ORAL SURGERY PROTOCOL

INTRODUCTION
The third molars are the teeth that are most frequently found.
included, constituting an important section of the pathology
dental, not only due to its frequency and variety of presentation,
but also due to the pathologies and accidents that frequently
they unleash, which explains that its extraction is the intervention that
are most commonly performed by oral and maxillofacial surgeons. The third
molar erupts at an average age of 19.5 to 20.5 years, it is
therefore, the last tooth to erupt, which can easily
to be impacted or suffer displacements, if there is not enough space
in the dental arch, they do not evolve towards a correct situation,
being able to generate pathology.
PATIENT INFORMATION
Diana Rosa Higuera Arreola
27 years
Personal pathological history: none reported
Medications: none reported
Allergies: none reported
Blood chemistry:

study result Values of

reference
glucose 71 mg/dl 60-110 mg/dl
creatinine 0.7 mg/dl 0.6-1.4mg/dl

Hematological biometrics:

study result Reference value

Total leukocytes 4.7 103/µL 4.0-10.0 103/µL
Erythrocytes 5.0 106/µL 3.80- 5.30 106/µL
Hemoglobin 15.1 g/dL 12.0- 18.0 g/dL
Hematocrit 43.9 % 36.0-56.0 %
platelets 192.0 103/µL 150-500 103/µL

Bleeding times

study result Values of

reference
TP 12.4 12-14 seconds
TTP 39.6 30-50 sec

Female patient, goes to the Padierna peripheral clinic located in

time and space with vital signs T/A: FC: x x.
No pain or mobility of dental pieces.
During the interrogation, the patient remarks that she wants to undergo the extraction.
of the 3rd molars, during the intraoral examination the
presence of the 4 third molars, of which 38 and 48 are
semi-erupted.

MATERIAL: Syringe for type anesthesia

carpal
Protective barriers Cannula
Disposable needles Straight lifts
Sterile gauze Carriage separators
Saline solution Soft tissue scissors
Syringe for irrigation 10 ml curved May scissors and
Latex hose straight lines
number scalpel blade Adson forceps with and without
15 teeth
Vicryl suture 0000 Curved mosquito tweezers
Lidocaine anesthesia 2% Straight tweezers
Lucas's little spoon
Needle holder
Bum bag
Scalpel handle number 3
Molt Legra
Conical tip strawberry 702
Surgical piece
INSTRUMENTAL: Straight elevators
TECHNIQUE:
Anesthetize with 2% lidocaine short needle
Mandibular: The mental nerve should be blocked.
The lower right third molar is biradicular, the distal root is shorter.
and straight that the mesial. We will use straight and flag elevators
various calibers. Extraction technique.
The upper right third molar is apparently uniradicular, without
embargo presents a root in which it is committed to the womb
maxilla
Step 1.- Raise the hanging part to gain access to the area and have
visibility of the bone that covers the tooth and must be removed, the
the flap lift must be of an appropriate size for
allow the stabilization of the separators and instruments for the
osteotomy. However, a wide incision is advisable that
it allows for an extensive flap providing ideal access to the bone that
will undergo osteotomy, where the most common incision in these
cases is the angle; where the first cut is drawn from the center of
the distal face of the second molar extending backward varying the
length according to the type of retention of the piece. The second cut is
it begins at the distal portion of the gingival ridge and moves downward,
forward and outward in an approximate length of 1 cm, this incision is
necessary to avoid lacerating gingival tissues during the application of
the elevators.

