Principles of Dentoalveolar Extractions

Seth Delpachitra, Anton Sklavos, Ricky Kumar

• Publisher: Wiley-Blackwell
• Year: 2021
• ISBN:
  9781119596448
• Edition: 1
• Topic: Medicina
• Subtopic: Medicina chirurgica e chirurgia

Combines the basic sciences and principles of dentoalveolar extractions with basic and advanced surgical techniques

Principles of Dentoalveolar Extractions is a comprehensive, technical text covering the basic sciences and principles of dentoalveolar extractions, exploring both the basic surgical techniques and advanced surgical practices.

Highly illustrated with colour photographs throughout, this text discusses the procedures, pitfalls, and practicalities of exodontia. It highlights the most common surgical principles encountered in clinical practice, the range of surgical instruments available, and how to manage the potential complications associated with extraction procedures. This important text:

• Focuses solely on dentoalveolar extractions and surgery
• Contains full colour photographs and detailed illustrations to aid learning
• Offers a technical walk-through guide that can be used as a reference prior to surgery
• Includes a Preface written by Professor Andrew A. C. Heggie, AM

Written for dental students, surgical trainees and other dental professionals, Principles of Dentoalveolar Extractions provides a comprehensive and pragmatic review of dentoalveolar extractions.

1
Principles of Surgery

surgery n. manual treatment of injuries or disorders of the body, operative therapeutics.

surgeon n. a person skilled in surgery.

Exodontia, the removal of teeth, involves the manipulation of hard and soft tissues and the amputation of the dentition or parts thereof in order to treat or prevent disease, or as part of an overall treatment plan. The surgeon who carries out this treatment must possess qualities, skills, and decision‐making abilities to the standard of any other trained surgeon who diagnoses and treats disease. It is the responsibility of this surgeon to provide the highest standard of care of which they are capable, and when they cannot provide it to a suitable level, to refer to the appropriate specialist service.

It is somewhat self‐evident, though easily forgotten, that the surgeon's responsibility is not limited to the operation only, but also involves preoperative consultation and postoperative monitoring, as well as other aspects of care such as liaising with other practitioners and communicating treatment plans. Surgeons are trained to possess several qualities and characteristics not limited to procedural skills:

• Knowledge. Knowledge can be considered the facts, information, skills, and experience gained through education, training, and professional practice. It is a fundamental and essential aspect of the carrying out of dentoalveolar extractions. It includes technical and medical expertise, which facilitate safe patient management. As scientific knowledge evolves over time, there is a need for ongoing maintenance through continuing professional development and keeping up to date with evidence‐based practice.
• Quality and Safety. Quality is the commitment to excellence, providing a service that is guided primarily by the best interests of the patient. This is achieved through recognition of one's own strengths and limitations, stringent self‐audit, and the fortitude to request assistance when needed. Safety is the avoidance of risk or injury to oneself, one's staff, and one's patients. Maintenance of a safe workplace is the responsibility of all individuals employed in a health environment, and requires appropriate training and awareness of risk‐mitigation strategies such as aseptic and sterilisation techniques. Quality and safety are dynamic components of surgery and necessitate constant refinement and improvement to ensure the wellbeing of patients and a high standard of care.
• Communication and Collaboration. Good communication is essential in the interaction both with patients and with other health professionals. Clear, concise, and relevant documentation of patient management will improve interactions with specialists and foster a culture of collaboration and professional development. This is particularly important when patients are undergoing tooth extraction as part of a wider treatment plan where multiple other medical comorbidities require interdisciplinary management. In such situations, good communication minimises delays to receiving time‐critical treatment, such as in the case of dental extractions prior to head and neck radiotherapy or bisphosphonate treatment.
• An Individualistic Approach. Patients will have a wide variety of backgrounds, demands, and prior medical knowledge. A tailored and individualised approach is required in order to ensure they understand the proposed procedure, its risks, and its expected outcomes, and are able to compare options in order to make an informed decision.
• Leadership and Management. A surgeon will often find themselves the leader of a multifaceted treatment team, including nursing staff, dental assistants, anaesthetic staff, and sterilisation technicians. This leadership comes with great responsibility: the expert surgeon must guide others in the team, provide feedback and education, and thus help maintain a standard of excellence. The surgeon must ensure that all staff are orientated towards the goal of achieving the best outcome for the patient. When the highest standard of care is compromised, the responsibility is on the surgeon to make sure the team gets back on track.
• Decision Making. The word ‘decision’ shares a common root with another word often associated with surgery: incision. Both are derivatives from the Latin word caedis, meaning ‘to cut’. Incision means to cut into something, such as the operative site; decision literally means ‘to cut away’. A decision thus precludes other options, and sets one upon a particular course of action. A skilled surgeon will be able to make treatment planning decisions that are in the best interests of their patients.

1.1 Wound Healing

Good outcomes following surgery depend on satisfactory wound healing. This involves a range of inflammatory, biochemical, and physiologic changes at the operative site, which will ultimately lead to resolution, healing, and bone remodelling. Wound healing does not always follow a predictable course, and therefore an understanding of its key aspects will serve as a foundation for interpreting clinical signs and determining when it is compromised.

There are four key stages in wound healing (Figure 1.1):

1. Haemostasis.
2. Inflammatory phase.
3. Proliferative phase.
4. Remodelling and resolution.

Figure 1.1 Phases of wound healing.

An interruption at any one of these stages will lead to a protracted recovery period.

1.1.1 Haemostasis

Any tissue trauma will result in bleeding from the local vasculature supplying the tissues. The immediate physiologic reaction is haemostasis, which involves reactive vasospasm, formation of a platelet plug, and activation of the coagulation cascade.

Reactive vasospasm occurs in the seconds to minutes following damage to the blood vessels. This is mediated through neurologic mechanisms, as well as the local release of endothelin. It rapidly reduces blood loss from trauma. In surgery, exogenous vasoactive medications such as adrenaline utilise this response to improve visual access to the surgical field by reducing blood flow.

Damaged endothelial cells result in a conformational change in von Willebrand factor expressed on the cell surface. Von Willebrand factor interacts with glycoprotein Ib on circulating platelets, resulting in activation and aggregation of the platelets, forming links to fibrinogen via the GpIIb/IIIa receptor. This leads to the formation of the platelet plug. Antiplatelet medications ...