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    Oral Surgery in Pediatric Dentistry

    Uploaded by

    Ravi Gowda
    This document provides information on oral surgery procedures for pediatric dental patients. It discusses hospital admission procedures, exodontia techniques, differences between primary and permanent teeth extractions, complications and post-operative care. Specific techniques are described for extracting primary teeth in different areas of the mouth. Soft tissue abnormalities like mucoceles, ranulas and frenum attachments are also reviewed with treatment methods like excision and marsupialization.

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    © All Rights Reserved
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    Oral Surgery in Pediatric Dentistry

    Uploaded by

    Ravi Gowda
    751 views54 pages
    This document provides information on oral surgery procedures for pediatric dental patients. It discusses hospital admission procedures, exodontia techniques, differences between primary and permanent teeth extractions, complications and post-operative care. Specific techniques are described for extracting primary teeth in different areas of the mouth. Soft tissue abnormalities like mucoceles, ranulas and frenum attachments are also reviewed with treatment methods like excision and marsupialization.

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    oral surgery techniques in pediatric dentistry

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    This document provides information on oral surgery procedures for pediatric dental patients. It discusses hospital admission procedures, exodontia techniques, differences between primary and permanent teeth extractions, complications and post-operative care. Specific techniques are described for extracting primary teeth in different areas of the mouth. Soft tissue abnormalities like mucoceles, ranulas and frenum attachments are also reviewed with treatment methods like excision and marsupialization.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    751 views54 pages

    Oral Surgery in Pediatric Dentistry

    Uploaded by

    Ravi Gowda
    This document provides information on oral surgery procedures for pediatric dental patients. It discusses hospital admission procedures, exodontia techniques, differences between primary and permanent teeth extractions, complications and post-operative care. Specific techniques are described for extracting primary teeth in different areas of the mouth. Soft tissue abnormalities like mucoceles, ranulas and frenum attachments are also reviewed with treatment methods like excision and marsupialization.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 54
    At a glance
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    The document discusses procedures for oral surgery in pediatric dentistry including extraction techniques and considerations for primary vs permanent teeth.

    Primary teeth have smaller crowns and roots, bulbous crowns, more splayed roots with the furcation positioned more cervically.

    Modifications for primary teeth extractions include using different types of forceps that can spread roots more and avoiding blind investigations of sockets due to more cervical furcation positions.

    1

    ORAL SURGERY IN
    PEDIATRIC DENTISTRY

    HOSPITAL PROCEDURE FOR


    DENTAL PATIENT
    Admission orders
    Admission note
    Chief complaint
    Present illness
    Past medical history
    Physical examination

    Medical check up
    Operating room
    Scrub technique
    Drapes
    3

    Post operative orders


    Record BP, pulse, respiration every 15 min for
    1 hour then every 30 min
    Suction to bedside
    Semi- fowler position
    Antibiotics and Analgesia
    Sedative
    Diet liquids after nausea has passed
    Post operative care
    Short procedure: discharged same day
    Long : every hour after operation

    EXODONTIA
    Def: Is the painless removal of the whole tooth,
    or tooth-root, with minimal trauma to the
    investing tissue, so that the wound heals
    uneventfully and no postoperative prosthetic
    problem is created.

    DIFFERENCES BETWEEN PRIMARY


    AND PERMANENT TEETH
    Size :smaller
    Roots are smaller they do form a
    proportionately greater part of the tooth
    Shape : crowns are bulbous
    Roots are more splayed
    Furcation is positioned more cervically than in
    the corresponding permanent teeth
    Physiology:- roots resorb physiologically
    Support: alveolus is much more elastic in the
    younger patient
    6

    MODIFICATIONS :Type of forceps


    Wide splaying of roots- more expansion of the socket
    Cervical position of furcation:

    cowhorn forceps

    Blind investigation of primary socket should not be


    performed
    Blind investigation of distal root socket of first
    permanent molar- unintentional elevation of second
    molar
    Curettes not used to remove periapical granulomas
    7

