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Module 1 | Oral Anatomy & Biology
41 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Identify the two types of bone and where we find them in the jaws.
- – Understand the characteristics of these types of bone and how they change our approach to exodontia.
- – Describe the periosteum and its functions.
- – State how the periosteum relates to surgical flaps.
- – Distinguish between attached gingiva and alveolar mucosa.
- – Identify the types of PDL fibres and their significance as they relate to exodontia.
- – Explain how we deal with these fibres to facilitate tooth removal.
- – Map the anatomy and sensory distribution of the IAN.
- – Understand the importance of the IAN as it relates to extractions and minor oral surgery.
- – Locate the buccal nerve and state the region it innervates.
- – State where lingual nerve is most often located.
- – Appreciate the significance of the lingual nerve as it pertains to exodontia.
- – Recall the anatomy of the mental nerve.
- – Discuss how the mental nerve relates to exodontia.
- – State the basic the anatomy and significance of the maxillary nerve.
- – Recall the structures of the Greater Palatine Foramen and their significance as they pertain to oral surgery.
- – Locate the greater palatine foramen.
- – Locate the incisive foramen.
- – Name the contents of the incisive foramen.
- – Properly manage the incisive foramen region during surgical procedures.
- – Understand when a palpated lymph node is normal or abnormal in the head and neck.
- – Correctly palpate lymph nodes.
- – Describe granulation tissue.
- – State the function of granulation tissue and know where and when we would find it.
- – Recall the approximate location of the facial vein and artery.
- – Learn how we avoid these structures when incising or creating flaps.
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Module 2 | Medical Considerations
41 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Understand the American Society of Anesthesiologists (ASA) Classification System and how it used to evaluate the health of our patients.
- – Recite concerns about removing teeth safely in patients with Hypertension.
- – Demonstrate proper technique for taking blood pressure and sizing blood pressure cuffs.
- – State how diabetes impacts oral surgery procedures.
- – List tips for treating diabetic patients more safely and predictably.
- – Say why NSAIDS are a relative contraindication in patients with asthma.
- – Note important considerations for treating the asthmatic patient.
- – Safely manage the hyperthyroid patient.
- – Appreciate the nuance of sedating hyperthyroidism patients.
- – Understand appropriate drugs for pain management in hyperthyroid patients.
- – Identify the signs and symptoms of hypothyroidism.
- – Understand the importance of hypothyroid disorders as they pertain to exodontia.
- – List types of anemia and why anemia is a concern when doing oral surgical procedures.
- – State treatment considerations for people with angina, history of heart attack or congestive heart failure.
- – Recall the current American Dental Association guidelines for prosthetic joint antibiotic prophylaxis.
- – Understand the guidelines for the treatment of patients with a history of infective endocarditis.
- – Know what to prescribe for prophylaxis when a patient is already taking an antibiotic prescription.
- – Describe what scarlet fever is.
- – Explain how scarlet fever relates to infective endocarditis.
- – Identify osteoporosis via clinical presentations of the patient.
- – See how osteoporosis relates to exodontia.
- – State some of the main causes of liver failure.
- – Confidently manage patients with liver disease.
- – Identify suitable prescription options for patients with liver disease.
- – Understand some of the concerns regarding the management of a hemodialysis patient.
- – Find information on Hemophilia or Von Willebrand Disease.
- – Appreciate the concerns regarding the management of a Hemophiliac or Von Willebrand patient.
- – Know when it is safest to complete procedures on pregnant patients.
- – State considerations for managing a pregnant patient.
- – Understand the guidelines regarding radiographs during pregnancy.
- – Recite the drug categories and know how they relate to employing drugs in pregnant patients.
- – Choose a safe antibiotic for pregnant patients.
- – Select an appropriate drug for pain management in pregnancy.
- – Respect the concerns regarding sedation of pregnant patients.
- – Select the most appropriate topical and local anesthetic agents for pregnant patients.
- – Identify the significance of chemotherapy as it relates to exodontia.
- – Recall a suggested protocol for managing the chemotherapy patient.
- – Understand the suggested protocol for extractions on patients undergoing radiation therapy.
- – Safely manage an immunocompromised patient.
- – Be familiar with the the signs, symptoms, and management of common medical emergencies in the dental office including syncope, seizures, hypoglycemia, mild allergic reactions, hyperventilation, orthostatic hypotension, acute asthma, airway obstruction, heart attack, stroke, cardiac arrest, and anaphylaxis.
- – Discuss the concept of Advanced Cardiac Life Support training and why they should consider taking it.
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Module 3 | Surgical Complications
75 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – List the causes of buccal plate fractures.
- – Prevent more buccal plate fractures.
- – Manage a buccal plate fracture.
- – Identify the difference between capillary, venous, and arterial bleeding.
- – Control intraoperative bleeding using a variety of local and hemostatic measures.
- – State the causes of bone chips after extracting teeth.
- – More readily avoid causing or leaving bone chips following an extraction.
- – Manage bone chips.
- – Define and understand what pain is.
- – Understand the etiology of postoperative pain.
