2012-3-20
Osseous Surgery
Xudong Wang,DDS,MD
Associate Professor
Dept,Oral and Maxillofacial Surgery
Ninth People’s Hospital
Shanghai,P.R,China 200011
xudongwang70@163.com
2012-3-20
Osseous Preprosthetic Surgery
? Alveoloplasty (exostosis,undercut,knife-edge ridge,etc )
? Torus(tori) removal (palatal/mandibular)
? Maxillary/ mandibular augmentation
(autologous bone graft,lyophilized cartilage/bone,
hydroxyapatite,guided tissue regeneration memberane,
tissue engineered bone)
? Correction of abnormal ridge relationship
(orthognathic surgery)
2012-3-20
Alveoloplasty
Anesthesia
(local infiltration)
Incision &
Mucoperiosteal flap reflection
(scalpel & periosteal elevator)
Tips
? exposure & visualization
? blood supply
? rest on intact bone
? full-thinckness
? avoid injury to vital structures
2012-3-20
Bone removal
(chisel&mallet / rongeur)
side-cutting unibevel
Bone smooth
(bone file)
Tips
? side-cutting for rongeur
? unibevel chisel
? preserve bone AMAP
?,pull” smoothing for file
Alveoplasty-cont’d
2012-3-20
Suturing (Interrupted/continuous/margin/matress)
Alveoplasty-cont’d
Post-op care
? Mouth rinse
? Suture removing
(1w post-op)
?Prosthetic restoration
(2w post-op)
2012-3-20
2012-3-20
Removal of mandibular tori
? Location
? Anesthsia
? Incision
2012-3-20
Remove bone with chisel Undermine the tori with fissure bur
Lingual mucoperiosteal flap reflection
2012-3-20
Removal of palatal torus
Indication
? Full/partial denture restoration
? Ulcerated of mucosa
? Interfered with speech
Anesthesia
? GP block
? NP block
2012-3-20
Incision Flap reflection
Segmenting w/ fissure bur
2012-3-20
Remove bone stripes smoothing
2012-3-20
Transparent surgical stent w/ iodoform gauze
2y post-op
2012-3-20
Surgery for
oroantral communication
Buccal flap
Palatal flap
? tooth extraction
? periapical lesions
? maxillary cysts surgery
Etiology
Closure of oroantral fistulas/ communication
(Caldwell-Luc procedure)
Bony & soft tissue
defects
2012-3-20
Oroantral communication
31y,female,tooth extraction for 4m
1m post-extraction,
dull pain and pressive sensitive
Water’s view
Shadowing
--sinusitis
2012-3-20
Closure of oroantral fistulas/ communication
Excision of fistula
Buccal flap
reflection
Buccal flap advancement
2012-3-20
Extending the mucoperiosteal flap
C:internal periosteal
releasing incision
Buccal flap advancement
2012-3-20
Buccal flap advancement
Smooth the bony edge
2012-3-20
Buccal flap advancement
Trim the excess tissue Suturing with matress suture
2012-3-20
Buccal flap advancement
? Matress suture
? Interrupted suture
2012-3-20
Buccal flap advancement
3m post-op
2012-3-20
Palatal flap advancement
Flap design Palpation of
bony adge
2012-3-20
Palatal flap advancement
Excising the fistula and reflect the flap
2012-3-20
Palatal flap advancement
Adapting and suturing the flap
2012-3-20
Palatal flap advancement
Iodoform gauze strip
covering the exposed
bone
Surgical stent fixed with screw
2012-3-20
Palatal flap advancement
Post-op follow-up
2012-3-20
Post-op care for
oroantral communication
Nasal precautions(10-14d)
? opening mouth wide while sneezing
? not sucking on a straw / cigarette
? avoid nose blowing
? others provide pressure changes
between the nasal passage and oral cavity
Medicine administration(7-10d)
? antibiotics
? antihistamine
? decongestant nasal spray
Wearing surgical stent (7-10d)
Suture removal (10-14d)
2012-3-20
DENTIST
General dentist
(practitioner)
Specialist
Endodontist
Oral (& maxillofacial) surgeon
Pediatric dentist
Orthodontist
Periodontist
Prosthodontist
Stomatologist
Oral hygienist
School of Dentistry
School of Stomatology
2012-3-20
1
2
3
4
5
6
7
8
9
10
Years of Study DDS PhD (from BA)
PhD
DDS/PhD
(Concurrent Study)
DDS and PhD
Residency
(plus MS)
DDS
PhD
MS/OB
MPH
MBA
Other MS
DDS and MS
TICR
Residency
PhD
PhD
DDS/MS (Oral Biology)
(Concurrent Study)
Other
Master’s
Graduation
ceremony