    INDICATIONS
    Hopeless carious and not restorable
    Decay reaches bifurcation
    Interfere with normal eruption..
    Improper root resorption
    Causing deflection of erupting tooth- lower Ant
    Irregular resorption
    Sinus opening
    R/F : periapical pathosis poor prognosis
    Root fracture- subsequent infection
    Supernumerary teeth
    8

    CONTRAINDICATIONSAcute infections- stomatitis, Vincents infection


    Herpetic stomatitis
    Acute dentoalveolar abscess with cellulitis
    Dentoalveolar abscess
    Malignancy
    Tissue receive radiation therapy

    Contraindications

    Acute systemic infections-

    resistance

    Blood dyscrasias
    Rheumatic heart disease, CHD, Renal diseases
    Diabetes mellitus

    Absolute contraindications
    Haemangioma
    Arterio venous fistula

    10

    PREOPERATIVE PREPARATION:PARENT & CHILD

    Parent

    Parent consent.
    Reassure that post- operative pain usually does not
    occur
    Not to discuss with child

    Child
    8 to 10 years old 4 to 7 days in advance
    Younger child: on the day appointment
    Armamentarium- kept behind the chair
    Never hold the needle in front of the child
    Difference pressure and pain
    Explain sensation of numbness

    11

    TECHNIQUE FOR REMOVAL OF


    PRIMARY TEETH
    Position of operator
    Maxillary right and left quadrant
    mandibular left quadrant :
    -operator in front and to the side
    of the patient
    Mandibular right quadrant:
    -operator in back and to the
    side of patient

    Position of child
    Upper jaw no more than 450
    Lower jaw parallel to floor
    12

    ARMAMENTARIUM
    BRITISH SYSTEM

    AMERICAN SYSTEM

    Usually employs a
    standup
    posture
    Force applied via
    whole forearm

    Dentist usually is
    seated
    Force is delivered
    wrist action

    13

    ARMAMENTARIUM
    #150 and 151- Universal forceps
    #17- Mandibular perm molar
    #53R and 53L- Maxillary molars
    #23 cowhorn forceps: Mand. Molar with distinct
    bifurcation

    14

    TECHNIQUE FOR REMOVAL OF


    PRIMARY TEETH
    Maxillary molar extraction
    Maxillary anterior teeth
    Mandibular molar extraction
    Extraction of Mandibular anterior teeth
    Management of fractured primary tooth roots

    15

    Maxillary molar extraction


    Palatal movement is initiated first , b/L movement

    16

    Maxillary anterior teeth


    Rotational movement

    17

    Mandibular molar extraction


    Apical- labial in sustained action- clockwise
    motion

    18

    Extraction of Mandibular anterior


    teeth
    Apical- labial in sustained action- clockwise
    motion

    19

    SPECIAL CONSIDERATION

    20

    SPECIAL CONSIDERATION

    21

    POST OPERATIVE COMPLICATIONS


    Dry socket rare in the children
    Aspiration or swallowing of the teeth or rootControlled pressure on the handle of forceps
    4 by 4 inch sponge curtain behind the tooth to
    xtd
    Absence of cough is not proof

    22

    COMPLICATED EXTRACTIONS.
    Anatomical abnormalities in the roots and
    alveolar structures, breakdown of crowns,
    ankylosis, and proximity to successor teeth

    23

    POST OPERATIVE
    INSTRUCTIONS

    For the child

    For the parent

    Child should not dismissed


    until a blood clot has
    formed

    A light meal with no hard


    food should be recommended

    Hold the small cotton roll


    half an hour

    Analgesia and Antibiotics

    for the day


    Blood can appear on the

    Not to bite his lips and


    tongue

    pillow the next day

    Do not disturb the


    extracted site

    symptoms develop

    Call office if undue

    Do not rinse mouth for 24


    hours after extraction
    Do not use straws for that
    day

    24

    ODONTOGENIC INFECTION
    Pulpitis
    Acute

    chronic

    Apical periodontitis

    Periapical Granuloma

    Periapical Abcess
    Osteomyelitis

    Periapical cyst

    Periostitis
    Cellulitis

    Abscess

    25

    ODONTOGENIC INFECTIONS:Most common- caries leading to pulpal exposure


    Anatomical considerations:
    Wide marrow spaces
    Infections involve buds of permanent tooth(Turners hypoplasia)
    Reach the growth site condylar region
    May produce cellulitis and abscess formation
    Depending on age and stage development of
    root
    26