- – Identify potential causes of dry socket.
- – Diagnose a dry socket.
- – Confidently treat a dry socket.
- – List causes of postoperative infections.
- – Manage most postoperative infections.
- – Discern between postoperative edema and postoperative infection.
- – Employ strategies to limit postoperative edema.
- – Recognize liver clots and describe why they form.
- – Resolve a liver clot.
- – State potential causes of hematomas.
- – Manage and limit the extent of hematomas when they form.
- – Avoid damaging adjacent teeth during extractions.
- – Share tips for managing teeth that are iatrogenically damaged during an extraction.
- – Describe what a wound dehiscence is and why they form.
- – Manage a dehiscence to complete resolution.
- – Avoid tissue tears during extractions.
- – Manage torn flaps and tissue.
- – Recall the timeline for normal healing of an extraction site.
- – List potential causes of postoperative infections.
- – Manage most minor to moderate postoperative infections.
- – Describe trismus and the causes and management of this condition.
- – State the causes of burns or avulsive injuries.
- – Treat tissue burns and avulsive injuries.
- – Prevent or limit puncture injuries during extractions.
- – Manage an inadvertent puncture injury.
- – Recognize a mylohyoid ridge sequestrum.
- – State the causes of lingual bony sequestra and management strategies for this condition.
- – Identify common causes of broken instruments.
- – Manage situations involving broken instruments.
- – Locate the buccal fat pad and know what this structure is.
- – Avoid and manage the exposure of the buccal fat pad.
- – Assess the risk for a possible sinus exposure.
- – Recognize signs and symptoms of sinus perforation.
- – Confidently and immediately manage a sinus perforation.
- – Describe the repair of a chronic oro-antral fistula.
- – State the potential causes of tuberosity fractures.
- – Manage a fractured tuberosity or know when to refer this complication to an oral surgeon.
- – Describe the management of roots displaced into the maxillary sinus.
- – Describe the management of roots displaced into soft tissue spaces.
- – Describe the management of roots displaced into the IAN canal space.
- – Locate the infratemporal fossa.
- – Prevent displacement of upper third molars into the infra temporal fossa.
- – Understand how to manage the displacement of a tooth into the infratemporal fossa.
- – Describe osteomyelitis.
- – Recognize clinically and distinguish between the types of osteomyelitis.
- – Appreciate the complexity of the management of osteomyelitis.
- – Describe osteonecrosis.
- – Recall causes and risk factors for osteonecrosis.
- – List the treatment goals for osteonecrosis.
- – Explain the staging categories for osteonecrosis.
- – Identify common causes of condylar dislocation and demonstrate 4 techniques for reducing a condylar dislocation.
- – Describe subcutaneous air emphysema and state how it happens.
- – Recognize the signs and symptoms of subcutaneous air emphysema.
- – Manage or refer subcutaneous air emphysema based on its severity.
- – Distinguish between paresthesia, dysesthesia, and anesthesia.
- – List the potential causes of paresthesia, dysesthesia, and anesthesia.
- – Assess and manage paresthesia, dysesthesia, and anesthesia.
- – Properly manage a lingual nerve injury.
- – List potential causes of lingual nerve damage.
- – Classify lingual nerve injuries.
- – Recognize palatal necrosis and state its cause.
- – Treat palatal necrosis.
- – State common causes of iatrogenic jaw fractures.
- – Prevent iatrogenic jaw fractures from occurring.
- – Prevent or limit cases of broken needles.
- – Manage a situation involving a broken needle.
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Module 4 | Infections & Fascial Spaces
6 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – State the anatomical boundaries of potential tissue spaces of the head and neck.
- – Recognize and classify infected spaces from mild, moderate, and severe.
- – Appreciate when one should consider referring infections to a more skilled provider.
- – List the hallmark signs of infection.
- – Identify and manage delayed postoperative infections.
- – Limit cases of delayed postoperative infections through proper surgical technique and perioperative care.
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Module 5 | Diagnosis & Planning
9 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – List the indications for extracting teeth
- – Appreciate the importance of a physical examination and interview of the patient as they relate to determining extraction difficulty and complexity.
- – Understand the role that patient psychology plays in tolerating surgical procedures.
- – List tips for identifying nervous or challenging patients.
- – Interpret radiographs to more easily predict the difficulty of an upcoming extraction.
- – Identify common positioning errors when taking panoramic or intraoral radiographs.
- – Expose more optimal radiographic images.
- – Appreciate the importance of surgical planning prior to removing a tooth.
- – Approach extractions in a controlled, methodical way to limit complications and expedite the procedure.
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Module 6 | Drugs & Materials
38 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Understand the mechanism of action of NSAIDS.
- – Comprehend the benefit of taking pre-op NSAIDS.
- – Realize a reasonable strategy for the management of postoperative pain.
- – Distinguish between ibuprofen sodium and ibuprofen.
- – Understand the mechanism of action of opioid analgesics.
- – Appreciate when you may select an opioid analgesic for your patient.
- – List various types of opioid analgesics commonly used in dentistry.