2012-3-20
Osseous Surgery
Xudong Wang,DDS,MD
Associate Professor
Dept,Oral and Maxillofacial Surgery
Ninth People’s Hospital
Shanghai,P.R,China 200011
xudongwang70@163.com
2012-3-20
Osseous Preprosthetic Surgery
? Alveoloplasty (exostosis,undercut,knife-edge ridge,etc )
? Torus(tori) removal (palatal/mandibular)
? Maxillary/ mandibular augmentation
(autologous bone graft,lyophilized cartilage/bone,
hydroxyapatite,guided tissue regeneration memberane,
tissue engineered bone)
? Correction of abnormal ridge relationship
(orthognathic surgery)
2012-3-20
Alveoloplasty
Anesthesia
(local infiltration)
Incision &
Mucoperiosteal flap reflection
(scalpel & periosteal elevator)
Tips
? exposure & visualization
? blood supply
? rest on intact bone
? full-thinckness
? avoid injury to vital structures
2012-3-20
Bone removal
(chisel&mallet / rongeur)
side-cutting unibevel
Bone smooth
(bone file)
Tips
? side-cutting for rongeur
? unibevel chisel
? preserve bone AMAP
?,pull” smoothing for file
Alveoplasty-cont’d
2012-3-20
Suturing (Interrupted/continuous/margin/matress)
Alveoplasty-cont’d
Post-op care
? Mouth rinse
? Suture removing
(1w post-op)
?Prosthetic restoration
(2w post-op)
2012-3-20
2012-3-20
Removal of mandibular tori
? Location
? Anesthsia
? Incision
2012-3-20
Remove bone with chisel Undermine the tori with fissure bur
Lingual mucoperiosteal flap reflection
2012-3-20
Removal of palatal torus
Indication
? Full/partial denture restoration
? Ulcerated of mucosa
? Interfered with speech
Anesthesia
? GP block
? NP block
2012-3-20
Incision Flap reflection
Segmenting w/ fissure bur
2012-3-20
Remove bone stripes smoothing
2012-3-20
Transparent surgical stent w/ iodoform gauze
2y post-op
2012-3-20
Surgery for
oroantral communication
Buccal flap
Palatal flap
? tooth extraction
? periapical lesions
? maxillary cysts surgery
Etiology
Closure of oroantral fistulas/ communication
(Caldwell-Luc procedure)
Bony & soft tissue
defects
2012-3-20
Oroantral communication
31y,female,tooth extraction for 4m
1m post-extraction,
dull pain and pressive sensitive
Water’s view
Shadowing
--sinusitis
2012-3-20
Closure of oroantral fistulas/ communication
Excision of fistula
Buccal flap
reflection
Buccal flap advancement
2012-3-20
Extending the mucoperiosteal flap
C:internal periosteal
releasing incision
Buccal flap advancement
2012-3-20
Buccal flap advancement
Smooth the bony edge
2012-3-20
Buccal flap advancement
Trim the excess tissue Suturing with matress suture
2012-3-20
Buccal flap advancement
? Matress suture
? Interrupted suture
2012-3-20
Buccal flap advancement
3m post-op
2012-3-20
Palatal flap advancement
Flap design Palpation of
bony adge
2012-3-20
Palatal flap advancement
Excising the fistula and reflect the flap
2012-3-20
Palatal flap advancement
Adapting and suturing the flap
2012-3-20
Palatal flap advancement
Iodoform gauze strip
covering the exposed
bone
Surgical stent fixed with screw
2012-3-20
Palatal flap advancement
Post-op follow-up
2012-3-20
Post-op care for
oroantral communication
Nasal precautions(10-14d)
? opening mouth wide while sneezing
? not sucking on a straw / cigarette
? avoid nose blowing
? others provide pressure changes
between the nasal passage and oral cavity
Medicine administration(7-10d)
? antibiotics
? antihistamine
? decongestant nasal spray
Wearing surgical stent (7-10d)
Suture removal (10-14d)
2012-3-20
DENTIST
General dentist
(practitioner)
Specialist
Endodontist
Oral (& maxillofacial) surgeon
Pediatric dentist
Orthodontist
Periodontist
Prosthodontist
Stomatologist
Oral hygienist
School of Dentistry
School of Stomatology
2012-3-20
1
2
3
4
5
6
7
8
9
10
Years of Study DDS PhD (from BA)
PhD
DDS/PhD
(Concurrent Study)
DDS and PhD
Residency
(plus MS)
DDS
PhD
MS/OB
MPH
MBA
Other MS
DDS and MS
TICR
Residency
PhD
PhD
DDS/MS (Oral Biology)
(Concurrent Study)
Other
Master’s
Graduation
ceremony
2012-3-20
