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Principles of Management of Impacted Teeth

An impacted tooth is one that fails to fully erupt into the dental arch within the usual range of expected time. The tooth becomes impacted because abnormal tooth orientation, adjacent teeth, dense overlying bone, excessive soft tissue, or a genetic abnormality prevents eruption. Because impacted teeth do not erupt, they are retained for the patient's lifetime unless surgically removed or exposed because of resorption of overlying…

Principles of More Complex Exodontia

The removal of most erupted teeth can be achieved by closed delivery, but occasionally these techniques do not provide adequate surgical access. The open or surgical extraction technique is the method used when greater access is necessary to safely remove a tooth or its remaining roots. In addition, removal of multiple teeth during one surgical session requires more than the routine techniques of tooth removal described…

Principles of Routine Exodontia

Extraction of a tooth combines the principles of surgery and elementary physical mechanics. When these principles are applied correctly, a tooth can usually be removed from the alveolar process, even by someone without great strength and without untoward force or sequelae. This chapter presents the principles of surgery and mechanics related to uncomplicated tooth extraction. In addition, there is a detailed description of techniques for removal…

Instrumentation for Basic Oral Surgery

This chapter is designed to introduce the instrumentation commonly used to perform routine dental extractions and other basic oral surgical operations. The instruments illustrated and described are used for a wide variety of purposes, including soft and hard tissue procedures. This chapter primarily provides a description of instruments; their use is discussed in subsequent chapters. Incising Tissue Many surgical procedures begin with an incision. The primary…

Pain and Anxiety Control in Surgical Practice

Virtually all oral surgery procedures produce pain, and for most patients the prospects of having surgery provoke some degree of anxiety. Therefore it is incumbent upon those performing oral surgery to master techniques that will control perioperative pain and anxiety. For most routine oral surgical procedures, local anesthesia is sufficient to manage pain produced during surgery and for the early postoperative period. Anxiety control, on the…

Infection Control in Surgical Practice

It would be difficult for a person living in a modern society to have avoided learning the current concepts of personal and public hygiene. Personal cleanliness and public sanitation have been ingrained in the culture of civilized societies through parental and public education and are reinforced by government regulations and media advertising. This awareness contrasts starkly with earlier centuries, when the importance of hygienic measures for…

Wound Repair

An important aspect of any surgical procedure is the preparation of the wound for proper healing. A thorough understanding of the biology of normal tissue repair is therefore valuable for individuals intending to perform surgery. Tissue injury can be caused by pathologic conditions or by traumatic events. The dental surgeon has some control over pathologic tissue damage such as the likelihood of a wound infection. In…

Principles of Surgery

Human tissues have genomically predetermined characteristics that define normal responses to injury. Because the response to injury is predictable, principles of surgery have evolved to help optimize the wound-healing environment guided by basic and clinical research. This chapter presents the evidence-based principles of surgical practice that have been found to be successful not only for oral surgery, but also for surgery in all sites of the…

Prevention and Management of Medical Emergencies

Serious medical emergencies in the general dental office are, fortunately, rare. The primary reason for the limited frequency of emergencies in dental practice is the nature of dental education that prepares practitioners to recognize potential problems and manage them before they cause an emergency or refer unhealthy patients needing surgery to oral-maxillofacial surgeons. Dental practices serving patients in medically underserved communities may see a disproportionate number…

Preoperative Health Status Evaluation

The extent of the medical history, physical examination, and laboratory evaluation of patients requiring outpatient dentoalveolar surgery, under local anesthesia, nitrous oxide sedation, or both, differs substantially from that necessary for a patient requiring hospital admission and general anesthesia for surgical procedures. A patient's primary care physician typically performs periodic comprehensive history taking and physical examination of patients; it is therefore impractical and of little value…

Acute Ischemic Stroke

Introduction Accounting for 87% of all types of stroke, ischemic stroke has both fatal and disabling consequences for affected patients. Ischemic stroke remains the leading cause of long-term disability; however, technologic and therapeutic advances made in the past decade offer significant potential to change this. Recent randomized controlled clinical trials have demonstrated the efficacy of endovascular intervention over tissue plasminogen activator (tPA) alone and have catalyzed…

