Preclinical dentistry III. Lectures 1.-2. ORAL AND MAFILOFACIOAL SURGERY. Dental speciality that deals with diagnosis and surgical treatment of diseases, injuries and deformities of teeth and surroundung structures (oral surgery). Maxilofacial surgery is focused also on jaws and face. SURGICAL PROCEDURES Incision Extractions Single ectraction Multiple extractions Surgical extractions Exposure of impacted tooth (e.g. Canine, third molar) Periodontal surgery <]J - Frenectomy - Gingivectomy, gingivoplasty - Osteoplasty Biopsy Implantation Endodontic surgery INCISION SURGICAL KNIFE RAISING THE FLAP (MUCOSA AND PERIOSTEUM) CONTROL OF INFECTION SPECIAL TERMS IN RELATION TO CONTROL OF INFECTION Asepsis All procedures that prevent contamination of the operating field: Sterile gloves and clothes* Sterile instruments Using antiseptics for decontamination the operative field before the surgical procedure. SPECIAL TERMS IN RELATION TO CONTROL OF INFECTION Antisepsis Preventin of infection by inhibiting or arresting the growth and multiplication 6f germs (infectious agents) on skin or mucosa. ANTISEPTICS Antiseptics (from Greek avri - anti, '"against" + oqTTTiKog - septikos, "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction SPECIAL TERMS IN RELATION TO CONTROL OF INFECTION Disinfection is destruction od macroorganisms that are living on the objects. Desinfection does not necesarilly kill all microorganisms. We use various substances - disinfectants. DISINFECTANTS • Disinfectants are substances that are applied to non-living objects to destroy microorganisms that are living on the objects. Disinfection does not necessarily kill all microorganisms, especially not resistant bacterial spores; it is less effective than sterilisation, which is an extreme physical and / or chemical process that kills all types of life. Disinfectants are different from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue. Disinfectants are also different from biocides — the latter are intended to destroy all forms of life, not just microorganisms. SPECIAL TERMS INFECTION RELATION TO CONTROL OF Sterilization (or sterilisation is a term referring to any process that eliminates (removes) or kills all forms offiife, including transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media. STERILISATION • Sterilization (or sterilisation) is a term referring to any process that eliminates (removes) or kills all forms of life, including transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) present on a surface, contained in a flurd, in medication, or in a compound such as biological culture media. Sterilization can be achieved by applying the proper combinations of heat, chemicals, irradiation, high pressure, and filtration. DRY HEAT STERILISATION Sterilisation unit - sterilisator • Hot air • Circulation „, • 160,170 or 180 °C (60,30,20 min) HOT STEAM STERILISATION Autoclave Phases: vacuum -steam-air - drying. Steam - pressure Autoclaves commonly use st#am heated to 121-134 °C (250-273 °F). To achieve sterility, a holding time of at least 15 minutes at 121 °C (250 °F) or 3 minutes at 134 °C (273 °F) is required. COLD STERILISATION • Irradiation • Special gas No in dental suraer SCRUBBING Aims and objectives: Effectively reduce the number of microorganisms on the skin By mechanical washing Microorganisms on skin • Transient :-Introduced by soil, dirt, contamination • Resident:- under finger nails, deeper layers of skin i.e. sweat gland, hair follicles & sweat glands Scrubbing removes -most of transient bacteria -resident bacteria from surface & just beneath skin Preparation for scrubbing • Personal Hygiene • Shower • Healthy skin on hands, fingers, nails & arms. • No boil, abrasion orHvound on hands • Free from cold or URTI Finger Nails • Short • Not over tips of fingers • Short nails - Easy to clean - Will not puncture glovfes Free from nail polish Chipped nail polish can harbor bacteria No artificial nails Jewelry