Surgery

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Dental surgery is any of a number of medical procedures that involve artificially modifying dentition; in other words, surgery of the teeth and jaw bones.

Types of Dental Surgery

- - Endodontic (surgery involving the pulp or root of the tooth).
  - Root canal
    – Pulpotomy : The opening of the pulp chamber of the tooth to allow an infection to drain; Usually a precursor to a root canal.
    – Pulpectomy :The removal of the pulp from the pulp chamber to temporarily relieve pain; Usually a precursor to a root canal.
    – Apicoectomy : A root-end resection. Occasionally a root canal alone will not be enough to relieve pain and the end of the tooth, called the apex, will be removed by entering through the gingiva and surgically extracting the diseased material.
  - Prosthodontics (dental prosthetics)
    – Implants : a procedure in which a titanium implant is surgically placed in the bone (mandible or maxilla), allowed to heal, and 4–6 months later an artificial tooth is connected to the implant by cement or retained by a screw.
    – Implant-supported prosthesis :a combination of dentures and implants, bases are placed into the bone, allowed to heal, and metal appliances are fixed to the gingival surface, following which dentures are placed atop and fixed into place.
  - Orthodontic treatment
    – Implants and implant-supported prosthesis :also an orthodontic treatment as it involves bones.
  - Extraction
    – It is a procedure in which a diseased, redundant, or problematic tooth is removed, either by pulling or cutting out. This procedure can be done under local or general anesthesia and is very common — many people have their wisdom teeth removed before they become problematic.

Disimpaction

IMPACTION —A tooth which fails to erupt in normal anatomical position either due to lack of space or due to obstruction from tooth, bone or soft tissue.

1. Causes :

» Irregularity in the position and pressure of an adjacent tooth.
» Density of the overlying or surrounding bone.
» Chronic inflammation with resultant fibrosis of the overlying mucosa.
» Lock of space due to under developed jaws. Unduly over retention of the deciduous teeth.
» Premature loss of deciduous teeth.
» Acquired disease such as necrosis due to infection.
» Inflammatory changes in the bone due to exanthematous diseases in children, like, Chicken pox, Parotitis.

2. Impaction In The Following Order Of Frequency:

» Mandibular third molars.
» Maxillary thirds molars.
» Maxillary cuspids.
» Mandibular bicuspids.
» Maxillary bicuspids.
» Upper central incisors.
» Upper lateral incisors

3. Complications From Retained Impacted Teeth:

»Infection
»Pain
»Fractures

Procedure or technique for removal:

A. Sectioning of the tooth.
B. Combination of the removal of surrounding bone and the sectioning technique.
C. Solely by removal of surrounding bone.

» Determine the surrounding and overlying osseous structure.
» Determine the best instrument.
» Determine the best direction for the removal of impacted to7oth.

FACTORS COMPLICATING THE OPERATIVE PROCEDURE

1. Fear of damaging the adjacent tooth since crown and root are in close proximity with the teeth.
2. Possibility of infection or root being forced into maxillary sinus due to its close proximity.
3. Most of the cuspids have hypercementosed roots.
4. Marked curvature of the roots.

POST OPERATIVE TREATMENT

1. Sockets should be cleaned and check for any tooth remnants.
2. Periphery of the socket should be trimmed and then smoothened.
3. Sutures should be placed properly to appose the tissue and cover the socket.
4. In case of excessive bleeding. Check for the bleeding site and apply gel foam.
5. Alternate hot and cold packs should be applied.
6. Possibility of swelling is always present and so is ecchymosis.
7. If pain develops in the socket then so called dry socket treatment must begin immediately.
8. Basic vitamin tablets should be given.
9. Sutures to be removed seventh day post operatively.

POST OPERATIVE COMPLICATIONS

1. Exposure of inferior dental canal.
2. Parasthesia.
3. Acute trismus.
4. Disruption of blood supply.
5. Fracture of a large section of alveolar process.
6. Traumatization or dislodgement of adjacent teeth.
7. Injury to the lips or cheeks due to traumatization.
8. Opening into maxillary sinus or tooth forced into the pterygopalatine fossa.
9. Dry Socket.
10. Extensive exposure of adjacent tooth resulting in premature loss.

Dental Surgery

Types of Dental Surgery

Disimpaction

Procedure or technique for removal:

FACTORS COMPLICATING THE OPERATIVE PROCEDURE

POST OPERATIVE TREATMENT

POST OPERATIVE COMPLICATIONS

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