Complications in the Endovascular Treatment of Intracranial Aneurysms

Introduction Since the initial introduction of endovascular coiling techniques by Guglielmi in 1991, endovascular therapies for intracranial aneurysms have evolved. Initially, intrasaccular coiling and parent vessel occlusion with coils after balloon test occlusion were the mainstays of treatment. At the turn of the 21st century, intracranial stents were designed as support and scaffolding for coils to treat wide-necked and unruptured aneurysms. With more advanced catheter and…

Complication of Endovascular Treatment of Intracranial Stenosis

Introduction Intracranial atherosclerotic disease (ICAD) is defined as atherosclerosis of the large intracranial arteries, namely the intracranial internal carotid artery (ICA), intracranial vertebral and basilar arteries, middle, anterior and posterior cerebral arteries, and their cortical branches (up to M3, A3, or P3 segments). Atherosclerotic disease of the small perforator and penetrating arteries is termed as small vessel (or small artery) disease. The term intracranial stenosis (ICS)…

Complications in the Endovascular Treatment of Intracranial Arteriovenous Malformations

Introduction Intracranial arteriovenous malformations (AVM) are a demanding pathology to treat. There is ample discussion about which single modality or which amalgam of modalities is the most optimal, i.e., endovascular embolization, microsurgical resection, or radiosurgery. The discussion also extends to not only how but also whether to treat. Several grading scales for AVMs exist, while classically the relative morbidity of the open microsurgical approach has been…

Subclavian Steal

Introduction Subclavian steal phenomenon (or syndrome) originates from severe stenosis or occlusion of the proximal subclavian artery resulting in the reversal of blood flow in the ipsilateral vertebral artery (VA) to perfuse the limb. Blood flows retrogradely from the brain (via blood from the contralateral VA or the circle of Willis) to the limb instead of anterogradely from the heart directly to the limb as a…

Transcarotid Artery Revascularization With the ENROUTE Transcarotid Neuroprotection System

Extracranial carotid artery occlusive disease is associated with the risk of stroke, disability, and death. The surgical treatment of carotid disease has undergone significant evolution from early attempts at carotid ligation to the first carotid endarterectomy by Michael Debakey in 1953. Over the following decades, carotid intervention was mostly limited for symptomatic patients. There was considerable research into the treatments of carotid disease and multiple randomized…

Carotid Stent: Device-Specific Complications With the Wallstent

Introduction The Carotid Wallstent (Boston Scientific, Marlborough, MA) is one of the most used stents in the endovascular treatment of carotid stenosis, particularly because of its design, which allows excellent plaque coverage. For that reason, it seems adequate for the treatment not only of stable uncomplicated plaques but also of dishomogenous stenosis. Although the advantages given in terms of plaque coverage are significant, as shown by…

Complications Specific to Closed and Open Cell Nitinol Stents in Carotid Artery Stenting

Introduction The use of carotid artery stenting to treat carotid bifurcation stenosis remains a topic of recent investigation and vigorous debate regarding safety and efficacy. Multiple prospective randomized controlled trials have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) and have shown comparable outcomes in asymptomatic patients. There are certain complications that are more frequent or specific to the use of closed versus open cell…

Embolic Protection Issues

Introduction Stenting of supra-aortic vessels has become a reasonable alternative or sometimes the treatment of choice for cases of athero-occlusive disease of the carotid, subclavian, innominate, and vertebral arteries. Protection from distal embolic debris or thrombus remains critical while performing stenting and angioplasty. The investigators of the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial and the Carotid Revascularization Endarterectomy…

Complications Associated With Carotid Artery Stenting

Introduction Interventionalists are especially cautious with carotid artery stenting (CAS) because complications can lead to devastating and permanent neurological sequelae, even death. Preparation for CAS can often seem excessive; however, careful and detailed planning is the key to circumvent unwanted outcomes. CAS should be used for appropriately selected patients. Knowing the fundamentals of the procedure and some tricks to adapt the procedure for the patient’s anatomy…