps during traction to prevent damage to the opposing teeth.
mandibular canines
Single-rooted teeth, the root is longer and slightly thicker, the cross-section is approximately triangular, and the root tip is sometimes slightly curved distally. The labial bone plate is thinner
Shake repeatedly toward the labial side first, then toward the lingual side, and can be combined with small twists, mainly the labial side.
Pull upward and labially
mandibular premolars
Single tapered root, sometimes the root tip is slightly curved distally, and the cross-section is oblate with a large buccal and lingual diameter. The buccal plate is thinner
Mainly buccal and lingual shaking, supplemented by small twisting
Traction in upward, buccal, and distal directions
Next 6
There are two mesial and distal roots. The buccal and lingual diameters are large, flat and thick, and slightly curved distally. Sometimes the distal root can be divided into buccal and lingual roots. The distal buccal root is oblate, similar to the mesial root, but slightly smaller; the distal lingual root is thin and round, slightly curved like a groove, and has a circular cross-section.
The distal tongue base is easily broken and left behind during surgery
If the crown is severely damaged, it is generally difficult to clamp the mandibular molar forceps and is easily broken. You can use horn forceps.
Next 7
It usually has two roots, similar to the first molar, sometimes it is one large fused root. The buccal and lingual bony plates are thick, and the buccal side is strengthened by external oblique lines.
The buccal and lingual rocking force expands the alveolar socket, and after loosening, it is pulled upward on the buccal side; sometimes the lingual bone plate is thin, and attention should be paid to the perception during the operation. At this time, the force can be increased on the lingual side and the dislocation can be pulled on the lingual side.
Next 8
For low-lying mandibular third molars, attention should be paid to the position of the mandibular canal The lingual bone plate is thin, and sometimes the root tip bone is almost missing. Care should be taken to prevent the root from pushing into the floor of the mouth and parapharynx.
root extraction
Refers to the method of removing the residual root left in the alveolar bone after the crown has been damaged and the broken root that was broken during tooth extraction.
Indications
In principle, residual roots and severed roots, especially those with various lesions in the periradicular tissue, should be removed.
If the root is short (less than 5 mm) and there is no obvious disease in the periradicular tissue, continuing to remove the root will cause too much trauma or may cause nerve damage, maxillary sinus perforation and other complications. You may consider not removing the root and just observe it carefully.
Root forceps method
High stumps and severed roots can be removed directly with root pliers
When the section is at the cervical level of the tooth or higher, use root pliers to remove the root after separating the gums.
Dental root extraction method
For high-level root cutting, choose straight teeth; Use root jacks for low-level root cutting; Use an apex lift to break the apical 1/3 of the root. Bending is suitable for posterior teeth
Fulcrum: alveolar septum, alveolar cavity wall or palatal bone plate
The key to root lifting and removal of broken roots: insert the lifting blade between the tooth root and the alveolar bone plate
If the tooth root section is a bevel, the root lift should be inserted from the higher side of the bevel.
flap bone removal method
Definition: A method of surgically incising part of the mucoperiosteum to form a pedicled soft tissue flap, exposing the underlying bone wall, chiseling out an appropriate amount of alveolar bone, exposing the tooth or tooth root, and then extracting the tooth/root.
Applicable to: Any tooth root that cannot be extracted using root forceps and dental elevators Disadvantages: It causes great tissue trauma, and removing the alveolar bone will cause the alveolar to become narrower and lower, which is not conducive to the repair of dentures.
incision
The scope of the incision is larger than the scope of bone removal. The position of the incision should ensure that there is bone support below after the flap is reset and sutured. The distance between the incision and the postoperative bone wound margin should be at least 6 to 8 mm.
The pedicle is wider than the free part, allowing the entire valve to have good blood supply
Commonly used incisions include trapezoidal, angular and arc shapes
The longitudinal incision should not exceed the vestibular sulcus, otherwise bleeding will be easy and postoperative swelling will be serious.
