Oral and maxillofacial surgery
I.
Dental speciality that deals with diagnosis and surgical treatment of diseases, injuries and deformities of
the face and jaws.
Surgical procedures
Routine extractions Multiple routine extractions Surgical extractions Third molar extractions Exposure of impacted cuspid Frenectomy
Gingivectomy, osteoplastic
Biopsy
Anaesthesia
• Dentist is responsible for providing the patient with comfortable dental treatment !
Pain
Sensory and emotional experience associated with actual or potentional tissue damage.
Pain and anaesthesia
Pain occurs when pain receptors or nerve endings transmit impulses to the central nervous system.
Anaesthesia eliminates the pain experience by interrupting the transmitted impulse.
Anaesthesia
• Absence of normal sensation, esp sensitivity to pain.
Anaesthesia
Topical: an application of substance to the tissues that creates loss of feeling
on the surface.
Local: placement of a substance by injection at a site that creates a loss of sensation to one part of the body
Anaesthesia
Conscious sedation: an anaesthetic agent used to produce a sedative effect while patient remains conscious. (Sometimes inhalation)
General anaesthesia: an anaesthetic agent creates a state od unconsciouness with absence of sensation of entire
body.
Local anaesthesia
The drug is delivered
> Locally (on the surface of oral mucosa) -topical anaesthesia.
> By injection
Local anaesthesia
Topical
Liquid or spray Lidocain, Xylocain.
Local anaesthesia
By injection
> Infiltration
> Nerve block
> Periodontal ligament injection
Infiltration anaesthesia
Depositing anaesthesia into tissues. Tte solution is absorbedby many terminal nerve endings.
Single tooth extraction or other tissue surgery.
Nerve block anaesthesia
Depositing anaesthesia near the nerv.
Mandibular arch (n. alveolais inferior) Foramen infraorbitale Foramen incisivum Foramen palatinum majus Tuber maxillae
Local anaesthesia
By injection
> Infiltration
> Nerve block
> Periodontal ligament injection
Instrumentarium
Syringes
Needels
Extracting teeth (exodontia)
Reasons:
> Caries
> Trauma
> Periodontitis
> Endodontic reasons
>Retention, semiretention if it causes >Inflammation and pain
Principles of extraction
Interruption, rupture of periodontal Ligaments and extraction - the tooth is pulled out.
Anaesthesia
Topical By injection
- Infiltration
- Nerve block
Nerve block anaesthesia
> Foramen mandibulare
> Foramen mentale
> Foramen palatinum majus
> Foramen incisivum
> Foramen infraorbitale
Nerve block anaesthesia
N. alveolaris inferior
Nerve block anaesthesia
Nervus alveolaris inferior In sulcus colli mandibulae
Nerve block anaesthesia
N. alveolaris inferior
Indirect Direct
Nerve block
anaesthesia
N. alveolaris inferior Indirect
Put the forefinger on the occlusal surface Rotate inside (nail inside) 1 cm up occlusal surface the puncture is situated
/
Nerve block anaesthesia
N. alveolaris inferior Indirect
1. The needle goes behind the crista temporalis, the syringe
on the opposite canine
/
Nerve block anaesthesia
N. alveolaris inferior Indirect
2. The needle goes deeper in the contact with the bone The syringe goes mesial
/
Nerve block anaesthesia
N. alveolaris inferior
/
Indirect
3. The contact with bone Is lost, the syringe goes back
Nerve block anaesthesia
N. alveolaris inferior
Direct
Put the forefinger on the occlusal surface
Rotate inside (nail inside)
1,5 cm deep
Nerve block anaesthesia
N. alveolaris inferior
Area:
Molars
Premolars
Tongue
Nerve block anaesthesia
N. alveolaris inferior Direct
> The puncture at the same place
> The syringe on opposite premolars
> The puncture goes into the small pink depression medial from crista temporalis and lateral from plica prerygomandibularis
1,5 cm deep
Molars, premooars, mucosa,
skin, bone
Nerve block anaesthesia
N. mentalis
F. mentale
The puncture is situated behind he distal surface of 2nd premolar The needle goes between roots of premolars
Nerve block anaesthesia
N. mentalis
F. mentale
The puncture is situated behind the distal surface of 2nd premolar The needle goes between roots of premolars, From up to down Forward and mesial
Premolars and canine, mucosa, skin.
Nerve block anaesthesia
Foramen palatinum majus
Distal surface of l.st molar The puncture is 0,5 - 1 cm before from behind forward
Half of palate
Nerve block anaesthesia
Foramen incisivum
Nervus incisivus Papilla incisiva Next tu papilla, mesial direction
Triangular area behind incisors
Nerve block anaesthesia
Raise the lip, the index finger on f. Infraorbitale (1cm below the border of the orbit) The needle from down tu
up
Suture material Silk,nylon Needels
- bent, rounded
- straight Needle holders
- autofix -without fixation
Suture
47
Suture
Suture material
Silk,nylon Needels
- bent, rounded
- straight Needle holders
- autofix -without fixation
Suture material Silk,nylon Needels
- bent, rounded
- straight Needle holders -autofix -without fixation Tweezers - tissue -anatomical -surgical
Suture
Control questions
• What is the principle of the local anaesthesia?
• What kinds of local anaesthesia do you know?
• Describe the principle of the nerve block anaesthesia, which konds do you know?
Control questions
Describe the infiltration anaesthesia.
Describe all techniques used for the nerve block anaesthesia including the affected area.
Which instruments and material are necessary for the suture?
Control questions
• Which kinds of the suture do you recognize?
• Practice them.
Sutura
Surgical knot - single suture
Suture
Continuus suture
Suture
Continous suture
Suture
• Well adapted borders
• Without tension
• Needle goes perpendiculary
Control questions
• What is the principle of the local anaesthesia?
• What kinds of local anaesthesia do you know?
• Describe the principle of the nerve block anaesthesia, which konds do you know?
Control questions
Describe the infiltration anaesthesia.
Describe all techniques used for the nerve block anaesthesia including the affected area.
Which instruments and material are necessary for the suture?
Control questions
• Which kinds of the suture do you recognize?
• Practice them.