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Oral Surgery (Injection Techniques (Buccal Infiltration (A/M/P- Superior…
Oral Surgery
Injection Techniques
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Intra-Ligamental
Pulpal anaesthesia for one isolated tooth, avoids nerve block
Gow-Gates
More proximal administration, Lower risk of intravascular injection, Entire mandibular anesthesia, good trouble shooting
Long Buccal Block
Long buccal n. crosses the
anterior border of the mandibular
ramus at a level just above the
occlusal plane of the last molar
tooth
Exodontia Technique
Perioperative
Hx & Ex - notably radiography: Crown, Surrounding structures, Roots
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Postoperative
Squeeze socket (only if not performing implants) Gauze Packs
Post-Op Instructions w/ Review Appt.
- Haemostasis, pain control, wound care, OHI, emergency contacts
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Local Anesthetics
L.A Agents
Lignocaine
(Amide)
- Metabolised in the Liver, excreted by the Kidneys
- Topical or injectable (@ 2%)
- Onset within 2-3mins with a halflife of 90mins
- Plain or with Adrenaline(vasoconstrictor)
Bupivacaine
(Amide)
- metabolized in the liver and excreted by the kidneys
- 4x more potent than Lignocaine (0.25 - 0.5% conc.)
- onset and duration is longer
- Issues with cardiac toxicity
Mepivacaine
(Amide)
- Metabolised in the liver and excreted by the kidneys
- Longer-acting and better absorbed than Lignocaine
- Less vasodilation than Lignocaine
- As 2% with 1:100,000 adrenaline or 3% plain solution
Prilocaine
(Amide)
- Metabolised in the Liver/Lungs, and excreted in the urine
- 40% less toxic than Lignocaine
- 3% with Felypressin or 4% plain solution
- Contraindication as metabolites indicated for formation of methemoglobin (so cannot be used for pregnant women due to potential fetal hypoxia)
Articaine
(Amide)
- metabolized in the Liver/lungs and plasma esterases, excreted by kidneys
- reduced halflife therefore used in 4% concentrations
- Longer lasting pulpal/soft tissue anesthesia
- Many contraindications
Vasoconstrictors
- To counteract the vasodilator effects of the L.A. agent
- helps with hemostasis (reduces blood loss)
- retains the L.A agent to site if injection (improves duration)
- reduces the need for a higher % conc, of LA agent
-Delays & slows systematic absorption
Adrenaline/Epinephrine
(Catecholamine)
- acts on α/β adrenergic receptors in blood vessels
- maximum dose is 0.22mg or 1:100,000
- Duration is 60-90mins in hard tissues & 3-4hrs in soft tissues
Felypressin/Octapressin
(Non-catecholamine)
- Synthetic analogue of vasopressin or ADH
- vasoconstrictor of venules
- Used adjuctive with Prilocaine
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Exodontia Equipment
Forceps
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Mandibular Exo
Universals - incisors, canines, premolars
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Curettes
Used for severing pericoronal gingival attachments =
- aids in forceps adaptation
- reduces gingival injury
- tests adequacy of L.A
Elevator/Luxators
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Warwick-James Elevators
Left, Right,(wheel/axle) or Straight(wedge)
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Complications
Postoperative
- Pain
- Bleeding
- Swelling
- Trismus
- Soft Tissue Infections
- Dry socket (Localized Osteitis)
- Delayed healing
- Foreign Body / Infection
- OAC
- Acute Osteomyelitis
- Nerve Damage
- Chronic Osteomyelitis
- Osteonecrosis
- Chronic pain
- Nerve damage
Perioperative
- LA failure
- wrong no. tooth /root
- Thermal injury
- Injury to adjacent teeth / soft tissues
- Hemorrhage
- TMJ dislocation
- OAC
- Bronchospasm, Collapse Lung, Aspiration
- Displacing tooth / root into tissue spaces / antrum
- Swallowing / aspirating tooth / root
- Damage to nerves
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