Complicated_Exodontia. .ppt

Basic exodontia complications

2. PRINCIPLES OF PRINCIPLES OF
COMPLICATED EXODONTIACOMPLICATED EXODONTIA
ByBy
Dr. Tanzila MushtaqDr. Tanzila Mushtaq
Demonstrator (OMFS)Demonstrator (OMFS)

3. LOCAL FLAPLOCAL FLAP
•A section of soft tissue that
•Out lined by surgical incison
•Carries its own blood supply
•Allows surgical acess to underlying
structure
•Can be placed to original position
•Can be sutured and is expected to heal

4. DESIGN PARAMETERS FOR DESIGN PARAMETERS FOR
SOFT TISSUE FLAPSSOFT TISSUE FLAPS
•Base of flap must broader than free
margin to preserve adequate blood supply

5. DESIGN PARAMETERS FOR DESIGN PARAMETERS FOR
SOFT TISSUE FLAPSSOFT TISSUE FLAPS
•Should be of adequate size for several reasons
– Adequate acess
–Easy flap reflection
–Long straight incision with adequate flap reflection heals rapidly than
short torn incison
–Envelop flap extend 2 teeth anterior & 1 tooth posterior to area of
surgery If releasing incision made than extension will be one tooth
anterior and one posterior to surgical area

6. •Full thickness muoperiosteal flap should
be taken.
•incision must be made over intact bone
that will present after surgical procedure is
complete.
•flap should designed to ovoid injury to
local anatomical vital stuctures.
•releasing incisions are used only when
necessary not routinely.
DESIGN PARAMETERS FOR DESIGN PARAMETERS FOR
SOFT TISSUE FLAPSSOFT TISSUE FLAPS

7. •vertical releasing incision should cross
free gingival margin should not directed on
the facial aspect of tooth nor directly in
papilla
•Incision must be carried out with a firdm
continous stroke nor intrupte stroke
DESIGN PARAMETERS FOR DESIGN PARAMETERS FOR
SOFT TISSUE FLAPSSOFT TISSUE FLAPS

8. TYPES OF MUCOPERIOSTEAL FLAP TYPES OF MUCOPERIOSTEAL FLAP
ENVELOP FLAPENVELOP FLAP
•In dentulous pt incision made in gingival sulcus to the
crestal bone through periosteum & full thickness flap
apically reflected
•Indicated when surgical procedure involves cervical line
of tooth
•ADVANTAGES
–Avoidance of vertical incison
–Easy approximation
•DISADVANTAGES
–Risk of end tearing
–Limited visualization
–Limited acess
–Possibility of injury of palatal vessels & nerves
–Defect in attached gingiva

9. Envelop flapEnvelop flap

10. THREE CORNER FLAP THREE CORNER FLAP
(Triangular flap)(Triangular flap)
•Envelop incison with one releasing incison
•Horizontal incison made along gingival sulcus & vertical
incison extending from vestibular fold to interdental
papilla to gingiva
•Indicated in surgical removal of root tips. Small cyst &
apicectomies
•ADVANTAGES
–Adequate blood supply
–Good stability & reproximation
•DISADVANTAGES
–Limited access to long roots
–Tension created while retraction
–Defect in attached gingiva

11. THREE CORNER FLAP THREE CORNER FLAP
(Triangular flap)(Triangular flap)

12. FOUR CORNER FLAP FOUR CORNER FLAP
(TRAPEZIODAL FLAP)(TRAPEZIODAL FLAP)
•An envelop flap with 2 releasing incison
•Mostly indicated for excessive surgical
procedure
•ADVANTAGES
–Excellent access
–Allows surgery to performed in one or more
teeth
•DISADVANTAGES
–Produce defect in attached gingiva

13. FOUR CORNER FLAP FOUR CORNER FLAP
(TRAPEZIODAL FLAP)(TRAPEZIODAL FLAP)

14. SEMILUNAR FLAPSEMILUNAR FLAP
•Curved incision just beneath vestibular fold; convex part
toward attached gingival
•Lowest point of incison must be at least 0.5 cm from
gingival margin
•Indicated for apicectomy ;small cyst & root tip
•ADVANTAGES
–Small incison ;easy reflection
–No intervention at periodontium
–Easy 2 maintain oral hygiene
•DISADVANTAGES
–Limited acess
–Increase tendency to tear
–Possibility of incison performed right over lesion

15. SEMILUNAR FLAPSEMILUNAR FLAP

16. FLAP RESULTING FROM Y FLAP RESULTING FROM Y
SHAPE INCISON SHAPE INCISON
•Incison made along midline of palate as well as
2 anterolateral incison which are anterior to
canine
•INDICATIONS
–Removal for long exostosis

17. PEDICAL FLAPPEDICAL FLAP
•Use occasionally on palate
•Mobilize from one area to another & fill
soft tissue defect
•Used to close oral antral fistula

18. BUCCAL FLAPBUCCAL FLAP
•Result of 2 oblique incison that diverge
upward & extend as far as tooth socket

19. PALATAL FLAPPALATAL FLAP
•Used in edentulous
•Flap rotated posteriorly & bucally & place
over the orifice of socket

20. PEDICAL BRIDGE FLAPPEDICAL BRIDGE FLAP
•Is plato buccal & perpendicular to alveolar ridge
•Flap rotated posteriorly or anteriorly to cover
orifice of OAF
•Used in edentulous part of alveolar ridge

