Oral and maxillofacial surgery II. completed with control questions Dental speciality that deals with diagnosis and surgical treatment of diseases, injuries and deformities of the face and jaws. Surgical procedures Routine extractions Multiple routine extractions Surgical extractions Third molar extractions Exposure of impacted cuspid Frenectomy Gingivectomy, osteoplastic Biopsy Anaesthesia • Dentist is responsible for providing the patient with comfortable dental treatment! Pain Sensory and emotional experience associated with actual or potentional tissue damage. Pain and anaesthesia Pain occurs when pain receptors or nerve endings transmit impulses to the central nervous system. Anaesthesia eliminates the pain experience by interrupting the transmitted impulse. Anaesthesia • Absence of normal sensation, esp sensitivity to pain. Anaesthesia Topical: an application of substance to the tissues that creates loss of feeling on the surface. Local: placement of a substance by injection at a site that creates a loss of sensation to one part of the body Anaesthesia Conscious sedation: an anaesthetic agent used to produce a sedative effect while patient remains conscious. (Sometimes inhalation) General anaesthesia: an anaesthetic agent creates a state od unconsciouness with absence of sensation of entire body. Local anaesthesia The drug is delivered > Locally (on the surface of oral mucosa) -topical anaesthesia. >By injection Local anaesthesia Topical Liquid or spray Lidocain, Xylocain. Local anaesthesia By injection > Infiltration > Nerve block > Periodontal ligament injection Infiltration anaesthesia Depositing anaesthesia into tissues. Tte solution is absorbedby many terminal nerve endings. Single tooth extraction or other tissue surgery. Nerve block anaesthesia Depositing anaesthesia near the nerv. Mandibular arch (n. alveolais inferior) Foramen infraorbitale Foramen incisivum Foramen palatinum majus Tuber maxillae Local anaesthesia By injection > Infiltration > Nerve block > Periodontal ligament injection Instrumentarium Syringes Needels Extracting teeth (exodontia) Reasons: > Caries >Trauma > Periodontitis > Endodontic reasons >Retention, semiretention if it causes >Inflammation and pain Principles of extraction Interruption, rupture of periodontal Ligaments and extraction - the tooth is pulled out. Anaesthesia Topical By injection - Infiltration - Nerve block Nerve block anaesthesia > Foramen mandibulare > Foramen mentale > Foramen palatinum majus > Foramen incisivum > Foramen infraorbitale Nerve block N. alveolaris inferior Foramen mandibulare anaesthesia Nerve block anaesthesia Nervus alveolaris inferior In sulcus colli mandibulae Nerve block anaesthesia N. alveolaris inferior Indirect Direct Nerve blöd N. alveolaris inferior Indirect Put the forefinger on the occlusal surface Rotate inside (nail inside) 1 cm up occlusal surface the puncture is situated anaesthesia Nerve blöd N. alveolaris inferior Indirect 1. The needle goes behind the crista temporalis, the syringe on the opposite canine anaesthesia Nerve blöd N. alveolares inferior Indirect 2. The needle goes deeper in the contact with the bone The syringe goes mesial anaesthesia Nerve blöd N. alveolares inferior Indirect 3. The contact with bone Is lost, the syringe goes back anaesthesia Nerve block anaesthesia N. alveolares inferior Direct Put the forefinger on the occlusal surface Rotate inside (nail inside) 1,5 cm deep Nerve block N. alveolaris inferior Area: Molars Premolars Tongue anaesthesia Nerve block anaesthesia N. alveolaris inferior Direct > The puncture at the same place > The syringe on opposite premolars > The puncture goes into the small pink depression medial from crista temporalis and lateral from plica prerygomandibularis 1,5 cm deep Molars, premooars, mucosa, skin, bone Nerve block anaesthesia N. mentalis F. mentale The puncture is situated behind he distal surface of 2nd premolar The needle goes between roots of premolars Nerve block anaesthesia N. mentalis F. mentale The puncture is situated behind the distal surface of 2nd premolar The needle goes between roots of premolars, From up to down Forward and mesial Premolars and canine, mucosa, skin. Nerve block anaesthesia Foramen palatinum majus Distal surface of I.st molar The puncture is 0,5-1 cm before from behind forward Half of palate Nerve block Foramen incisivum Nervus incisivus Papilla incisiva Next tu papilla, mesial direction ; anaesthesia Nerve block Raise the lip, the index finger on f. Infraorbitale (1cm below the border of the orbit) The needle from down tu anaesthesia up Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation Suture ■ Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation iuture A e=i B BL1D8N 9 BL109N 10 QLIION 11 BL111 N IZ blii2n 3 BL113N 4 BL11-ÍN 5 BL115N e BL 116 N Fíg. Á ™= S SL 208 N 9 BL209N 10 BL210N ti BU 211 N 12 BL212N 13 BL 213 N 14 BL214N )5 BL 215 N 16 BL216N Ba. 1 —=r 1 BL SOI N 2 BL602N 3 BL603N 4 BL604N S BL605N E F.g. • 0 BL 320 N 1 BL321N 2 BL322N 3 BL323N 4 BL32J N 5 BL 325 N C f'll Fig. • 0 BL540N 1 BL541 N 2 BI £42 N 3 BL 543 N í (5L544N S 1JLÍ45N B HL 546 N 7 EL 547 N e BI '.-WiN Suture Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation Tweezers - tissue forceps -anatomical -surgical 90 Control questions • What is the principle of the local anaesthesia? • What kinds of local anaesthesia do you know? • Describe the principle of the nerve block anaesthesia, which konds do you know? Control questions Describe the infiltration anaesthesia. Describe all techniques used for the nerve block anaesthesia including the affected area. Which instruments and material are necessary for the suture? Control questions • Which kinds of the suture do you recognize? • Practice them. Sutura Surgical knot - single suture Suture Continuus suture Matress suture- Continous suture jtu re Suture • Well adapted borders • Without tension • Needle goes perpendiculary ^D T f rv^ C5fer_ 21 L- ^_T-z.l-eriJ -v njrce (a. — Íi5 ä popis ■v textu Control questions • What is the principle of the local anaesthesia? • What kinds of local anaesthesia do you know? • Describe the principle of the nerve block anaesthesia, which konds do you know? Control questions Describe the infiltration anaesthesia. Describe all techniques used for the nerve block anaesthesia including the affected area. Which instruments and material are necessary for the suture? Control questions • Which kinds of the suture do you recognize? • Practice them.