5/5/06

-Tissue over tori, thin tear; remove cuz oral hygiene and ability to eat and not
traumatize all the time
-Incisions: Linear or Linear with release at each end
-Removal: 1. mallet & chisel 2. Surgical Bur (thus combo, use bur, but also mallet
& chisel
-Post op:
-Splint to prevent: infection, necrosis of flap, hematoma formation
-Y incision on each end; dissect with periosteal elevator so dont tear tissue cuz
paper thin!
-Acrylic bur: grind away, BIGGEST THING IS IRRIGATE THE HELL OUT OF
THIS OR ELSE LITTLE PIECES OF BONE UNDERNEATH! (even put pt on AB for 1
week cuz dont want infection in palate)
-ex: w/o Y: have problem at ends that can tear and dont want to have to reapair
on palate cuz so thin and hard to grabv
-If dont have denture and made stent or splint; clasp around 2 cuspids; drill
through plastic one each side
-Make incision, make Y at end being careful NOT TO TEAR TISSUE & carefully
(dont grind and grind patient will have migraine headache; dont go too deep cuz will
be in nasal cavity; take 702, 703 bur and use guideplanes then take mallet and chisel and
knock off each of pieces
-Minute it closes immediately starts to pull down and dont want palatal necrosis
of flap and very painful and take long time to re-epi
-Mandibular tori removal: envelope flap around necks of teeth or on ridge; PROB
IN LOWER: FLOOR OF MOUTH SWELLING (if tori large on both sides do one at a
time)
-When tori take out cuz of hygiene:
-Trough with bur,d epth of bur when want to cleave, tap with mallet & chisel
always making sure have something underneath torus
-2 ways damage nerve: pressure from MINNESOTA
-on very large tori when bring everything back together will have excess tissue, trim
tissue before close
-Suture in each papialla violate, tongue is splint (preventn hematoma formation, potential
for hematoma formation in lower so EVERYBODY GETS HEMATOMA IN LOWER
FOR 1 WEEK, IF LARGE PATIENT MORE THAN 1 WEEK?, if tori humungous than
done in OR cuz potential for airway obstruction from swelling
-MAXILLARY EXOSTOSES
-Neoplasm? Unilateral, huge growth be concerned (send specimen for biopsy)
-Envelope flap open up grind away (for denture)
-Lower: envelope flap open up (but again soft tissue is very very thin, be careful with
dissection ,get BELOW BASE OF TORUS so dont have triangle of bone

-IMPLANTS: Types: 1. Subperiosteal (ATROPHIC MANDIBLE THAT IS SICK AND

CANT HAVE SURGERY IN HOSPITAL SO CAN PUT IN GRAFT; prob? Prongs
through mucosa so dont get nice healing around prongs, bacteria get in, get resoprtion,
keep losing bone and fails) 2. Transmandibular (bone Stapel: mandibular is titantium just
like implants; this is OR procedure so need to be halthy enough to be able to withstand
hospital surgery, incision made in chin and implant with prongs placed thorugh chin in
mouth) 3. Nedossesous (Blade: put in ramus; NOT USED ANYMORE, Clylinder or
screw: treated with hydroxyapatie to increase SA ) 4. Hydroxyapatite (migrates
-Subperiosteal implant: placed like framework of partial; full thickness flap; prob: prong
go through tissue and bacteria get in and get resoprtion of bone and no long erstable and
rocks and cuase more resoprtion of bone
-Transosteal implant: chin dissection; 7 prong (1-7 into mouth and rest in metal, very thin
plate of titanium
3 major prob: mental formaen, need General Anesthesia, and mental nerve
-Endosteal implant:
-Factors for oseointegration: 1. Strict Asepsis 2. Stress free haling (3 -4 months: maxilla
> mandible) 3. Temperature
-Temperature: Heat gerneated by bur cannot exceed 116 F or 43 C without casuing
inrreversible boen damage. Such damage, no matter now minute, necessitates bone
remodelingm first step of which ruslts in interostion of CT b/n implant and bone. Once
present, this CT could iekly lead to implant failure because osseointegration omay not
take place
-Biggest issues: ASEPSIS & TEMPERATURE
-POST OP COMPLICATIONS: easiest way to avoid complications is to explain to
patient what theyre in for
-When take out lower 3rd moalrs area inflamed trismus (explain in detail
complications so pt knows and no surprises)
1. Pain
2. Edema: any time cut gum and bone will have edema
3. Trismus:
4. Infection
5. Hemorrhage
6. Ecchymosis
7. Fibrinolytic Alveolitis
8. COndylar Subluxation
9. aspiration
-Dry socket: quicker, less trauma less dry socket
-