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Oral Surgery. 02 / 08 / 08 Lecture 5. Causes of Subperiosteal Infections. Bone debris Bacterial byproducts Metal filings All of the above. Pt presents w/impacted nasopalatine cyst. What incision?. Envelope flap. If you don’t have enough access add more teeth to the flap.

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Oral Surgery

02 / 08 / 08 Lecture 5

Causes of Subperiosteal Infections

  • Bone debris

  • Bacterial byproducts

  • Metal filings

  • All of the above

Pt presents w/impacted nasopalatine cyst. What incision?

  • Envelope flap.

    • If you don’t have enough access add more teeth to the flap

Nerves / Neurovascular bundles that you are allowed to cut:

  • Long buccal

  • Nasopalatine

    Just make sure that you are doing dentistry when you cut them… don’t cut them when you are gardening or grocery shopping because you might get sued. You’ve been warned.

Easiest instrument to reflect a flap

  • Molt curette

Sling suture good for:

  • Papilla approximation


  • Gravity is our enemy when removing torri because gravity will pull down our flap… so, what is done?

    • Plastic stent for palate

    • 7-10days

    • Lab fabricated

      • Leave baseplate thickness, please, for swelling

    • If pt has no teeth?

      • Drill holes in stent and suture it to palate!

Sinus anatomy clues:

  • When you see the sinus go off in its own direction, independent of the rooth, you’re looking at overlapping structures – low risk.

  • If you see the sinus follow the tooth anatomy – bad news – be careful.

Most frequent perf of sinus?

  • Caused by6 palatal root of maxillary first molars.

When is it ALWAYS surgical?

  • Lone-standing molars in older patients are always surgical.

    There are other cases as well, discussed elseware.

Root morphology

  • Thirds have greatest variability

  • For thirds removal

    • Want 1/3 of root to be formed (minimum)


  • Something is going to break… schedule four appointments for the extraction… get Starbucks

    Just like Britney Spears:


For sinus perforations…

  • Prescribe

    • Antibiotics

      • Generally, amox 500tid for 7d

      • Some may prescribe augmentin

    • Decongestants

    • Home care instructions

Removing a tooth is like removing what?

  • Pole from a hole!

    • Expansions of the bony socket is key

    • Dilate the plate by emphasizing the movement where the bone is thinnest

      • Generally the buccal

Pinch-grasp technique

  • One is on the forcep, the other is on the buccal and lingal plate to help you feel the bone when it breaks

Thick / Thin

  • The palatal bone is the thickest, the thinnest is over the cuspids

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