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Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery
• Branch of dentistry that focuses on
diagnosis and treatment of diseases,
injuries, and malformations
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Oral and
Maxillofacial Surgery Team
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Surgeon
Receptionist and business staff
Dental assistant
Nurse anesthesiologist or
anesthesiologist
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Scalpel Setup
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Retractors
• Tissue
• Cheek and lip
• Tongue
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Tissue Retractors
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Tongue and Cheek Retractors
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Mouth Prop
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Hemostats
• Multiple uses
– Retract tissue
– Remove small root tips
– Clamp blood vessels
– Grasp loose objects
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Needle Holders
• Similar to hemostat
• Function similar to hemostat
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Surgical Scissors
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Surgical Aspirating Tips
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Surgical Curettes
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Surgical Chisel and Mallet
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Surgical Bone File
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Rongeurs
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Periosteal Elevators
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Elevators
• Loosen and remove teeth, retained
roots, and root fragments
• Types
– Apical
– Root tip picks
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Extraction Elevators
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Root Tip Picks
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Extraction Forceps
• Used to remove teeth from alveolar
bone
• Hinged with various handles and beak
styles
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Asepsis in Oral Surgery
• Infection control is critical
• Increased risk of exposure to blood in
surgery
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Patient Considerations
• Review
– Medical records
– Dental records
– Referring dentist notes
– Radiographs
– Treatment options
– Patient consent
– Financial arrangements
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Oral Surgery Procedures
• Uncomplicated extractions
– Removal of permanent or primary teeth
that have erupted into the oral cavity
– Also known as routine or simple
extractions
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Simple Extraction Setup
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Oral Surgery Procedures
• Multiple extractions and alveoplasty
– Multiple extractions are performed to prepare
patient for partial or dentures
– Bone and soft tissue of the edentulous ridge
is contoured and smoothed
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Multiple Extractions Setup
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Oral Surgery Procedures
• Extractions of impacted teeth
– Tooth may be partially or fully covered by
tissue or bone
– Tooth has not erupted into the oral cavity
– Extraction is difficult due to depth, position,
or angulation of tooth in bone
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Problems Caused
by Impacted Wisdom Teeth
Impacted
Three roots
Impacted
Two roots
Wisdom teeth (# 3
above) develop
inside the bone.
Crowns form first,
then the roots.
If the jaw grows
long enough, the
wisdom teeth
can erupt and be
used.
If the jaws are not
long enough by
age 16, wisdom
teeth stay trapped
(impacted) inside
the bone.
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Problems Caused
by Impacted Wisdom Teeth
Gum infected
Impacted wisdom
teeth can cause:
(A) Infection of the
gums over or
around them
(B) Infection in
the bone
around them
(C)
Destruction
of the next
tooth
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Problems Caused
by Impacted Wisdom Teeth
(D) Destruction of the
bone by formation of
a cyst
Looking down on
the biting surfaces
of the lower teeth
(E) Other teeth
pushed out of line
(arrows)
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Removal of Boney Impaction
• Handpieces and surgical burs required to
gain access
(A)
(B)
(D)
(C)
(E)
Irrigation
syringe
(F)
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Oral Surgery Procedures
• Biopsy procedures
– Total or partial removal of tissue from
suspicious areas for microscopic
examination and diagnosis
– Three types
• Excisional, incisional, exfoliative
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Incisional Biopsy
Top view
• Removal of small
section of lesion and
a small border of
normal tissue
• Used when lesions
are larger than 1 cm
Normal tissue
Lesion
Incision
Side view
Lesion
Normal tissue
Incision
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Excisional Biopsy
Top view
• Complete removal of
lesion including
border of normal
tissue
• Performed on smaller
lesions
Normal tissue
Lesion
Incision
Side view
Lesion
Incision
Normal tissue
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Exfoliative Cytology
• Smear biopsy
– Nonsurgical procedure
• Removal of a layer of cells from surface
of lesion
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Exfoliative Cytology
• Cells spread on a glass slab for
microscopic examination
• Often done in addition to other forms of
biopsies
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Oral Surgery Procedures
• Dental implant surgery
– Method for replacing missing teeth
– Screw or framework placed into jaw bone
– Tooth shaped restoration is screwed into
framework
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Oral Surgery Procedures
• Treatment sequence for implants
– Patient meets with restorative dentist
– Referral to oral surgeon
– Diagnostic consultation
– Decision on treatment plan
– Stages of treatment depend on technique
used
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Dental Implant
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Oral Surgery Procedures
• Types of implants
– Subperiosteal
– Endosteal
– Mini Implant
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Postoperative Patient Care
• Given verbally and written
• Lists expectations, what to do, and what
to avoid
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Postsurgical Complications
• Alveolar osteitis (dry socket)
– Cause is loss of blood clot from extraction
site
– May be the result of insufficient blood
supply, infection, or trauma
– Occurs three to five days following surgery
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Treatment of Dry Socket
• Irrigate tissue with warm saline solution
• Pack extraction site with iodoform
gauze
• Rx: analgesic and antibiotics
• Procedure repeated every one to two
days
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Treatment for Alveolitis
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Temporomandibular Joint Disease
• Muscles, bones, and joints of mandible
fail to function properly
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Temporomandibular Joint Disease
• Signs and Symptoms
– Pain around ear
– Tenderness of the masticatory muscles
– Popping and clicking noise when opening
and closing the mouth
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Temporomandibular Joint Disease
• Signs and Symptoms
– Crepitus or tinnitus
– Limited movement of mandible
– Trismus
– Headaches or neckaches
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Temporomandibular Joint Disease
• Diagnosing
– Dental and medical history
– Examination of joint
– Radiographs
– Dental study casts
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Temporomandibular Joint Disease
• Treatment
– Application of ice
and heat
– Learning to rest jaw
– Medications
– Stress management
– Physical therapy
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Occlusal splinting
Orthodontics
Steroid injections
Arthrocentesis
Arthroscopic surgery
Open joint surgery
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Hospital Dentistry
• Trauma
• High risk patients
• Patients with mental or physical
disabilities
• Extensive surgeries
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Advanced Chairside Functions
• Suture removal
– Hold tissue in original position
– Prepare patient and equipment
– Examine site
– Consult with dentist
– Remove with care to avoid trauma or
infection
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Advanced Chairside Functions
• Types of Sutures
– Simple
– Continuous simple
– Sling
– Continuous sling
– Mattress
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