The additional incision should be located at the mesial or distal axial angle of the tooth surface, at an angle of approximately 45° to the gingival margin. Longitudinal incisions should not be made on the gingival papilla to avoid damaging the shape of the papilla; and do not make incisions on the buccal side of the tooth surface, otherwise small defects may be formed in the attached gingiva on the buccal side.
Note: When designing a flap in the mandibular premolar area, injury to the buccal nerve should be avoided Incision in the retromolar area of the mandible, but care should be taken not to deviate too far to the lingual side to avoid damaging the lingual nerve
flap
The soft tissue flap of the alveolar process should be a full thickness mucoperiosteal flap
Boneless
The root of the tooth should be exposed so that the tooth lifter or root forceps can be inserted and clamped. The bone removal width must be cut so as not to expose or damage the root of the adjacent tooth.
Extract tooth root
Root extraction method into the maxillary sinus
Commonly found in: palatal root of upper 6 and mesiobuccal root of upper 7
possible situations
The tooth root completely enters the maxillary sinus
Performance: The resistance suddenly disappears, the tooth root is not visible in the alveolar socket, and a large cavity is detected above the root apex. When the nasal cavity is inflated, signs of alveolar air leakage appear; X-ray examination shows that the tooth root is located in the sinus cavity
Removal method: Flap bone removal method. To reduce damage, it can be combined with flushing method.
The sinus floor has been penetrated and the tooth root is adhered to the sinus floor mucosa.
Symptoms: Air leakage in the alveolar socket may occur X-ray examination shows that the tooth root is located at the edge of the sinus floor penetration and has not moved far away.
The tooth root moves below the sinus floor mucosa without breaking through the mucosa.
No signs of alveolar air leakage X-ray examination shows that the tooth root does not extend beyond the maxillary sinus floor
The root of the tooth has not completely entered the sinus cavity, which can usually be discovered and removed under direct vision.
Impacted tooth extraction
Impacted teeth
Definition: Refers to teeth that can only partially erupt or cannot erupt completely due to obstruction by adjacent teeth, bone or soft tissue, and will not be able to erupt in the future.
Common teeth: upper and lower third molars, followed by upper 3 and lower 5
Indications
Impacted teeth causing pericoronitis
Impacted teeth with caries or leading to caries of adjacent teeth
Impacted teeth causing food impaction
Those whose impacted teeth cause root resorption of adjacent teeth
Those who suffer damage to the periodontal tissue of adjacent teeth due to pressure from impacted teeth
Impacted teeth causing odontogenic cysts or tumors
Impacted teeth that need to be removed for orthodontic treatment
Impacted teeth that may be a cause of temporomandibular joint disorder
Those who are suspected to have unexplained neuralgia or diseased teeth due to complete bone impaction
Orthognathic surgery requiring extraction
Prevent mandibular fractures
Contraindications (8 situations that can be reserved)
The orthotopic eruption reaches the occlusal plane of the adjacent teeth. After the distal covering gingival flap is removed, the distal coronal surface can be exposed and a normal occlusal relationship can be established with the opposing teeth.
When the second molar is missing or cannot be retained due to disease, if the mesial inclination angle of the impacted third molar does not exceed 45°, it can be retained as a restorative abutment.
Although caries on adjacent teeth can be treated, due to excessive bone loss, the adjacent teeth may become severely loose after extraction of the impacted teeth. Therefore, both adjacent teeth and impacted teeth can be preserved.
7 After extraction, if 8 the tooth roots are not completely formed, they can be moved forward to replace them 7 to establish normal occlusion with the opposing teeth.
Asymptomatic impacted teeth that are completely embedded in the bone and have no periodontal communication with adjacent teeth can be kept under observation (there may be cysts)
When the root apex of an impacted tooth is not fully developed and other teeth cannot be retained due to damage, it can be extracted and transplanted to other teeth.
6. The caries cannot be preserved. If 8. is not in the buccal and lingual position (preferably in the anteverted position), after 6. is removed, the gap may disappear due to the natural adjustment of 7. 8. Cooperate with orthodontic treatment.