    Odontogenic infections:Bifurcational or trifurcational infection often


    precedes the periapical involvement
    Differences in progress of infection (cuspid region
    & molar region)
    Facial planes are important anatomic pathways
    for the extension and spread of infection
    Cellulitis and abscess formation may be quite
    exaggerated cavernous sinus thrombosis, brain
    abscess,
    septcemia, airway obstruction and mediastinitis
    27

    ODONTOGENIC INFECTIONS:Subperiosteal abscess- hard, circumcumscibed


    swelling, that can be palpated either in the
    mucobuccal fold from external surface
    Spread through alveolar spaces- gravity and
    anatomical spaces
    Important to recognize the pitting and fluctuation
    of abscess progressing towards the skin

    28

    Manifestation & Treatment


    Fever especially high in small children- with rapid
    pulse and rapid but shallow respiration.
    General malaise, nausea and vomiting

    Treatment :
    Elimination of cause
    Incision and Drainage
    Antimicrobial therapy
    29

    Ludwigs angina
    Life threatening infection of sublingual
    submental and submandibular spaces
    Etiology : odontogenic infections, lacerations,
    #mandible, foreign bodies and
    immunocompromised statusC/F: Pan cervical brawny induration usually
    accompanied by fewer, malaise, and leukocytosis
    Mandible will be fixed with mouth half open,
    tongue is elevated along with floor of mouth,
    drooling due to inability to swallow.
    30

    Ludwigs Angina- Treatment


    Support of airway endotracheal intubation and
    tracheostomy
    Incision and drainage:
    Purulent exudate is small
    Decompression: cervical incision from angle of
    mandible to other side
    Thru this submandibular and sublingual spaces
    connected with Penrose drains
    Antibiotic therapy
    31

    Soft Tissue Abnormalities


    Prominent frenum
    Maxillary labial frenum
    Mandibular labial frenum
    Lingual frenum-tongue tie
    Mucocele
    Ranula
    Irritation Fibroma and papilloma or warts
    Eruption cyst and natal teeth

    32

    MAXILLARY LABIAL FRENUM


    Labial frenum: band of fibroelastic tissue that
    originates in the lip and inserts in to the attached
    gingiva at the middle of the maxilla.

    Prominent : inserting on the crest of the


    alveolar ridge and incisive papillaRelocates apically with normal vertical growth of
    alveolus

    33

    Treatment- Frenectomy
    Timing : If diastema has failed to close , after
    the six maxillary anterior teeth
    Standard Frenectomy
    Laser Frenectomy

    34

    Standard Frenectomy

    Bell shaped defect

    35

    Laser Frenectomy
    Using CO2 laser
    Advantages :
    Less time, less swelling and less discomfort
    No suturing required

    Safety precautions:
    Room closed with large sign warning
    O2 and inflammable gases
    Protective eye wear
    Isolated field with protection of adjacent
    structures
    36

    MANDIBULAR LABIAL FREMUM


    Attaches high on the interdental papilla btw the
    lower incisors
    Results : trapping of food and plaque
    accumulation

    Techniques
    Excision
    Excision and Z- Plasty closure
    Laser Excision
    37

    Excision

    38

    Excision and Z- Plasty closure

    39

    LINGUAL FRENUM TONGUE


    TIE
    Attached high on the lingual alveolar ridgecommonly seen in infant
    Becomes less prominent during first 2 to 5 years
    Children with mixed dentition complains of
    difficulty moving tongue and speech
    Technique :
    Excision and V- Y closure
    Excision and Z- plasty
    Laser excision

    40

    Excision and V- Y closure


    Milder form of tongue tie
    Straight line defect V

    41

    Excision and Z- plasty


    Excellent procedure- excision of band with single
    or multiple Z- plasties to lengthen the ventral
    surface of tongue
    Improves tongue mobility without endangering
    submandibular duct

    42

    Mucocele
    Most common benign salivary gland tumor
    Mucous retention cyst- pseudocyst
    Common location- lower lip
    Pathogenesis extravasation of saliva from minor
    salivary gland
    Lesion not painful, clear bluish or pale and
    fibrotic.

