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Oral and Maxillofacial Surgery

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Oral and Maxillofacial Surgery

• Branch of dentistry that focuses on diagnosis and treatment of diseases, injuries, and malformations

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Oral and Maxillofacial Surgery Team

• Surgeon

• Receptionist and business staff

• Dental assistant

• Nurse anesthesiologist or anesthesiologist

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Scalpel Setup

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Retractors

• Tissue

• Cheek and lip

• Tongue

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Tissue Retractors

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Tongue and Cheek Retractors

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Mouth Prop

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Hemostats

• Multiple uses– Retract tissue– Remove small root tips– Clamp blood vessels– Grasp loose objects

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Needle Holders

• Similar to hemostat

• Function similar to hemostat

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Surgical Scissors

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Surgical Aspirating Tips

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Surgical Curettes

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Surgical Chisel and Mallet

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Surgical Bone File

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Rongeurs

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Periosteal Elevators

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Elevators

• Loosen and remove teeth, retained roots, and root fragments

• Types– Apical– Root tip picks

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Extraction Elevators

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Root Tip Picks

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Extraction Forceps

• Used to remove teeth from alveolar bone

• Hinged with various handles and beak styles

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Asepsis in Oral Surgery

• Infection control is critical

• Increased risk of exposure to blood in surgery

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Patient Considerations• Review

– Medical records– Dental records– Referring dentist notes– Radiographs– Treatment options– Patient consent– Financial arrangements

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Oral Surgery Procedures

• Uncomplicated extractions– Removal of permanent or primary teeth

that have erupted into the oral cavity– Also known as routine or simple

extractions

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Simple Extraction Setup

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Oral Surgery Procedures

• Multiple extractions and alveoplasty– Multiple extractions are performed to prepare

patient for partial or dentures– Bone and soft tissue of the edentulous ridge

is contoured and smoothed

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Multiple Extractions Setup

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Oral Surgery Procedures

• Extractions of impacted teeth– Tooth may be partially or fully covered by

tissue or bone– Tooth has not erupted into the oral cavity– Extraction is difficult due to depth, position,

or angulation of tooth in bone

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Problems Caused by Impacted Wisdom Teeth

Wisdom teeth (# 3 above) develop inside the bone. Crowns form first, then the roots.

If the jaw grows long enough, the wisdom teeth can erupt and be used.

If the jaws are not long enough by age 16, wisdom teeth stay trapped (impacted) inside the bone.

Two roots

Three roots Impacted

Impacted

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Problems Caused by Impacted Wisdom Teeth

(B) Infection in the bone around them

(C) Destruction of the next tooth

Impacted wisdom teeth can cause:

(A) Infection of the gums over or around them

Gum infected

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Problems Caused by Impacted Wisdom Teeth

(D) Destruction of the bone by formation of a cyst

Looking down on the biting surfaces of the lower teeth

(E) Other teeth pushed out of line (arrows)

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Removal of Boney Impaction• Handpieces and surgical burs required to

gain access

(A)(B) (C)

(D) (E) (F)

Irrigation syringe

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Oral Surgery Procedures

• Biopsy procedures – Total or partial removal of tissue from

suspicious areas for microscopic examination and diagnosis

– Three types• Excisional, incisional, exfoliative

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Incisional Biopsy

• Removal of small section of lesion and a small border of normal tissue

• Used when lesions are larger than 1 cm

Top view

Side view

Normal tissue

Normal tissue

Lesion

Incision

Lesion

Incision

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Side view

Top view

Excisional Biopsy

• Complete removal of lesion including border of normal tissue

• Performed on smaller lesions

Normal tissueLesion

Incision

Normal tissue

Lesion

Incision

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Exfoliative Cytology

• Smear biopsy– Nonsurgical procedure

• Removal of a layer of cells from surface of lesion

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Exfoliative Cytology

• Cells spread on a glass slab for microscopic examination

• Often done in addition to other forms of biopsies

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Oral Surgery Procedures

• Dental implant surgery – Method for replacing missing teeth– Screw or framework placed into jaw bone– Tooth shaped restoration is screwed into

framework

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Oral Surgery Procedures

• Treatment sequence for implants– Patient meets with restorative dentist– Referral to oral surgeon– Diagnostic consultation– Decision on treatment plan– Stages of treatment depend on technique

used

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Dental Implant

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Oral Surgery Procedures

• Types of implants– Subperiosteal– Endosteal – Mini Implant

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Postoperative Patient Care

• Given verbally and written

• Lists expectations, what to do, and what to avoid

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Postsurgical Complications

• Alveolar osteitis (dry socket)– Cause is loss of blood clot from extraction

site– May be the result of insufficient blood

supply, infection, or trauma– Occurs three to five days following surgery

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Treatment of Dry Socket

• Irrigate tissue with warm saline solution

• Pack extraction site with iodoform gauze

• Rx: analgesic and antibiotics

• Procedure repeated every one to two days

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Treatment for Alveolitis

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Temporomandibular Joint Disease

• Muscles, bones, and joints of mandible fail to function properly

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Temporomandibular Joint Disease

• Signs and Symptoms– Pain around ear– Tenderness of the masticatory muscles– Popping and clicking noise when opening

and closing the mouth

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Temporomandibular Joint Disease

• Signs and Symptoms– Crepitus or tinnitus– Limited movement of mandible– Trismus– Headaches or neckaches

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Temporomandibular Joint Disease

• Diagnosing – Dental and medical history– Examination of joint– Radiographs– Dental study casts

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Temporomandibular Joint Disease

• Treatment – Application of ice

and heat– Learning to rest jaw– Medications– Stress management – Physical therapy

– Occlusal splinting – Orthodontics– Steroid injections– Arthrocentesis– Arthroscopic surgery– Open joint surgery

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Hospital Dentistry

• Trauma

• High risk patients

• Patients with mental or physical disabilities

• Extensive surgeries

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Advanced Chairside Functions

• Suture removal – Hold tissue in original position– Prepare patient and equipment– Examine site– Consult with dentist– Remove with care to avoid trauma or

infection

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Advanced Chairside Functions

• Types of Sutures– Simple– Continuous simple– Sling– Continuous sling– Mattress