If the extraction of the impacted tooth will cause damage to the surrounding nerves, teeth or original restorations, it can be left in situ for observation
Preparation before impacted tooth extraction surgery
Clinical examination: medical history/physical examination/laboratory examination/oral examination
Film degree exam
Classification of lower 8 impacted teeth
The angle of impacted tooth: the angle between the long axis of tooth 8 and the long axis of tooth 7 Vertical, mesial, horizontal, inverted, distal, lingual, buccal impaction
The relationship between impacted teeth and the anterior edge of the mandibular ramus Class I: The mesiodistal diameter of the crown of the impacted tooth is completely in front of the anterior edge of the mandibular ramus. Class II: less than half of the mesiodistal diameter of the crown of the impacted tooth is located within the mandibular ramus Class III: The mesiodistal diameter of more than half of the crown of the impacted tooth is located within the mandibular ramus I-III, increasing difficulty
The relationship between impacted teeth and the occlusal plane High impaction; the occlusal plane of the tooth reaches or is higher than the occlusal plane of 7 Median impaction: the occlusal plane of the tooth is between the occlusal plane of 7 and the cervical line of the tooth Low impaction: the occlusal plane of the tooth is lower than the cervical line of the tooth. Opposite of upper 8
Other factors affecting the difficulty of extraction
Root morphology/width of periodontal ligament or dental follicle/surrounding bone density/relationship with adjacent teeth/relationship with surrounding important anatomical structures
Tooth extraction instrument preparation/informed consent/anesthesia and positioning
Extraction of mandibular impacted third molar
Resistance analysis
crown resistance
soft tissue resistance
The gingival flap covering the impacted tooth forms resistance to the occlusal and distal dislocation of the impacted tooth. It can be relieved by incision and separation of soft tissue.
bone resistance
It comes from the bone tissue that wraps the crown, mainly the bone above the high point of the crown. In vertically impacted coronal bone, the resistance is mostly distal, The coronal bone resistance of mesial or horizontal impaction is mostly distal and buccal. This resistance can be relieved by dividing the crown and/or bone removal.
root resistance
The bone tissue around the tooth root is the main resistance to tooth extraction.
Impacted tooth inclination Root morphology root tip morphology Surrounding bone tissue density
Methods to remove root bone resistance include root division, bone removal, and gap enlargement
adjacent tooth resistance
The resistance generated by 7 that hinders the extraction and dislocation of the impacted tooth depends on the degree of contact between the impacted tooth and 7 and the location of the impaction. Solved by crowning and bone removal
Removal steps
anaesthetization
In order to reduce intraoperative bleeding, ensure clear surgical field and facilitate operation, Anesthetic containing a vasoconstrictor (epinephrine) can be injected into the buccal and distal parts of the impacted tooth.
incision
Note: The lingual nerve is often located under the mucosa at the lower 8 points, and some locations are higher. During the operation, the distal incision should not be deviated to the lingual side, and should not be too long to avoid damaging the lingual nerve.
If the impacted tooth is deeply embedded, a triangular flap incision can be used. This incision is based on the pocket incision and adds a forward and downward oblique angle at 7 mesial or distal buccal axis angle at approximately 45° to the gingival margin. Angular tension reduction incision, The additional incision must maintain an obtuse angle with the incision in the gingival sulcus to ensure that the base is wide enough (to provide adequate blood supply), and the length cannot exceed the bottom of the vestibular sulcus.
Buccal incision: Do not cut in the middle of the gingival margin (too much tension) Do not cut on the gingival papilla (causing necrosis)
flap
In principle, it is sufficient to expose the surgical area. The buccal side should not exceed the external oblique ridge, and the lingual side should not cross the alveolar ridge.
Boneless
Principle: Expose the maximum circumference of the crown; Try to maintain the buccal cortical height; Determine the amount of bone removal based on the difficulty of extracting the tooth and the method of cutting the crown.