Step 2.- Removal of the bone coating: once the tissue

soft tissue was lifted and retracted through the incision so that the
surgical field can be visualized it is necessary to perform a
evaluation regarding the amount of bone that should be removed,
sometimes the tooth can be divided with a bur (odontosection) and
extracting without bone removal. However, in most of the
In some cases, it is necessary to perform the osteotomy.
Initially, it is necessary to remove bone in the occlusal, vestibular.
from the distal to the cervical line of the retained tooth, the amount of bone
eliminated varies according to the type of retention, the morphology of the
roots and the angulation of the tooth. It is very important to take into account
that bone removal should not be performed for any reason in the
lingual aspect of the mandible due to the likelihood of injuring the nerve
lingual. At the same time as performing the osteotomy, it can be incorporated.
a maneuver called 'cavity' which is the removal of the bone between the
tooth and the cortical bone in the area of the spongy bone,
providing a support point for the throwers or lifters for the
extraction of the dental piece.
Step 3.- Odontosection: Once the bone has been removed in quantity
the possibility or necessity of sectioning the must be assessed
tooth, the odontosection allows the extraction of the dental piece by
separated by elevators through the opening created with the
osteotomy. The direction of the odonto-section is determined by the
molar angulation, the division of the tooth is done with a bur and is
section the tooth three-quarters of the way towards the lingual but it is
It's important to emphasize that the tooth should not be sectioned in any way.
complete in the lingual direction as it is more likely to injure the nerve
lingual, then the insertion of a straight pusher is proceeded with
slot created with the cutter and a rotary motion is performed to
split the tooth in two.
Step 4.- Extraction of the sectioned tooth with a punch: A
once the bone has been removed and the tooth has been sectioned, it must be extracted from
the alveolar apophyse with the use of levers or elevators, in the
the most frequently used pushers are the
straight reamer, Cryer, Crane Peak, these instruments are designed
to avoid applying excessive force, but to hold the tooth or the root
the same and apply force in the right direction. The difference with the
the extraction of the upper third molars is based on the choice of the
paddlers being of greater preference the angled instruments
like the Potts, Miller, or Warwick elevators that provide greater
access in the posterior parts. The application must be taken into account
adequate forces to prevent dislocation and fracture of the root of
second molar.
Step 5.- Preparation of the Wound Suture after the
the removal of the dental piece requires the use of a bone file
to eliminate any type of irregularity thus avoiding
annoying edges for the patient and achieving uniform healing
from the incision.9Additionally, a final irrigation must be carried out and a
thorough inspection before closing the wound, checking a
correct hemostasis and the ideal distribution of points in the suture.
Finishing the treatment with the appropriate medication, which by
preference is the administration of antibiotics such as tetracyclines,
that in the alveolus will help prevent an alveolitis, for a period
prescribed by the operator. On the other hand, the administration of
anti-inflammatory and analgesic medications are part of the post-treatment
surgical procedure for the extraction of third molars.

POST-OPERATIVE INSTRUCTIONS:
1. Keep the gauze in position with moderate pressure, for at least
half an hour
2.- Place an ice pack on the skin of the area where it was done.
extraction
For 10 minutes every half hour, for the first eight hours.
The purpose of cold is to minimize postoperative inflammation.
3.- Do not spit, rinse, smoke, or drink with a straw during the
first twelve
Hours
4.- It is important to recommend mouth opening and closing exercises.
to avoid
trismus, ten times every hour during the first 24 hours.
5. During the first hours, you should rest, preferably in
position
semi-reclined
6.- During the first day you should eat soft foods and drink
abundant liquids
7.- The day after the extraction, rinses must be done.
heat several times a day, dissolving in a case of water such
hot as it can be tolerated a teaspoon of common salt or
sodium bicarbonate. The aim is to increase blood circulation.
local through heat, which promotes healing and reduces
inflammatory process
8.- In case of swelling in the area, applications should be alternated.
heated by means of wet cloths

PHARMACOLOGY:

Ibuprofen 400 mg capsule

Take one capsule orally every 6 hours for 3 days.

Chlorhexidine Mouthwash 0.12%

Perform rinses of 5ml for one minute three times a day for 5 days.
days.

BIBLIOGRAPHY:
Gay EC. Oral Surgery. Madrid. Spain. Ediciones Ergon. S.A; 1999
Raspall, Oral Surgery and Implantology. 2nd edition. Madrid. Spain.
Pan American Medical; 2006