Treatment Planning Seminar I

8/13/2019 Treatment Planning Seminar I

1/23

Done By

Ahmad Yamin MehdiHassan

200820175 200711869


2/23

38 old patient had his last remaining tooth

on the upper right quadrant removed withsome difficulty 6 days ago . He is no

presented with swollen cheek, he noted thathe started smoking much more than the

usual and felt salty tast in his mouth.


3/23

Oroantral Fistula

Dry socket

NASOPALATINE DUCT CYSTS Dental infection


4/23

Intolerable pain Foul odor

blood clot disintegrates

no supparation

History of extraction within

5 days

Confirm diagnosis

-extremely painful upon light palpation


5/23

non-odontogenic cysts

upper maxilla

Etiologic factorsClinical symptoms are:

salty taste

swelling on the anteriorpart of the palate


6/23

Buccal spase

infection

Periapical abcess


7/23

Based on:-

1-Last remaining tooth on the upper right quadrant .

2-Removed with some difficulty 6 days ago.

3- No presented with swollen cheek.

4- Started smoking much more than the usual.

5- Felt salty taste in his mouth.


8/23

The rate and degree of sinus pneumatization after tooth

extraction.


9/23


10/23

Salty-tasting discharge or the awareness of an

unpleasant smell.

Reflux of fluids and food into the nose from the

mouth.

Escape of air into mouth during nose blowing. Recurrent or chronic sinusitis on the affected

side.

Proliferation of soft tissue around the fistula.

A visible defect between the mouth and antrum .

Bone fragments with s smooth concave uppersurface (antral floor fragments) adhering to the

root of the extracted tooth.


11/23

1-Confirmed by carful examination using a

mirror and a good light.

2-Gentle suction applied to the socketproduce a characteristic hollow sound .

3-The temptation to confirm the presence of

OAC by probing or irrigation should beresisted.


12/23

3- patient ask to blow the nose whilst

pinching the nostrils .

4- OAFs often have small slit-like or pinholeoral opening conceal much wider

underlying bony defects.

5- x-rays.


13/23

The underlying factors :-

exodontia (48%)

tumours (18.5%)

osteomyelitis (11%)

Caldwell-Luc procedures (7.5%)

trauma (7.5%)

dentigerous cysts (3.7%)

correction of septal perforations (3.7%)


14/23

Gingival tissues cantbe approximated

Post-op rgime is not followed

Wound dehiscence

Enucleationof a cyst

May develop 4 6 weeks post-extraction.

Problems with smoking, eating or drinking.

Chronic maxillary sinusitis.

Antral polyp herniating into oral cavity.

Purulent discharge from nose.


15/23

Large sinus

Large and unfavourable shaped roots

extending into the sinus

Being older (over 40)

A history of difficult extraction

Periodontal disease (significant bone loss)


16/23

1- patient should be warned pre operatively 2- surgical exodontia is preferable than

forceps extraction

3- if mucoperiosteal flap is raised its designshould allow it to be adopted for OAC repaire

Possible Complications Chronic sinusitis


17/23

Estimate the diameter of communication

1-2 mm: No treatment required as it will usually

naturally heal.

2-4 mm: Carefully follow the patient after 1-2weeks and advise to avoid straining the area (no

holding back sneezes, no smoking, no use of

straws, no pressure on the sinus).

5 mm or larger : requre surgary


18/23

1-this aims to encourage the regeneration of

new bone between the oral and antral

cavities.

2-protect blood clot within the socket till

organization and bone formation take plase

by extention existing denture or by acrylic

base plate or ribbon gause

3- palatal and bucal mucosa may be held

together with matress suture


19/23

1-the epithelium lining the fistula tract and

soft tissue margine is excised

2-A broad base three sided buccal

mucoperiosteal flap is cut and extend

3-periosteum lining the inner surface of flap

cut parallel to and close to it's base

4-the palatal margine is

slightly undermined and the

wound close with mattress suture


20/23

buccal fat pad

1-A broad base three sided buccal

mucoperiosteal flap is raised and periosteumincised

2-using vestibular incision in the region of the

upper first molar3-the tissue advanced to cover bony defect and

suture


21/23

palatal rotation flap

1-the epithelial lining is excised2- An elongated full thickness mucoperiosteal

palatal flap which course of grater palatine

artery with short distance ANT to OAC cut

and raised.

3- the flap is sutured

across the defect and area

of expose bone cover

by ribbon gause and suture


22/23

Antibiotic

Decongestant nasal drop

steam inhalation

Antibiotic

Amoxicillin (500 mg/adults) 3 times daily for at least 1 week

For resistant infections consider using levofloxacin 500 mg

once daily.

nasal decondestions

sympathomimetic drop such as ephedrine 0.5% for patient with

monoamino oxidase inhibitor we can use pseudoephedrine

tablet

steam inhalation

using hot water rather than boiling to avoid risk of scalding


23/23

THANKS

ANY Q?

Documents

Treatment Planning Seminar I