Note: When removing the buccal bone plate, first vertically and then horizontally In principle, the lingual and mesial alveolar bones cannot be removed (otherwise, the lingual nerve, 7th and 7th cementum may be damaged) Since the lingual nerve is located in the lingual soft tissue and may run parallel to the alveolar ridge, in order to avoid damaging the nerve, try not to exceed the midline during distal bone removal.
increase gap
A method of utilizing the compressibility of cancellous bone to expand the periodontal space and relieve periradicular bone resistance
Segmentation of the affected tooth
Including: crown cutting, root division
Purpose: to relieve resistance from adjacent teeth and reduce root bone resistance
Advantages: reduce trauma, reduce operation time, reduce complications
Method: Vertical division method: when the root bifurcation is high Oblique division method: mesial obstruction Horizontal division method: horizontal obstruction
Extract the affected tooth
Treating the extraction socket
Use normal saline to clean the extraction socket and/or use strong suction to thoroughly remove the debris or debris generated during tooth extraction. The fragments adhered to the soft tissue can be removed with a curette, but the alveolar socket should not be scratched excessively to avoid damaging the periodontal ligament on the remaining alveolar bone wall and affecting wound healing. If the lingual bone plate is fractured, it should be compressed and reduced. If it has been separated from the periosteum, it should be removed. Compress and reduce the enlarged alveolar socket, trim the sharp bone edges, and remove the free broken bone fragments
suture
When suturing the incision, first suture the anatomical landmarks of the tissue flap, such as the incisal angle of the incision and the gingival papilla (this can avoid the displacement of the tissue flap during suturing).
Postoperative medical instructions
If there is swelling, pain, difficulty in opening your mouth, pain in swallowing, etc., immediately give cold compresses, anti-inflammatory and analgesic drugs, and heat compresses within 48 hours.
Extraction methods for various types of mandibular impacted teeth
vertical impaction
The affected tooth has fully erupted and there is little bone resistance at the root. The gums can be separated and extracted directly with a dental elevator. If the affected tooth has not fully erupted and there is considerable soft tissue resistance, the occlusal surface and distal gingival flap of the affected tooth can be incised and flapped, and the soft tissue resistance can be completely eliminated before extraction with a tooth lifter. Place the dental elevator in the mesial part of the affected tooth, use the alveolar process as the fulcrum, use wedge force as the main force, and rotate counterclockwise distally, so that the affected tooth can gain upward dislocation force.
Mesial obstruction
High mesial impacted teeth with little resistance to adjacent teeth and roots can often be pushed out directly Most of the rest are divided into teeth
horizontal impaction
distal obstruction
inverted impaction
tooth germ
Extraction of maxillary impacted third molars and other impacted teeth
Removal of superior impaction 8
incision
flap
Bone removal, gap augmentation
Teeth separation, loosening, extraction
Cleaning and suturing of alveolar sockets
Postoperative medical instructions
Up to 8 categories
According to the relationship between impacted teeth and superior collar sinus: Close to the sinus floor: there is no bone between the two, only a thin layer of tissue No…………: There is more than 2mm of bone between the two
Impacted canine extraction
Extraction of impacted extra teeth (also called supernumerary teeth) in the front of the maxilla
Removal of other impacted impacted teeth
Tooth extraction wound healing
Tooth extraction wound bleeding and blood clot formation
After 15 to 30 minutes, the bleeding stops and a blood clot forms to seal the wound. Blood clot function: protect the wound, prevent infection, and promote normal wound healing
Blood clot organization and granulation tissue formation
Start machineization in 24 hours 7 days of organization completed
Connective and epithelial tissue replaces granulation tissue
In 3-4 days, more mature connective tissue begins to replace the granulation tissue, It will be basically completed in about 20 days. New bone begins to form 5-8 days after surgery
Original fibrous bone replaces connective tissue.
The bone density is low, and the image of the alveolar socket can still be seen on X-ray examination
Mature bone tissue replaces immature bone
The reconstruction process is basically completed after 3 to 6 months.