21. PRINCIPAL OF SUTURINGPRINCIPAL OF SUTURING
•Function of suturing
•Hold the flap in position & approximate two
wound edges
•Aids in hemostasis
•Help hold the soft tissue over bone
•Maintain the blood clot in alveolar socket

22. ARMANTERIUMARMANTERIUM
•A needle holder
•The suture needle (small 3/8th- _ ½ circle)
•Most common needle shape of oral surgery are
fs-2 & x-1

23. SUTURE MATERIALSUTURE MATERIAL
•RESORBABLE
– Gut
– Polyglycolic acid
– Polyglactan
•NON RESORBABLE
– Silk
– NYLON
– Polyester
– Polypropylene

24. THINGS TO REMEMBERTHINGS TO REMEMBER
•Needle should enter at right angle to flap to
make small possible hole in flap
•The minimal amount of tissue b/w suture & edge
of flap should be 3mm
•Suture should not tied too tightly
•There should be no blenching of wound edges
•In three corner flap vertical incison must be
closed separately
•Suture should placed for approx 5-7 days

25. TECHNIQUES TECHNIQUES
SIMPLE INTRUPTED SUTURESIMPLE INTRUPTED SUTURE
•The suture simply goes through one side of
wound comes through other side & is tied in a
knot at top

26. CONTINOUS SUTURECONTINOUS SUTURE
•For suturing wound that are superficial & long
•After passing needle through both flap initial knot made
free end cut; needle bearing suture used
•to create successive continuous suture at wound margin

27. PRINCIPLE & TECHINQUES FOR PRINCIPLE & TECHINQUES FOR
SURGICAL EXTRACTIONSURGICAL EXTRACTION
INDICATIONS
•When initial attempt at forcep extraction failed
•Pt has dense & heavy cortical bone
•Short clinical crowns
•Hypercementosis of roots
•Widely divergent roots
•Maxilary sinus has expand to include roots of
maxillary molar
•Crown with extensive caries

28. ROOTMORPHOLOGYROOTMORPHOLOGY

29. TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION
SINGLE ROOTED TOOTH
•Adequate flap reflection
•Access to need for bone removal
–Reseat extraction forcep
–Grasp a bit of buccal cortical bone in forcep to obtain better
mechanical advantage
–Forcing straight elevator down to PDL space of tooth
–Final option is to remove bone over the area of tooth in vertical
dimension bone removal is one half to two third of length of root
–If tooth is still difficult to out then purchase point made in apical
portion of bone removal crane pick then used for extraction
•Bone edge should inspected
•Wound irrigated
•Sutured

30. TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION

31. MULTI ROOTED TOOTH
MANDIBULAR MOLARS
•Reflection of flap
•Evaluation of need for suctioning roots &
removing bone
•A small amount of crestal bone removed
•Tooth should be suctioned
•Small straight elevator then inserted to mobilize
suctioned roots
•Forcep or straight elevator or triangular elevator
used to elevate tooth from socket
TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION

32. TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION

33. MULTI ROOTED TOOTH
MAXILLARY MOLARS
•Flap reflected
•Crestal bone removed to expose trifurcation
area
•Bur used to suctioned mesio buccal & disto
buccal & a palatal root
•Roots luxated with straight elevator & deliver
with creyer
TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION

34. TECHNIQUES FOR OPEN TECHNIQUES FOR OPEN
EXTRACTIONEXTRACTION

35. REMOVAL OF ROOT REMOVAL OF ROOT
FRAGMENTS & ROOT TIPFRAGMENTS & ROOT TIP
•Pt should be repositioned to achieve
adequate visualization & suction achieved
•If irrigation suction technique unsuccessful
then tease the loose root apex with a root
tip pick
•Root tip can be removed by using small
straight elevator

36. REMOVAL OF ROOT REMOVAL OF ROOT
FRAGMENTS & ROOT TIPFRAGMENTS & ROOT TIP
•OPEN TECHNIQUE
–Flap reflected
–Bone removed to expose buccal surface of root
–Root delivered by straight elevator
•OPEN WINDOW TECHINQUE
–Flap reflected
–Apex area of tooth root located
–Dental bur used to remove bone from apex of root
–Instrument inserted into window & root is pushed out

37. REMOVAL OF ROOT REMOVAL OF ROOT
FRAGMENTS & ROOT TIPFRAGMENTS & ROOT TIP

38. POLICY FOR LEAVING ROOT POLICY FOR LEAVING ROOT
FRAGMENTFRAGMENT
•Small root tip less than 4mm
•No evidence of periapical pathology or infection
•Inability to visualize root tip
•Removal of root tip will cause destruction to
adjacent structure
•Proximity to IDN
•Proximity to maxillary sinus
•ill fitting pt
•Un controlled hemorrhage

39. MULTIPLE EXTRACTION MULTIPLE EXTRACTION
SEQUENCESEQUENCE
•Maxillary teeth
•Mandibullar teeth
•Posterior to anterior teeth
•From 1 quardent to another
•Reflection of minimal buccal flap will facilitate
extraction & allow alveloplasty
•Irrigation
•Suturing
• Post operative instruction

40. QUESTIONS?QUESTIONS?

41. THANK YOU.THANK YOU.