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Oral Surgery

Oral Surgery. V-Day +1 – 02/15/08. For Older Patients. Maxillary K9’s Always surgical! . When is pinch grasp used?. Use pinch grasp to make sure you are not fracturing the buccal and lingual bone. Maxillary Extractions. Use buccal and palatal motion

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Oral Surgery

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  1. Oral Surgery V-Day +1 – 02/15/08

  2. For Older Patients • Maxillary K9’s • Always surgical!

  3. When is pinch grasp used? • Use pinch grasp to make sure you are not fracturing the buccal and lingual bone.

  4. Maxillary Extractions • Use buccal and palatal motion • Emphasize the side that you can expand easiest • Buccal is typically thinner • First primolars • Don’t rotate • Mostly traction • Traction means pull  • Also can use buccal and lingual motion often

  5. Maxillary Extractions • First molar • Strong buccal and strong lingual movement • Seat the beaks as much as you can, expand the bone, tear the fibers

  6. Alternative to bite block for support? • Mandibular sling grasp supports the muscles of the jaw and the TMJ

  7. Thinnest v. Thickest Mnd Bone: • Thickest bone in mandible: • Buccal of mandibular thirds • Thinnest bone in mandible: • Lingual of the thirds

  8. Mental Foramen Problems • Generally not an issue, but can be… • If you drop a flap in that area • Minnesota retractor during a full thickness envelope flap

  9. What happens from osteoradionecrosis? It kills the endothelial cells in the bone – an irreversible process

  10. Osteoradionecrosis • Most common Jaw: • Mandible • Cause: • Death of the endothelial cells • Length: • Permanent • Treatment: • Hyperbaric oxygen

  11. Hyperbaric Oxygen • Concept of ‘dives’ … • 1hr at 2atm • Stimulates growth of endothelial cells and mucosa • Each dive is 30min • Give the patient 20-40 dives before you: • Saucerization – cleaning out the necrosis until you get to bleeding bone • End block – take a big chunk of bone out – generally does not work well • Give patient more dives at the end of treatment DO ANYTHING YOU CAN TO PREVENT A TOOTH EXTRACTION on a osteoradionecrosis patient. Cut it off at the gumline and do a RCT if necessary.

  12. Problem with operating on osteoradionecrosis patients: • If we take out a tooth in a radiated jaw, there are not enough endothelial cells. • We can’t get the lymphocytes to get there and kill bacteria due to loss of circulation • Hence, even major doses of antibiotics won’t help because there is little to no blood supply to the area • THEREFORE : the bone necroses quickly!

  13. Keys to radiation know-how: • Be sure you know 3 things: • How much radiation was given? • Where was the radiation given? • Was the jaw shielded from the radiation? • (upper and lower)

  14. Shielding Goals • You’re OK if: • Total dose value lower than 3500 and not shielded • Shielded jaws • NOTE: Date is insignificant… don’t need to know the date.

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