Complications of tooth extraction surgery
intraoperative complications
Fainting
The same thing that happens with local anesthesia
Tooth root fracture, tooth and root displacement
Root fractures are most common
reason
a. The tooth extraction forceps are in the wrong direction.
b. Improper selection of pliers
C. The crown has extensive caries.
d. Teeth are too brittle
e. Variations in tooth root shape
f. Excessive density or adhesion of the apical bone
g. Violent tooth extraction
soft tissue injury
Gum damage
Mostly lacerations It mainly occurs when the tooth is extracted and the tooth forceps are placed, and the gums are sandwiched between the beak of the forceps and the teeth; or when the gums are not completely separated and the teeth and gums are still connected, gum tears occur as the teeth are pulled out.
adjacent soft tissue injury
bone tissue damage
alveolar process fracture
Often due to improper force during tooth extraction
When removing the upper jaw, if the direction of extension is improper and excessive distal force is applied, it is easy to cause fracture of the maxillary tubercle. When the lower 8 is pulled out and pushed out, it may cause fracture of the lingual bone plate. When the upper 3 is removed, labial bone plate fracture is likely to occur
If an alveolar process fracture is found, if the tooth has been extracted and more than half of the bone fragment has no periosteal attachment, the bone fragment should be removed If most of the bone fragment has periosteal attachment, it can be reduced and the gums can be pulled together and sutured.
mandibular fracture
Prevalent site: mandibular angle
Direct cause: violence
Injuries to adjacent teeth and opposing teeth
adjacent teeth
Loss of restorations and damage to adjacent teeth
The beak of the dental forceps used is too wide or the dental forceps are not placed in line with the long axis of the tooth.
Improper use of dental elevators, using adjacent teeth as a fulcrum
Opposing teeth
Poor tooth extraction and dislocation force control
nerve damage
Inferior alveolar nerve injury
Treatment can include drugs that reduce edema and reduce pressure, such as dexamethasone and dibazole; drugs that promote nerve recovery, such as vitamins B1, B6, B12, etc.; physical therapy can also be used. Inferior alveolar nerve injury can usually recover within half a year
lingual nerve injury
The distal incision of the impacted mandibular tooth is too lingual
temporomandibular joint injury
This is usually due to the opening being too large and the time being too long. TMJ discomfort caused by mandibular tooth extraction
intraoperative bleeding
Oral and sinus communication
It usually occurs when the roots of maxillary molars are removed, causing the tooth roots to move into the maxillary sinus and perforate the sinus floor; There may also be a lack of bone in the sinus floor due to apical lesions of molars, and the sinus floor may be penetrated when scraping the lesions.
Consequences: Can cause maxillary sinus infection, or later form oral and sinus fistula
Approach
A small perforation with a diameter of about 2mm can be treated as usual after tooth extraction and allowed to heal naturally. Note: Patients should avoid nasal inflating, smoking, and strong sneezing to prevent infection.
Medium-sized perforations with a diameter of 2~6mm can also be treated according to the above method, such as pulling the gums on both sides together and suturing them to further fix and protect the blood clot, which is more conducive to natural healing.
If the intersection is larger than 7mm, the adjacent tissue flap needs to be used to close the wound.
Other complications
Accidental swallowing and aspiration of teeth and foreign objects
Instrument breaks
Reactions and complications after tooth extraction
Reactive pain after tooth extraction
Within 24 hours
postoperative swelling reaction
Especially after flap surgery It is easy to occur after the extraction of mandibular impacted teeth, and it often occurs in the front cheek. It is also related to the trauma during flap flap, the incision of the flap is too low or the suture is too tight.
Starts 12-24 hours after surgery and gradually subsides within 3-5 days Prevention methods: Try not to make the incision of the mucoperiosteal flap beyond the bottom of the transitional groove; The incision should not be sutured too tightly to facilitate the drainage of exudate; Postoperative cold compress or pressure bandage
Difficulty opening the mouth after surgery
When extracting impacted mandibular teeth, the lower part of the deep tendon of the temporalis muscle and the anterior part of the medial pterygoid muscle are stimulated by trauma and traumatic inflammation, resulting in reflex muscle spasm. If the opening is obviously restricted, hot gargles or physical therapy can be used to help recovery.
