Principles of Dentoalveolar Extractions

SETH DELPACHITRA, M.B.B.S.(Hons) B.D.S. is qualified in both medicine and dentistry. He is an experienced dentoalveolar surgeon and holds an academic appointment as Clinical Demonstrator at University of Melbourne, Australia.ANTON SKLAVOS, B.D.S. is a dentist with a special interest in dentoalveolar surgery and holds an academic appointment as Clinical Demonstrator at University of Melbourne, Australia.RICKY KUMAR, M.B.Ch.B. B.D.S. currently holds public appointments at the Royal Melbourne Hospital, Royal Children's Hospital, Royal Dental Hospital of Melbourne and Monash Health. He is a supervisor of surgical training at the Royal Dental Hospital and Dandenong Hospital and is a guest lecturer at University of Melbourne, Australia.

• Foreword ixAbout the Companion Website xi1 Principles of Surgery 11.1 Wound Healing 21.1.1 Haemostasis 21.1.2 Inflammatory Phase 41.1.3 Proliferative Phase 41.1.4 Remodelling and Resolution 41.2 Patient Assessment 41.3 Radiographic Assessment 51.4 Informed Consent 71.5 Anaesthesia 71.6 Preparation of Equipment 91.7 The Surgeon’s Preoperative Checklist 101.8 Operative Note 122 Local Anaesthesia 152.1 Principles of Anaesthesia 162.2 Mechanism of Action 162.3 Common Local Anaesthetic Preparations 182.4 Side Effects and Toxicity 192.4.1 Local Risks 192.4.2 Systemic Risks 192.5 Basic Oral Anaesthesia Techniques 192.5.1 Buccal Infiltration Anaesthetic 202.5.2 Mandibular Teeth 212.5.2.1 Conventional ‘Open-Mouth’ Technique 222.5.2.2 Akinosi ‘Closed-Mouth’ Technique 232.5.2.3 Gow–Gates Technique 232.5.2.4 Mandibular Long Buccal Block 242.5.2.5 Mental Nerve Block 252.5.3 Maxillary Teeth 262.5.3.1 Greater Palatine Block 272.5.3.2 Palatal Infiltration 282.5.3.3 Nasopalatine Nerve Block 292.5.3.4 Posterior Superior Alveolar Nerve Block 292.6 Adjunct Methods of Local Anaesthesia 302.6.1 Intraligamentary Injection 302.6.2 Intrapulpal Injection 312.7 Troubleshooting 323 Basic Surgical Instruments 353.1 Retractors 353.2 Elevators, Luxators, and Periotomes 373.3 Dental Extraction Forceps 403.4 Ancillary Soft Tissue Instruments 443.5 Suturing Instruments 473.6 Surgical Suction 493.7 Surgical Handpiece and Bur 503.8 Surgical Irrigation Systems 513.9 Mouth Props 534 Simple Extraction Techniques 554.1 Maxillary Incisors 554.2 Maxillary Canines 574.3 Maxillary Premolars 584.4 Maxillary First and Second Molars 594.5 Mandibular Incisors 614.6 Mandibular Canines and Premolars 624.7 Mandibular Molars 645 Surgical Extraction Techniques 675.1 General Principles of Surgical Extraction 685.2 Practical Aspects of Surgical Extraction 695.3 Common Soft Tissue Flaps for Dental Extraction 705.4 Bone Removal 735.5 Tooth Sectioning 745.6 Cleanup and Closure 756 Intraoperative Complications 796.1 Lip Burns and Lacerations 796.2 Damage to Adjacent Teeth or Restorations 806.3 Mandible Fracture 816.4 Tooth Aspiration or Ingestion 816.5 Instrument Fracture 826.6 Intraoperative Bleeding 826.7 Oroantral Communication 836.8 Dentoalveolar Fracture 847 Third Molar Surgery 877.1 Treatment Planning of Impacted Third Molars 877.2 Difficulty Assessment and Preoperative Workup 897.3 Radiographic Assessment of Inferior Alveolar Nerve Risk 917.4 Surgical Approach to Third Molars 917.4.1 Maxillary Third Molars 917.4.1.1 Erupted 917.4.1.2 Unerupted/Partially Erupted 927.4.2 Mandibular Third Molars 937.4.2.1 Mesioangular 937.4.2.2 Distoangular/Vertical 937.4.2.3 Horizontal 957.4.2.4 Full Bony Impaction (Early Root Development) 997.4.2.5 Buccolingual/Other Impactions 998 Management of the Medically Compromised Patient 1018.1 Ischaemic Cardiovascular Disease 1028.2 Patients with a History of Infective Endocarditis 1028.3 Hypertension 1038.4 Medication-Related Osteonecrosis of the Jaws 1038.5 Diabetes Mellitus 1078.6 Increased Bleeding Risk 1088.6.1 Bleeding Diatheses 1088.6.2 Medications 1098.6.2.1 Management of Antiplatelet Agents Prior to Dentoalveolar Surgery 1108.6.2.2 Management of Patients Taking Warfarin Prior to Dentoalveolar Surgery 1108.6.2.3 Management of Patients Taking Direct Anticoagulant Agents Prior to Dentoalveolar Surgery 1108.7 Adrenal Suppression 1108.8 The Irradiated Patient 1128.8.1 Management of the Patient with a History of Head and Neck Radiotherapy 1138.9 Hepatic or Renal Impairment 1138.10 Pregnancy and Lactation 1149 Postoperative Care and Late Complications 1159.1 Immediate Postoperative Period 1159.2 Postoperative Instructions 1169.3 Postoperative Medications 1169.4 24-Hour On-Call Service and Tertiary Hospital Referral 1179.5 Management of Late Complications 1179.5.1 Alveolar Osteitis 1179.5.2 Acute Facial Abscess 1189.5.3 Postoperative Haemorrhage 1199.5.4 Temporomandibular Joint Disorder 1199.5.5 Epulis Granulomatosa 1209.5.6 Nerve Injury 121Appendix A Special Cases: Common Indications for Surgical Extraction 123Appendix B Extraction of Deciduous Teeth 127Bibliography 133Index 135