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Surgical exodontia |
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Six steps in the surgical removal of teeth 1. Raising a flap 2. Removal of bone 3. Tooth division 4. Removal of tooth / tooth fragments 5. Wound toilet 6. Primary closure
Raising a flap ¨ Provides access to site ¨ Must be large enough for easy access and have sufficient subcutaneous tissue (mucosa and periosteum unseparated) ¨ Adequate support and blood supply ¨ Avoid major structures—including mental nerve, palatal artery ¨ Acts as a primary dressing to cover defect created ¨ Mucoperiosteal flap described by site—e.g. buccal, palatal, lingual
1. Incise in one continuous stroke through to bone at right angles to the surface mucosa 2. Base of flap must be wider to maintain viability 3. Dental papilla wholly included (not split) to avoid poor gingival contours after healing 4. Handle gently— stretching and tearing will compromise healing 5. Edges of flap must lie on sound bone at the end of the operative procedure to prevent wound dehiscence and breakdown 6. One relieving incision is all that is normally required. It should run anteriorly, so that the base of the flap is broad, ensuring a good blood supply 7. Reflect the flap by scrapping the bone. Retract with minimal pressure—rest retractor on bone and allow flap to lie beneath it. If pressure is necessary enlarge the flap.
Bone removal Allows adequate tooth exposure: ¨ Permits dental elevation ¨ Enables sectioning of tooth ¨ Pathway for delivery Instruments: sharp chisels, slow handpiece and water supply using round or fissured surgical burs.
Sectioning teeth ¨ Awkward angulation ¨ Smaller fragments can be easily lifted to minimise removal of further bone ¨ Division can be axial / coronal, vertical/ horizontal Instruments: osteotome, powered hand-piece
Removal of tooth / fragments Correct removal depends on: ¨ Quality of surgical access created ¨ Correct use of dental elevator
Wound toilet Remaining surgical defect must be thoroughly debrided and irrigated to remove all loose debris that may cause infection and delay wound healing. 1. Excise redundant soft tissue 2. Remove any loose fragments of bone / tooth in and around the surgical defect, including under the flap 3. Smooth rough bony edges with bur or bone files 4. Irrigate with sterile isotonic solution and suction area to remove microscopic debris 5. Surgical defect may be dressed with antiseptic-soaked ribbon gauze
Primary closure ¨ Replacement of flap ¨ Suturing to permit well-approximated wound margins without tension ¨ Evert edges of wound margins
The flap acts as a primary dressing and contains the osteogenic layer of periosteum which will help promote bone regeneration within the surgical defect.
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The removal of teeth or tooth fragments via the transalveolar approach, whereby access to and delivery of the tooth or its fragments are achieved via a surgically created pathway. |
