::Departments : Clinical : Dental Surgery
DEPARTMENT OF DENTAL SURGERY

       GOVERNMENT RAJAJI HOSPITAL

                          MADURAI
 
I.          Conservative Management
  • Restorative procedures in carious teeth
    • Temporary restorations
    • Permanent restorations
    • Fractured teeth :
                        Permanent restorations with light cure composite
                        Materials.
  • Carious teeth with pulpal involvement :
                        Root canal treatment under local anesthesia followed by
                        Permanent restoration.
 
II.         Prosthodontic management :
  • Removable partial dentures : replacing maxillary and mandibular anterior teeth (6 teeth)
  • Removable partial dentures replacing 1 or 2 maxillary / mandibular posterior teeth.
  • Obturators – immediate, intermediate and permanent surgical obturators in patient’s undergone maxillectomy for maxillary tumors.
  • Cap splint immobilization : done for dentalveolar fractures / greenstick fractures / greenstick fracture in maxilla and mandible of pediatric patients immobilization done for 25-45 days with cementation.
  •   Cleft lip  / Cleft palate management :
  • Feeding plate obturators given for new born with unilateral or bilateral cleft lip or palate for 3 to 6 months.
  • Maxillary expansions screw with acrylic plate given for patients with light arched narrow palate in mixed dentition period.
  • Acrylic screw gauge : given for patients with restricted mouth opening developed after trauma or TMJ fibrous ankylosis.
 
III.        Orthodontic management :
  • Upper and lower Hawley’ s appliance given for patients with malocclusion and proclination spacing in maxillary and mandibular teeth.
  • Hawley’s appliance with bite plane given for patients with rotated teeth
  • Hawley’s appliance with bite plane given for patients with deep bite.
 
IV.       Pediatric Management :
  • Restorations both temporary and permanent for carriers teeth
  • Scaling for poor oral hygiene and in gum disease
  • Root canal treatment in pulpally involved teeth.
  • Removable orthodontic appliance for malalignment of teeth
  • Extraction of carious teeth / retained deciduous teeth and fractured teeth beyond conservative management.
  • Extraction of natal teeth and neonatal teeth.
 
V.        Periodontal Management
  • Complete scaling and oral prophylaxis in patients with gingivitis and periodontitis.
  • Flap surgeries under local anesthesia followed by graft placement in patients with periodontal bone loss.
  • Gingivectomy under local anesthesia in patients with inflammatory and drug induced gingival enlargement.
  • Complete scaling patients with extrinsic stains.
 
VI.       Surgical management :
  1. Extractions : extraction of carious teeth, periodontally week teeth, fractured teeth (dento trauma) done under local anesthesia.
  2. Impaction : Surgical removal of bony impaction of maxillary and mandibular canines and III molars under local anesthesia and in some cases under general anesthesia.
  3. Transalveolar extractions : done under LA for patients with
  1. Grossly decayed teeth
  2. Teeth with dilacerated roots
  3. Hypercementosis teeth
  4. Teeth with supernumerary roots
  5. Fused teeth
  6. Compound odontomes with or without impacted molars.
4)         Dental cyst : Enucleation or marsupillization of dental cyst under general anesthesia or local anesthesia.
 
5)         Biopsy :
A)        Excisional biopsy for odontogenic tumors followed by artificial bone graft (hydroxyapetite crystals) placement under general anesthesia or local anesthesia.
B)        Wedge biopsy : performed for chronic oral ulceration and for in tumors before radiotherapy or chemotherapy under local anesthesia.
C)        Incisional biopsy performed under local anesthesia for dermatologically affected patients with oral manifestation. (lichen planus, actinic chelitis, discoid lupus erythematosis)
 
            6)         Trauma management :
A)        Open reduction and internal fixation done with stainless steel / titanium screws and plates in maxillary zygoma and mandibular bone fractures under general anesthesia / local anesthesia.
B)        Erich’s arch bar wiring : done in patients with traumatic subluxation of teeth associated with maxillary or mandibular bone fractures
C)        Eyelet wiring : done under local anesthesia in patients with jaw bones fracture this is followed by intermaxillary fixation for 45 days.
D)        Condyle fracture : eyelet wiring done under local anesthesia followed by intermaxillary fixation for 21 days.
E)        Elastic traction done in patients with jaw bone fracture with severe occlusal derangement where IMF with stainless steel wire is not possible initially.
F)        Cap splint / gunning splint
 
