Oral Surgery: Implant Stability & Trauma

Implant Stability & Types

• Primary stability: initial biomechanical stability of the implant when placed.
• Secondary stability: osseointegration (long-term) of the implant into the bone.
• Osseointegration: direct bone-implant connection.
• Implant types, from most to least dense bone quality:
  • Type I: anterior mandible (best primary stability)
  • Type II: posterior mandible (best osseointegration)
  • Type III: anterior maxilla
  • Type IV: posterior maxilla (worst prognosis)

Facial Trauma & Surgical Procedures

• Orthognathic surgery: corrects facial bone abnormalities.
• Midface fractures: Le Fort I, II, and III fractures.
  • Le Fort I: horizontal fracture across the maxilla
  • Le Fort II: pyramidal fracture involving the maxilla
  • Le Fort III: complete craniofacial disjunction impacting the orbits and nasal bones
• Mandibular fractures: common fractures include condyle, angle, and symphysis.
• Fracture Types:
  • Simple: closed fracture
  • Compound: open fracture (breaks skin)
  • Greenstick: partial thickness fracture
  • Comminuted: fractured in multiple pieces
• Surgical Procedures:
  • Le Fort I osteotomy: for retrusive maxilla; moves upper jaw.
  • Bisagittal Split Osteotomy (BSSO): for retrusive or protrusive mandible; splits mandible to adjust position. Major complication: inferior alveolar nerve (IAN) damage.
  • Distraction osteogenesis: gradual traction for bone deposition. Has stages: osteotomy -> latency -> distraction.

Temporomandibular Joint (TMJ) Disorders

• TMJ disorders: nonsurgical and surgical treatments.
• Nonsurgical treatments: counseling, medical therapy (NSAIDs, steroids, analgesics, muscle relaxants), physical therapy, occlusal splint.
• Surgical treatments:
  • Arthrocentesis: flushing the superior joint space.
  • Arthroscopy: using instruments in the superior joint space.
  • Arthroplasty: disc repositioning surgery.
  • Discectomy: disc repair or removal.
  • Condylotomy: vertical ramus osteotomy.
  • Total joint replacement.

Medical Emergencies - General Steps

• SPORT: Stops treatment, positions the patient, oxygen, reassure, take vitals.

Medical Emergencies - Specific Conditions

• Airway Obstruction: difficulty breathing, signs/symptoms hands around neck, treatment (Clear airway, check for breathing, chin tilt, back blows, Heimlich maneuver).
• Anaphylactic Shock: severe allergic reaction, signs/symptoms rash, difficulty breathing, low BP, nausea, vomiting; treatment (albuterol, epinephrine, antihistamine, oxygen, EMS).
• Asthma: difficulty breathing due to bronchiole constriction; signs/symptoms wheezing; treatment (albuterol inhaler).
• Angina: chest pain due to ischemia of heart tissue; treatment (oxygen, nitroglycerin (NTG), aspirin). Note: Administer NTG multiple times with 5-minute intervals, then aspirin, and EMS. Patient position upright.
• Myocardial Infarction (Heart Attack): ischemia of heart tissue with necrosis; signs/symptoms chest pain, difficulty breathing, nausea/vomiting, pain in jaw, neck, or arm; treatment (MONA: morphine, oxygen, nitroglycerin, aspirin, EMS). Patient position upright.
• Epinephrine Overdose: due to intravascular injections of local anesthetic with epinephrine; signs/symptoms increased BP and HR; treatment (beta blockers); prevention via calculating correct dosage of local anesthetic, aspirate during injection.
• Hyperventilation: breathing uncontrollably; signs/symptoms dizzy, weak, lightheaded; treatment; sit upright, reduce O2 intake, relaxation techniques. Note: only condition where supplemental O2 is contraindicated.
• Diabetic Complications:
  • Hypoglycemia: sweating, pale, irritable, hungry, sleepy; treatment (conscious: glucose tab, juice; unconscious: IV dextrose, IM glucagon, EMS).
  • Hyperglycemia: dry mouth, thirst, headache, blurred vision, weak; treatment (activate EMS).
• Seizure: abnormal brain electrical activity; signs/symptoms uncontrollable jerking, staring, temporary loss of consciousness or awareness; treatment (remove objects from mouth, do not restrain, benzodiazepine); Subtypes: Grand mal (dilantin, phenytoin), status epilepticus (valium, diazepam).
• Stroke: blocked blood supply to the brain or burst blood vessel; signs/symptoms facial droop, arm drift, slurred speech; treatment (administer O2, EMS).
• Syncope (Fainting): most common emergency.
  • Vasovagal syncope: anxiety related
  • Orthostatic hypotension: blood pressure decreases upon standing; signs/symptoms reduced HR and BP, loss of consciousness; treatment (supine or left lateral decubitus (pregnant) position).