Professional Documents
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Outlines
1) Orthodontic Considerations
Crowding of mandibular Incisors (controversial) Interference of orthodontic treatment/orthognathic surgery
Multiple Extraction
1. Preextraction treatment planning
Dentures, soft tissue surgery, implants Maxillary teeth first
Infiltration anesthetic: more rapid Debris may fall into the empty sockets With mainly buccal force more effective use of dental
1. Extraction Sequencing:
Multiple Extraction
Summary
1) Upper posterior teeth, leaving the 1st molar 2) Upper anterior teeth, leaving the canine 3) Upper 1st molar 4) Upper canine 5) Lower posterior teeth, leaving the 1st molar 6) Lower anterior teeth, leaving the canine
43% Least difficult 3% More difficult than mesioangular ones 38% Third in difficulty 6% Most difficult
63%
25%
12%
Surgical Procedure
A. The bone overlying the O surface of tooth is removed with a fissure bur. B. Bone on the B and D sides of
Mesioangular impaction A. B and D bone are removed B. D of the crown is sectioned. Occasionally the entire tooth. C. Small straight elevator into M side, and the tooth is delivered with a rotational and level motion of
Horizontal impaction A. B and D bone are removed B. Crown is sectioned from the roots. C. Roots are delivered together or independently with a Cryer. D. M root is
Vertical impaction
A. Bone on O, B, D of crown is removed, and the tooth is sectioned into M and D. If fused single rootD of the crown is sectioned off. B. The posterior aspect of the crown is elevated first with a Cryer.
Distoangular impaction A. O,B,D bone is removed with more D bone. B. Crown is sectioned off. C. Roots are delivered by a Cryer with a wheel-andaxle motion. If the roots diverge, it may be necessary in some cases to split them into
Impacted maxillary third molar A. B bone is removed with a bur or a hand chisel. B. Tooth is then delivered by a small straight elevator with rotational and lever types of motion in DB and O direction.
Postoperative Management
Analgesics
During the first 24 hours, analgesics are prescribed routinely; after this time, they are used only when required. Combination of codeine and aspirin/acetaminophen or NSAID might be suggested.
Antibiotics
Preexisting pericoronitis antibiotics for a few days No preexisting infection antibiotics is not indicated
Anti-inflammatory medication
Post-OP Complications
Trismus
Reaches its peak on the second day and resolves by the end of the first week.
Bleeding
Moist gauze pack ing with pressure Socket packed with oxidized cellulose
Swelling/edema
Corticosteroids Ice packing has no effect on edema Reaches its peak by the end of the second day
Infection (1.7~2.7%)
Post-OP Complications
Fracture
Broken root displaced into submandibular space, IAN canal, or maxillary sinus Radiographic follow-up