ORAL SURGERY

CASE DISCUSSION
(MAXILLARY
TEETH)
AGREGADO, SKEET MARVIN P.
CLINIC 3
 PRINCIPLES IN ORAL SURGERY
PRINCIPLES OF INCISIONS
 USE SHARP BLADE OF PROPER SIZE
 FIRM CONTINUOUS STROKE
 AVOID CUTTING VITAL STRUCTURES
WHEN INCISING
 BLADE HELD PERPENDICULAR TO
EPITHELIAL SURFACE
 INCISIONS PROPERLY PLACED
PRINCIPLES OF FLAP
 BASE SHOULD BE BROADER
 LENGTH OF FLAP SHOULD BE NO MORE
THAN TWICE OF THE BASE
 AXIAL BLOOD SUPPLE SHOULD BE
INCLUDED IN THE FLAP
 BASE OF THE FLAP SHOULD NOT BE
TWISTED, STRETCHED OR GRASPED WITH
ANYTHING THAT MIGH DAMAGE TH
VESSELS.
PRE-OPERATIVE PROCEDURE
 DO THE COVID PROTOCOLS
 GET PATIENT’S INFORMATION
 GET THE CASE HISTORY OF THE PATIENT
-chief complaint, hpi, past medical history, past dental history, personal and social history
 GET THE RADIOGRAPH OF THE TOOTH FOR ASSESSMENT
 GET THE VITAL SIGNS OF THE PATIENT
-blood pressure, respiratory rate, pulse rate
 PREPARE ARMAMENTARIUM
- forcep: 150, 18R, 18L
TECHNIQUES AND NERVES TO BE
ANESTHESIZED IN MAXILLARY QUADRANT
 NASOPALATINE NERVE BLOCK
AREA OF INSERTION: nasopalatine papilla
LANDMARKS: nasopalatine papilla, maxillary central incisors.
AREAS ANESTHESIZED: anterior portion of hard palate, hard and
soft tissue
 ANTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
AREA OF INSERTION: mucobuccal fold directly over the first
premolar
LANDMARKS: mucobuccal fold, infraorbital notch, infraorbital
foramen
AREAS ANESTHESIZED: maxillary incisors, premolars, and
mesiobuccal root of maxillary first molars, buccal periodontium, bone
of these teeth, lower eyelid, lateral aspect of the nose and upper lip.
 MIDDLE SUPERIOR ALVEOLAR NERVE
BLOCK
AREA OF INSERTION: mucobuccal fold above the
maxillary 2nd premolar
LANDMARKS: mucobuccal fold
AREAS ANESTHESIZED: maxillary premolars,
mesiobuccal root of maxillary 1st molar, buccal
periodontal tissues and bone over these teeth.
 POSTERIOR SUPERIOR ALVEOLAR NERVE
BLOCK
AREA OF INSERTION: mucobuccal fold above the
maxillary 2nd molar
LANDMARKS: mucobuccal fold, maxillary
tuberosity
AREAS ANESTHESIZED: maxillary molars except
mesiobuccal root of maxillary 1st molar, buccal
periodontal tissues and bone over these teeth.
ANESTHESIOLOGY
PROPERTIES OF ANESTHETIC SOLUTION
 Potent
 No systemic toxicity
 Reversible Action
 No allergic reaction
 Rapid onset of action
 Sufficient duration of action

 Lidocaine 2%= 36mg/cartridge

Lidocaine 2% w/ epinephrine 1:100,000= 7.0mg/kg
7.0mg/kg x 70kg (patient’s weight)= 490mg (MRD)
490mg ÷ 36mg/cartridge=
490mg ÷ 36mg=13.6= 14mg
 PATIENT MANAGEMENT
• If the patient is HYPERTENISVE ask for medical • If the patient had STROKE should have clearance from
clearance from his physician, before the procedure his physician
patient should have taken his/her meal and medications
and minimize the usage of the epinephrine.
• If the patient is a FIRST TIMER take skin test before the
procedure wait 10 to 20 minutes, while waiting explain
• If the patient is DIABETIC ask for medical clearance the procedure to the patient.
from the physician, patient should have taken his/her
meal and medications.
• If the patient has ANXIETY should perform the
procedure in a calm and stress free environment, and use
• If the px has ASTHMA ask for medical clearance from an anxiety reduction.
his/her physician, prepare oxygen in your clinic for
emergency.

• If the px is MINOR should be accompanied by his

parents, and have a consent form signed by his parents
and present a valid ID of his parents.
 ARMAMENTARIUM
• Four basic instrument : mouth mirror, spoon excavator, explorer, cotton plier
• Gum separator FLAP TRAY:
• Muco-periosteal elevator (MPE)
• Curved hemostat
 Needle holder
• Curette
•
 Needle
Bone file
• Forcep no. 150, 18R, 18L  scalpel
• Elevator 301 and 304  Blade no. 15
• Gauze pad  Handle no. 3
• NSS
 Curved needle
• Local anesthesia
• Topical anesthesia
 Size 3.0 black silk
• 27 gauge long needle  Iris scissors
• Cotton roll and pellet  Surgical round bur
• Irrigating syringe
 Rotary instrument.
• Aspirating syringe
 SURGICAL PROCEDURE
• Gargle with chlorhexidine mouth rinse for 30 sec. before
surgery
• Compress the socket to control the bleeding.
• Dry the area of tooth. Apply topical anesthesia
• Use curette to clean the socket
• Assemble the aspirating syringe (put pressure and make sure
that the harpoon is engaged to the rubber) • Irrigate
• Perform local infiltration • Use bone file to remove sharp edges
• Irrigate
• Wait for the anesthetic solution to take effect while waiting
check again the bp of the patient • Curette again to clean the socket
• Check if the area of the teeth if it is already numb (use gum • Irrigate
separator & prick the area) • Let the patient bite on gauze soak in povidone
• If the area is already numb you can start your procedure iodine
• Use gum separator to separate the gums from the tooth
• Use MPE- to deflect the gingiva from the bone
• Use elevator 301 first and then 304- 45 degree long axis of
the tooth (elevate on the mesial and distal)
• If the tooth is already mobile you can use now use the forcep
- beak is at the CEJ of the tooth, orient it as apically as
possible. (movement is buccal, lingual, buccal,lingual, and
buccal)
POST OP PRESCRIPTION
• Apply ice pack on the inflammation
caused by the extraction for 24hrs • MEFENAMIC ACID 500mg – 8 tablets
20 mins on 20 mins off.
Take 1 tablet every 6 hours for 3 days or as needed for pain
• Soft diet
• Do not drink hot beverages • AMOXICILLIN 500mg – 21 capsules
Take 1 capsule every 8 hours for 7 days for infection.
• Avoid using straw
• Avoid spitting • TRANEXAMIC ACID 500mg – 3 capsules
• Avoid strenuous activity Take 1 capsule every 8 hours as needed for bleeding.
• Avoid touching the area with tongue
• Avoid smoking