Remove all jewelry i.e. rings, watches, bracelets from hands & arms Keep them at a sage place or in pocket • Dead skin & accumulate beneath them Theatre Attire • Scrub Suit • Surgical Cap & face mask • Eye Wear/Wiser • Shoes • Protective wearing - Plastic apron - Lead apron Scrub Suit • Street clothes not allowed • Short sleeved cotton scrub suit • Sleeves 4 inches above elbow •Shirt tucked in trouser • -to avoid shirt tail flapping on sterile field •Trouser legs not touching floor - to avoid transport of bacteria Shoes • Street shoes not allowed • Close ended shoes • Chappals or open ended shoes not allowed • Shoe cover for single use only Surgical Cap & Face mask Surgical cap cover hair completely Including pierced ear rings Face mask cover nose & mouth completely FOOD/ DRINK NO food or drinks in Patient Care Areas Food/ Drinks must be consumed in Staff Lounges Scrubbing Agents Povidone iodine solution 2minutes ( 8ml required) - Chlor-hexidine Solution (Hibiclens) 2 minutes (8ml needed) Desirable properties of scrubbing agent •Non irritating to skin •Leaves minimum bacteria on skin •Prolonged antibacterial effect on skin •Should leather in hot, cold , or hard water Scrubbing Procedure Nail brush for nails Water Steady flow Comfortable temperature. Hands above the level of the elbows Clothing should remain dry Movements steady. Scrub technique Scrubbing do not include rinsing time • Set water temperature • Wet hands & forearms • Hold soap in hands till scrubbing complete • Keep hands elevated above elbow through out Scrubbing Procedure •Turn off taps with elbows • keep hands elevated, •skin should be blotted dry • Use 2 towels • Towel should be folded • Discard towel immediately Gowning Procedure • Pick up gown from opened pack • gown is folded with the inside uppermost. • Slide both arms into gown • Not to touch outside the gown. •All gowns must be in a good state PARAMETERS OF A STERILE GOWN GOWNS ARE CONSIDERED STERILE FROM WAIST LEVEL TO CHEST LEVEL INCLUDING SLEEVES TO 2' ABOVE ELBOW • STOCKINETTE CUFFS MUST BE COVERED BY STERILE GLOVES • STERILE PERSONS MUST HAVE HANDS IN SIGHT AT ALL TIMES Gloving Procedure The Open Metho< Closed Method •Once gowned and gloved stand with hand palms together Above the waist Away from the gown At the end of the sterile procedure • First remove the gown over the gloved hands • Then the gloves. • Hands should then be washed and dried. Gloves disposed of according to polic\ THE PREPARATION OF OPERATOR AND OPERATING FIELD WILL EXPLAINED AND TRAINED PRACTICALLY FROM 3RD YEAR This is the endo of the first lecture. ANAESTHESIA 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. PAIN CONTROL - INDICATIONS OF ANAESTHESIA Surgical treatment Preparation of cavities Preparation for crowns Endodontic treatment Peridontal treatment (scaling, periodontal surgery) CLASSIFICATION General anaesthesia Analgesia (inhalation, sedation) Hypnosis Local anaesthesia 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 • Topical (sprayjiquid) applied on mucosa • By injection - Infiltration - Nerve block - PDL-periodontal ligament anaesthesia - Intrapulpal anaesthesia PAIN CONTROL - INDICATIONS OF ANAESTHESIA Surgical treatment Preparation of cavities Preparation for crowns Endodontic treatment Peridontal treatment (scaling, periodontal surgery) LOCAL ANAESTHESIA CONTRAINDICATIONS • Allergy • Serious systemic diseases (blood circulation) • Antithrombotic therapy, coagulopathy -nerve blocked anaesthesia DRUGS Articain 4% with epinephrine 1: 200 000 Articain 4% with epinephrin 1:100 000 Mepivacain 3%plain Prilocaine 4% with epinephrine 1:200 000 Prilocaine plain Lidocain spray 10% Xylocain spray 10% BENEFITS OF LOCAL ANAESTHESIA • Comfort for the patient • Haemostasis (addtion of epinephrin - hormone of suprarenal gland - arteficial) • Operator efficiency TOPICAL ANAESTHESIA (ON MUCOSA OR SKIN) • Liquid • Spray • Creme, paste Only nerve endings are affected For extraction of