Bleeding after tooth extraction (Common causes and how to prevent them)
primary hemorrhage
secondary bleeding
systemic factors
Such as the application of anticoagulant drugs, etc.
local factors
Infection after tooth extraction
The key to preventing chronic infection of tooth extraction wounds is to carefully inspect and clean the tooth extraction wounds after tooth extraction.
Dry socket
Complications after tooth extraction mainly characterized by pain and failure to heal the tooth extraction wound
The incidence rates are: X8, X6, X7
Main manifestation: infection of the bone wall of the alveolar socket
Infection theory, trauma theory, anatomic factors theory and fibrinolysis theory
Diagnostic criteria: Severe pain (persistent) 2 to 3 days after tooth extraction, which can radiate to the ear, temporal area, mandibular area, or top of the head. General analgesics cannot relieve pain; the tooth extraction socket is empty, or there is a putrefactive blood clot. , strong rancid smell
Treatment principle: Through thorough debridement and isolation of external stimulation of the alveolar socket, the purpose of rapid pain relief and promotion of healing is achieved.
Treatment plan: Channel block anesthesia and complete debridement with complete painlessness. Use a 3% hydrogen peroxide solution cotton ball to wipe it repeatedly to remove decayed and necrotic materials until the alveolar socket is clean and the cotton ball is clean and odorless; Do not use a curette to repeatedly scratch the alveolar bone wall. Use a curette only when there are large pieces of decayed and necrotic material. Rinse the socket with saline. Fill the tooth extraction wound with fried strips of iodoform
subcutaneous emphysema
Oral erosion
Dental alveolar surgery
pre-restorative surgery
Refers to surgical techniques to achieve good retention and stability of dentures and effectively perform masticatory functions.
alveolar process revision surgery
Purpose: To correct various alveolar process deformities that hinder the insertion and placement of dentures; Remove the protruding tip or ridge in the alveolar process area to prevent local pain; Removal of protruding bone nodules or undercuts; Correction of the protrusion of the alveolar process of the maxillary anterior teeth. Note: The operation should be performed 2 to 3 months after tooth extraction.
For the isolated small bone tip, use a blunt instrument to pad it with gauze and directly hammer it to flatten it.
Larger range of trimming: incision - flap - exposure of the bony prominence - rongeur/osteotome removal of the bone tip - bone rasp filing - irrigation of the surgical area - suturing
Palatal protuberance surgery
An X-shaped incision is made on the palatal protuberance
Mandibular protrusion revision surgery
The mandibular protuberance is located on the lingual side of the mandibular canines and premolars
Make an arc-shaped incision parallel to the alveolar arch along the lingual side of the alveolar ridge.
Maxillary tubercle hypertrophy and revision surgery
Alveolar process reconstruction and labiobuccal groove deepening
guided bone regeneration
Other alveolar surgeries
Lip tie correction surgery
Commonly used V-shaped resection
Tongue tie correction surgery
The main symptoms of congenital tongue tie are as follows: the tongue cannot move forward freely, and the tip of the tongue becomes W-shaped when it is forced forward; Difficulty raising the tip of the tongue; The occurrence of retroflex and velopalate articulatory disorders
Correction of congenital tongue-tie abnormalities is best performed after the age of 2 years
Oroantral fistula
Oral and maxillary sinuses communicate to form a chronic fistula, that is, oral and sinus fistula
Treatment: Control the maxillary sinus infection first. The maxillary sinus can be irrigated through the fistula, and nasal drops and antibiotics can be given at the same time
The fistula often shrinks after treatment. Silver nitrate or trichloroacetic acid solution can be used to cauterize the fistula epithelium. Use instruments to scrape and remove the epithelium, and repeat the process to allow it to heal naturally. If the fistula still does not heal, the aforementioned buccal or palatal flap can be used to close the fistula. During the operation, the position of the bone edge should be determined first, and the soft tissue should be incised 2 to 3 mm away from the bone edge to form a fresh wound. After the transfer flap is sutured, there should be bone support underneath.