7)         Extraction in medically compromised patients
A)        Cardiac patients under IE prophylaxis extractions of carious / mobile teeth done under local anesthesia
B)        Epileptic patients : under local anesthesia and IV Phenytoin 1 hour before procedure extraction done.
C)        Diabetic patients : extractions done under local anesthesia after tight glycemic control.
E)        Hypertensive patients / renal disorders : extraction done after BP control and after physician opinion with necessary precautions.
F)        Extractions under other conditions : periodontally involved mobile teeth or decayed teeth with septic foci extracted under LA in patients undergoing various surgeries :
                        Cataract surgery
                        Orthopaedic management – jt replacement
                        Renal transplantation
                        Pregnancy
                        Malignancy of other internal organs.
 
8)         TMJ dislocation : reduction followed by barrel bandage dressing  IMF given in patients with chronic and acute TMJ dislocation
 
 
9)         Local drug delivery :
a)       oral sub mucous fibrosis : intralesional injection of dexamethasone and lignocaine given every third day and dosage gradually reduced after achieving sufficient mouth opening.
b)       Zinc oxide eugenol dressing given in patients with alveolar osteits developed 2 to 3 days after traumatic extractions or due to poor post operative care.
c)       Packing gauze with medicaments in marsupilized cavities.
 
10)      operculectomy : Pericoronal flap excision done under LA in patients with partially erupted teeth specially lower III molars and maxillary incisors.
 
11)      Periapical surgery : Periapical lesions involving more than 2 to 3 teeth performedin patients with nonvital or fractured or teeth with RCT failures.
 
12)      I&D : incisional and drainage done under LA in patient with various space infection surgical drain kept.
 
13)      Forceful mouth opening : done in patients with restricted mouth opening due to fibrous ankylosis of TMJ or due to submassetric space infection followed by extraction of decayed teeth.
 
14)      Trigeminal Neuralgia : Maxillary or mandibular division or trigeminal nerve neuralgia managed by peripheral neurectomy under GA.
 
15)      Cleaning and dressing : done in patients with severe lacerations and abrasions of face associated with trauma.
 
16)      Alveloplasty : done under LA in patients with sharp bony spicules in tooth sockets seen after 3 to 4 days after extractions.
 
17)      Plate removal : done in LA in patients with infections in surgical site (ORIF) or in plate exposure developed after 6 months.
 
18)      Frenectomy : high frenal attachments in maxillary arch having midline diastema excised under LA. Followed by orthodontic treatment.
 
19)      Tongue tie : high frenal attachment of lingual frenum causing difficulties in speech, excised under LA.
 
20)      Apicectomy : done under LA in patients RC failure due to overextensions of GP points causing periapical infection and extraoral sinus drainage followed by excision of extraoral fistula tract and suturing to prevent of infections.
 
21)      saucerisation and decortications : done under LA in patients with chronic osteomyelitis with sequestrum formation.
 
22)      Orthognathic surgery : for maxillary mandibular bony protrusion orthognanthic surgery done under GA followed by arch bar wiring.
 
23)      Caldwel luc surgery : performed under GA for retrieving any foreign body or are lodged maxillary molar roots into the maxillary sinus causing intraoral fistula and drainage.
 
24)      Salivary gland lesions :
a)       Silolithiasis of submandibular and sublingual salivary gland causing under GA salivary flow obstruction is excised under GA.
b)       Mucocele : formed in the lower labial mucosa due to the trauma to minor salivary glands excised under LA followed by suturing.
 
25)      Reconstructions : hemimandiblectomy done for odontogeic tumors like ameloblastoma for by stabilization with reconstruction plates.
 
26)      Gunning splint immobilization  : done for completely edentulous patients having fractures in jaw bones due to trauma.
 
Radiology & Imaging :
  • IOPA – intra oral periapical films are taken to rule out any intraosseous lesions in the apex of 1 or 2 teeth of both maxillary and mandible.
  • Lateral oblique view of left and right mandible :
    • Taken to rule out impacted molars canines and for any intraosseous lesions like odontogenic cyst and tumors.
  • PA view of mandible : taken to rule out fracture of symphsis and parasymphysis fractures of mandible.
  • PNS view or waters view : taken to rule out fractures in maxilla zygoma and any cystic lesions in maxilla.
  • CT Mandix Maxilla – 3D imaging
  • TMJ view
  • Sialogram
 
 
 
 
 
 

 

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