Good Afternoon

Minor Oral Surgery

In General Practice

I hear and I forget,

I see and I remember,
I do and I understand.
-Confucius

Tooth

--------------

Transalveolar Extraction

Impacted Tooth

--------------

Surgical Removal

Small Cyst

--------------

Enucleation

Periapical Surgeries

--------------

Apicectomy

Pre-Prosthetic
Surgeries

--------------

Alveoloplasty
Small Tori Removal

Abscess

--------------

Incision & Drainage

Lesion

--------------

Biopsy

Risk Assessment
Overall- Medical
Dental

Common health conditions to inquire

about verbally or on a health
questionnaire

Angina
Myocardial Infarct (heart
attack)
Heart murmurs
Endocarditis/Pros. Valves
Bleeding Disorders
Anticoagulant use
Asthma
Lung disease
Tuberculosis
Hepatitis

Sexually transmitted
disease
Renal disease
Hypertension
Diabetes
Steroid use
Seizure disorder
Implanted prosthesis
Allergies (drugs/non drugs)
Pregnancy
Breast feeding

Anxiety-reduction
protocol
(Patient / Doctor)

Before

appointment

During

appointment

After

surgery

Anxiety control during

Appointment

Non pharmacologic

Frequent verbal reassurances

Distracting Conversation

No surprises (warn patient before doing

anything that could cause anxiety)

No unnecessary noise

Surgical instruments out of patients sight

Relaxing background music

Anxiety control during

Appointment

Succinct instructions for post operative care

Patient information on expected postsurgical

sequelae (i.e. swelling or minor oozing of blood)

Further reassurance

Effective analgesics

Patient information on who can be contacted if

any problems arise

Telephone call to patient at home during

evening after surgery to check if any problems
exist

Consider the following complications in turn and,

in discussion with your dental assisstant, plan for:
a)

What steps you would take in order to assess the

likelihood of each complication.

b)

How you would minimise the incidence of each

complication.

c)

How you would manage the complication, were it

to occur.

Unexpected!!!!!!!
Forced to do minor surgery

Fractured maxillary tuberosity.

Creation of an oro-antral fistula.

Fracture of the coronal tooth structure, leaving

one or more roots in situ.

Displacement of a root into the maxillary antrum.

Damage to adjacent teeth or restorations.

Inability to complete the extraction.

Fracture mandible.

Principles of Surgery

Diagnosis

Basic necessities of surgery / Asepsis

Adequate visibility and assistance (access, light

and clean field)

Flap design

Tissue handling

Haemostasis

Dead space management

Suturing

Infection & Edema control

Instruments

Suction Tip (No. 3), Coupland Elevator, Periosteal Elevators (Big & Small), Adsons
forcep (Toothed & non Toothhed), BP blade & Handle (No. 3), Curette, Bone file, Bone
Rongeur, Needle Holder, Scissor, Cheek Retractor, Surgical Burs

Instruments

Suction
Tip

Instruments

Coupland
Elevator

Instruments

Periosteal
Elevators

Instruments

Adsons tissue forceps

(Toothed & Non- Toothed)

Instruments

BP Handle (No. 3) &

Blade

Instruments

Curette

Instruments

Bone File

Instruments

Bone Rongeur

Instruments

Needle Holder

Instruments

Scissor

Instruments
Cheek
Retractor

Instruments
Surgical
Bur

Requirements of any surgical

procedure

Good mucoperiosteal flap

Bone guttering

Removal of tooth or lesion

Types of Mucoperiosteal flap

1.

Envelop Flap

2.

Three cornered

3.

Four cornered

Base of flap never

stretched or twisted

Never incise over bony prominences

Never incise the attached gingiva,

over the facial aspect of the tooth

Never incise the papila

Transalveolar
1extraction 2

Root Extraction After Removal of

Part of the Buccal Bone

Transalveolar
root
of a maxillary first premolar
extraction
1

Root Extraction by Window hole

Transalveolar
root
of a maxillary first premolar
extraction

Root Extraction by Window hole

Removal of Impacted
teeth- Most common minor
surgical procedure
It Requires extensive training,
skill and experience to Perform
in an

ATRAUMATIC FASHION

Different Tooth Position,

Angulations and Depth

Difficulty Index
3-4 simple
5-6 Moderate
7-10 very difficult

Angulation

Different Tooth Position,

Angulations and Depth

Difficulty Index
3-4 simple
5-6 Moderate
7-10 very difficult

Space available (Class I, II, III)

Different Tooth Position,

Angulations and Depth

Difficulty Index
3-4 simple
5-6 Moderate
7-10 very difficult

Depth (Position A, B, C)

Removal of Third molar

Planning
1.

Clinical examination and radiographs

2.

State of eruption

3.

Vertical, mesioangular, distoangular, horizontal, buccolingual tilt.

Root pattern

5.

Soft tissue impaction, embedded in bone/thickness of overlying

bone.

Position and type of impaction

4.

Periapical view, lateral oblique of mandible, Orthopantomographs

Favourable, unfavourable

Crown

Caries, resorption(rare), state of 2nd molar, mandibular bone,

Inferior Alveolar Nerve

Problems faced while doing

Surgical Removal of Impacted
With the radiograph
tooth

With the design of the flap

With the bur (excessive heat and excessive cutting)

Risk of intervention

Minor transient : sensory nerve alteration, alveolitis,

Trismus and infection, hemorrhage, dentoalveolar
#,and displacement of tooth

Minor permanent : Periodontal injury, adjacent tooth

injury, TMJ problem

Major : altered sensation, fracture of mandible

Tooth Sectioning

Distoangular tooth sectioning

Tooth Sectioning

Horizontally impacted tooth sectioning

Tooth Sectioning

Mesioangularly impacted tooth sectioning

Cyst enucleeation &

Apicectomy

PRE-OP

Cyst enucleeation &

Apicectomy

RADIOGRAPH

Cyst enucleeation &

Apicectomy

INTRAOP

Cyst enucleeation &

Apicectomy

INTRAOP

Cyst enucleeation &

Apicectomy

Intra-op
(Suturing Done)

7 Days postop
(Suture removal)

Small Tori Removal

Pre-op

Small Tori Removal

Intra-op

Small Tori Removal

7 days Post-op

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

Preop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

MO 32
mm

Preop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

Preop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

Intraop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

Intraop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

18 days postop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

MO 60
mm

18 days postop

Incision & Drainage

Case 1 - Lt. Submandibular Space Infection

18 days postop

Incision & Drainage

Case 2 Lt. Canine & Buccal Vestibular
Space Infection

Preop

Incision & Drainage

Case 2 Lt. Canine & Buccal Vestibular
Space Infection

Preop

Incision & Drainage

Case 2 Lt. Canine & Buccal Vestibular
Space Infection

Intraop

Incision & Drainage

Case 2 Lt. Canine & Buccal Vestibular
Space Infection

2 days

Biopsy

Incisional
biopsy

Biopsy

Excisiona
l biopsy

Excision Biopsy

Pedunculated Lesion

TMJ Dislocation

Thumb (Fingers) should be padded by gauze.

First Downward and then Backward pressure is give.

TMJ Dislocation

Thumb (Fingers) should be padded by gauze.

First Downward and then Backward pressure is give.

Good Afternoon Again

6
4

65

Thank
You