primary teth (when roots are completely resorbed) Anesethesia of the puncture will be INFILTRATION ANAESTHESIA The drug is delivered by infiltration of soft tissues using syringe and needle. Nerve branches in tissues are affected. INFILTRATION ANAESTHESIA • Suitable for - indications - simple extractions in maxilla, - extractions of mandibular incisors, canines - soft tissue surgery INFILTRATION Syringe with short needle Raise lip or cheek The puncture is situated into mucosa appr. 1cm from fornix vestibuli. Do not touch periosteum. NERVE BLOCK ANAESTHESIA Syringe with long needle > Foramen mandibulare > Foramen mentale > Foramen palatinum majus > Foramen incisivum > Foramen infraorbitale NERVE BLOCK ANAESTHESIA N. alveolaris inferior NERVE BLOCK ANAESTHESIA Nervus alveolaris inferior 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 syringe on the opposite canine The needle goes behind the crista temporalis, 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 Aspiration and a injection of the drug. DIRECT METHOD The beginning is the same 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 > The puncture see previous slide > The syringe on opposite premolars > The puncture is situated medially from crista temporalis and laterally from plica prerygomandibularis (into a small depression in mucosa) 1,5 cm deep NERVE BLOCK ANAESTHESIA N. alveolaris inferior Anaesthetic zone Molars, premolars, mucosa, skin, bone, tongue NERVE BLOCK ANAESTHESIA 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 mesially Anaesthetic zone: Premolars and canine, mucosa, skin. NERVE BLOCK ANAESTHESIA Foramen palatinum maius - nervus palatinus major Distal surface of second molar N The puncture is 0,5 - 1 cm before from behind forward Anaesthetic zone: Half of palate NERVE BLOCK AESTHESIA Foramen incisivum - n. nasopalatine Nervus incisivus Papilla incisiva Next tu papilla, mesial direction Triangular area I behind incisors ANAESTHESIA ON F. INFRAORBITALE Find the margo infraorbitalis Raise the lip The puncture is situated between canine and 1st premolar The needle goes to the region (appr 1 cm below margo infraorbitalis) Anaesthetic zone: Canine and premolars ANAESTHESIA ON TUBER MAXILLAE • The durg si delivered on tuber maxillae • The puncture is situated behind 2nd molar (distal surface), goes behind and upper around tuber maxillae. Anaesthetic zone: Upper molars PDL ANAESTHESIA • Intraligamentary • Special syringe (pen or gun) The needle is inserted into periodontal space - few drops on anaesthetic • Indication: single extraction, preparation, pulp exstirpation The puncture is between gingiva and tooth and goes into gingival sulcus MB, ML, DB, DL INTRAPULPAL ANAESTHESIA • Exstirpation of the pulp - additional step. Directly into the pulp chamber ANAESTHESIA - COMPLICATIONS • Bleeding • Breakage of needle • Heamatoma • Allergy (swelling, collaps) • Patient's history is necessary!!!! ADAPTATION OF THE FLAP, SUTURE SUTURE SUTURE Instruments: Needles: bent Straight Various size Needleholder: Without fixation Autofix Ob Fig. BL601 N BL 602 N BL 603 N BL 604 N Fig. Wlt/llll/lk BL320N BL 321 N BL 322 N BL 323 N BL 324 N BL 32S N Pb BL 540 N BL 541 N BL 542 N BL543N BL 544 N BL 545N GL 546 N BL 547 N 91 548 N SUTURE Vi BD 215 BD 216 Tweezers - tissue forceps Vi Vi BD 23 BD 25 Vi BD 27 BD 29 e -e BD 547 BD 549 BD 553| SB i BD 557 SUTURE Suture material Resosbable, Polyglycol, polyglactin, polydioxynon Non resorbable Silk.nylon, PTFE, Polyester.polyamid. Monofil, polyfi SINGLE SUTURE The puncture is situated appr. 2 mm from the border of the wound The same on the opposite site. The knot is out of the wound Single suture \ Coninuing suture WIDE WOUND - THE BORDERS ARE BROUGHT CLOSER For the exam: Students will be asked for preformance of: Single suture Matress suture Here is also a link on you tube: https://www.voutube.com/plavlist?reload=9&list=PLWXXOUaxJ VP8lxhFP7iJbXVSdXDi0iaC This is an end of second lecture.