Indications for maxillofacial surgery
-extractions of decayed teeth that cannot be restored
-surgical removal of impacted teeth
-extraction of nonvital teeth
-preprosthetic surgery to smooth and contour the alveolar ridge
-removal of teeth for ortho treatment
Indications for maxillofacial surgery continued
-removal of root fragments
-removal of cysts and tumors
-biopsy
-treatment of fractures of the mandible or maxilla
-surgery to alter the size or shape of the facial bones
-surgery of the tempromandibular joint
-salivary gland surgery
-surgical implant pro
The surgical setting
-dental operatory
-surgical suite
-operating room
In which two settings can a patient receive oral surgery?
-private practice
-hospital operating room
Are outpatient oral and maxillofacial surgical procedures considered major or minor surgeries?
most are considered minor
surgical instruments are designed to
-separate the tooth from the socket
-retract tissue
-loosen/elevate the tooth
-extract the tooth
Elevators
used to apply leverage against the tooth to loosen it form the periodontal ligament and ease extraction
uses for root tip picks
-removing root rips or fragments that get broken during the extraction procedure
forceps
-extraction forceps are available in many different shapes and designs
-the goal is to remove the tooth in one piece with the root and crown intact
-handles help to luxate and remove the tooth
apical retention forceps
-thin beaks
-tapered
-allows instrument to pass deeper onto root surface
surgical curette
-used to clean and scrape the interior of the tooth socket to remove diseased tissue
Rongeur
-used to trim alveolar bone
-used to contour and shape the edentulous ridge
Bone file
-used to trim and smooth the bone after the teeth have been extracted and the rongeurs have contoured the bone
Scalpel
-surgical knife used to make precise incisions into soft tissue
Hemostat
-used to grasp and hold things
1. soft tissue
2.bone
3. tooth fragments
surgical scissors
-straight or curved blades
-used to trim soft tissue
Suture scissors
-cuts only suture material
-notch on cutting edge of one blade
tissue retractors
used to hold or retract tissue during surgery
cheek and tongue retractors
hold and retract cheeks and tongue
mouth prop
also known as bite block; allows the patient to rest and relax the jaw muscles during surgery
Chisel/mallet
-either in a single bevel or bi bevel design
-single bevel type is used for removing bone
-bi bevel is used for splitting teeth
-mallet: source of pressure on the chisel handle
surgical burs
-used to remove bone, cut or split the crowns or roots of the teeth
-have extra long shanks
surgical hand piece
-allowing sectioning of tooth and removal of bone
-does not allow air to vent into surgical field
What does the periosteal elevator reflect and retract?
the periosteum
What number is given to the universal forceps
150/151, can be used on both sides of the arch
what surgical instrument resembles a spoon excavator
surgical curette
What surgical instrument is used to trim and shape bone?
a rongeur
when a chisel is used, what additional surgical instruments must be used?
mallet
surgical asepsis
-maintain chain of asepsis
-instruments
-surgical drapes
-gloved hands
-principles of asepsis
-sterile technique
-sterile principles
sterile field
-site where surgical instruments and accessory items are placed during the surgery
-prepare just before surgery
-if opened for more than 1 hour due to delays, the setup is considered unsterile and must be discarded
surgical scrub
type of hand wash used to lessen the chance of infection
steps for surgical scrub
-hair covered and protective eyewear and masks on first
-remove all jewelry
-under running water use orange stick under nails, discard, rinse w/o touching faucet of inside of sink
-wet hands and forearms up to elbows with warm water then dispense 5 ml of
proper gloving
-glove package should be opened before the surgical scrub. touch only the inside of the package
-glove dominant hand first
-pull glove on, touch only folded cuff
-with dominant gloved hand, slide forefingers under cuff of other glove
-pull glove over othe
what equipment is used when a surgical scrub is performed?
-orange stick, antimicrobial soap, sterile surgical scrub brush, sterile disposable towels
Prepping for surgery
-have all patient records and radiographs in order
-have consent forms signed and available
-information requested from the patients physician must have been received
-check for lab cases
-ensure surgical setups have been prepared and sterilized
-provide
Informed consent
-discussion with the patient of the potential/expected:
-risks
-benefits
-alternatives
-options for tooth replacement
-option of going to a specialist
informed refusal
if a patient refuses a treatment you feel is necessary, and failure to have the procedure may result in life or health threatening consequences the patient should sign a form stating that they have been informed of all the consequences of their decision
typical preoperative patient instructions
-wear loose fitting clothing and low heeled shoes, wear short sleeved shirt
-remove contacts
- notify the DDS if a cold, sore throat, fever, or other illness develops prior to surgery
-dont consume alcoholic beverages 24 hours before surgery
-arrange tran
treatment room preparation
-place barriers
-keep surgical instruments in their sterile wraps until they are to be used
-have appropriate pain control medications set out and ready for admin.
-have post op instructions ready to provide
patient preparation
-update medical history and lab reports
-confirm with the patient that any prescribed premeds was taken as directed
-place radiograghs on veiw box
-take vital signs
-seat and drape patient
-position the chair
during surgery
-maintain the chain of asepsis
-transfer and receive instruments
-provide aspiration and retraction as needed
-maintain a clear operating field with light
-monitor vital signs
-steady patients head and mandible
-observe the patients condition and anticipa
after surgery
-stay with patient
-give verbal and written post op
-schedule post op visit
-update the patients treatment records
-return the patients records
-break down and disinfect the treatment area
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