    Treatment: surgical excision

    43

    Ranula
    Latin word: Ranula pipiens
    Retention cyst appearing in infants and toddlers
    congenital- as a result of dilatation of sublingual or
    submaxillary gland ducts in the floor of the mouth
    Older children post traumatic
    Located in the sublingual space between the
    mylohyoid muscle and lingual mucosa
    Extends in to submental or submandibular space
    by perforating through the mylohyoid musclePlunging Ranula
    44

    Ranula- Marsupialization
    Before marsupialization : mature (shows distinct
    fibrous lining)
    Roof of cyst excised
    cavity drained
    mature lining sutured to raw edge of the mucosa
    Important to have the submandibular duct
    identified and cannulated prevents injury and
    subsequent obstruction

    45

    Marsupialization

    46

    Hard Tissue Abnormalities


    Tumors

    Odontoma
    Most common odontogenic tumor
    Asymptomatic, small and slow growing have
    low recurrenceafter curettage
    well encapsulated - Enucleated

    Ameloblastoma fibroma
    benign neoplasm associate with erupted teeth
    Most common in children than adults
    Treatment is enucleation and curettage
    47

    Hard Tissue Abnormalities


    Non odontogenic cyst
    Hemorrhagic bone cyst
    Most common traumatic cyst
    Asymptomatic radiolucent lesion of
    mandible in premolar region
    Treatment exploration and curettage
    Aneurysmal bone cyst
    Common in children than adults
    Females more common
    R/F: soap bubble appearance
    Treatment : curettage
    48

    Treatment modalities
    Enucleation and/
    or curettage

    Marginal / partial
    resection

    Complete
    resection

    Odontogenic tumors
    Odontoma
    Ameloblastic
    fibroma
    AOT

    Ameloblastoma
    CEOT
    Ameloblastic
    odontoma

    Malignant
    ameloblastoma

    Fibrosseous lesions
    Central ossifying

    sarcoma

    fibroma
    Fibrous dysplasia
    Cherubism
    Aneurysmal bone
    cyst
    Osteoma
    Others:
    Hemangioma

    Hemangioma

    Lymphomas
    Salivary gland

    49

    Enucleation
    Process by which total removal of a cystic lesion is
    achieved

    Def : it means shelling out of entire cystic lesion


    without rupture

    Indications :
    Safely removed without unduly sacrificing adjacent
    structures

    Advantages:
    Pathologic examination of the entire cyst
    patient need not worry about marsupial cavity constant irrigations
    50

    Marsupialization
    Decompression/ partsh operation all refers to creating a
    surgical widow in the wall of the cyst, evacuating the
    contents of the cyst, and maintaining continuity between
    the cyst and the oral cavity, max sinus, or nasal cavity.

    Only portion of cyst that is removed

    Intracystic pressure
    Promotes shrinkage of the cyst and bone fill
    51

    Marsupialization

    Indications:-

    Amount of tissue injury


    Proximity to vital structures- Oronasal fistula

    Surgical accessAll portion of cyst is difficult- recurrence

    Assistance in eruption of teeth


    Tooth dentigerous cyst

    Extent of surgery
    Unhealthy and debilitated pt

    Size of cyst
    Risk of jaw#
    52

    Marsupialization

    Advantages:
    Simple procedure to perform
    Spare vital structures from damage

    Disadvantages:
    Pathologic tissue is left insitu
    Patient inconvenience
    Kept clean to prevent infection
    Several times irrigation

    53

    54

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