- – Describe epinephrine and its properties.
- – Understand why epinephrine is used in local anesthetics.
- – Comprehend the risks associated with epinephrine.
- – List which emergency situations epinephrine may be useful for.
- – Describe a Collaplug®, how they work and when they would be employed.
- – Describe Gel Foam, how it works and when it would be employed.
- – Distinguish between bone wax and bone putty.
- – Apply bone wax or bone putty correctly at the appropriate times.
- – Describe Tranexamic Acid (cyklokapron).
- – Understand the applications for Tranexamic Acid.
- – Understand what Alveogyl® is and how it works.
- – Use Alveogyl® to treat the symptoms of alveolar osteitis.
- – Describe Warfarin (coumadin) and its properties.
- – Explain what an international normalized ratio (INR) is and why is it relevant to oral surgery.
- – Recall tips for managing a patient taking Warfarin safely.
- – Understand the mechanism of action of Aspirin.
- – Understand the mechanism of action of Plavix® (clopidogrel).
- – Manage patients taking Plavix® (clopidogrel) or Aspirin that require extractions.
- – Explain what direct oral anticoagulants are and when they are used.
- – Manage exodontia cases when a patient is taking a direct oral anticoagulant.
- – Discuss the effectiveness of preoperative steroids.
- – Discuss methylprednisolone (Medrol® Dose Pack) and when might you consider employing this drug.
- – Understand the current literature on the use of postoperative antibiotics.
- – Identify the stages of odontogenic infection and the bacterial composition of each stage.
- – Judiciously select the appropriate antibiotic for a given odontogenic infection.
- – Describe the mechanism of action of the commonly employed antibiotics in dentistry.
- – Distinguish between bacteriostatic and bactericidal antibiotics.
- – Know which drugs must be on hand for medical emergencies.
- – Identify additional drugs that should be considered as part of an emergency kit.
- – Realize how and when we employ each emergency drug in our kit.
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Module 7 | Local Anesthesia
61 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – State why needle gauge is important.
- – Understand why we aspirate prior to injecting anesthetic.
- – Demonstrate the proper aspirating technique.
- – Demonstrate safe techniques for re-capping needles.
- – Demonstrate proper technique for injecting local anesthetic.
- – Deliver more comfortable palatal infiltrations.
- – Supplement a lower block with a lingual infiltration in the appropriate situations.
- – Identify situations when mandibular infiltrations could be effective on their own.
- – Describe a periodontal ligament (PDL) infiltration and its applications.
- – Demonstrate the proper technique for a PDL infiltration.
- – Deliver atraumatic palatal anesthesia via the papilla injection technique.
- – Be familiar with the interseptal injection.
- – Demonstrate the proper interseptal injection technique.
- – Describe the gate control theory of pain.
- – Employ this theory to make injections and exodontia more comfortable for our patients.
- – Competently utilize the greater palatine nerve block.
- – Competently utilize the nasopalatine nerve block.
- – Describe the posterior superior alveolar (PSA) nerve block.
- – Demonstrate the proper technique for a PSA nerve block.
- – Understand the application of an anterior middle superior alveolar (AMSA) nerve block.
- – Demonstrate the proper technique for an AMSA nerve block.
- – Describe the anterior superior alveolar (ASA) nerve block.
- – Demonstrate the proper technique for an ASA block.
- – Understand and demonstrate 2 different approaches to maxillary (V2) nerve blocks.
- – Discuss the intraoral cervical plexus anesthetic technique (ICPAT) and the potential merits of this injection.
- – Perform a successful supplementary ICPAT injection.
- – Describe the mental nerve block and its application.
- – Demonstrate the proper technique for a mental nerve block.
- – Understand the applications for the Vazirani-Akinosi nerve block.
- – Perform a successful Vazirani-Akonosi nerve block.
- – Discuss the buccal nerve block.
- – Utilize a more predictable technique for buccal nerve block anesthesia.
- – Describe the Gow-Gates block.
- – Demonstrate the proper technique for a Gow-Gates nerve block.
- – Describe the proper inferior alveolar nerve (IAN) block technique and deliver more predictable anesthesia of the IAN.
- – Recall and demonstrate additional less-conventional approaches to IAN nerve blocks.
- – List reasons why mandibular blocks fail and how to limit failures of these blocks.
- – List the various types of anesthetic allergies.
- – Circumvent and or manage various anesthetic allergies.
- – Explain what methemaglobinemia is and how can it be triggered.
- – Discuss tachyphylaxis and how it affects the quality of our anesthesia.
- – Appreciate why infection counteracts profound anesthesia and how to overcome this.
- – Recognize the signs and symptoms of anesthetic toxicity and common causes of toxicity.
- – Identify causes of pain during dental injections and how to minimize this discomfort for our patients.
- – Recognize and manage other common complications of local anesthesia.
- – State the cause and management of temporary facial nerve paralysis.
- – Recall useful facts about anesthetic carpules.
- – Learn the properties of the 5 most commonly employed local anesthetics in dentistry.
- – Select the appropriate anesthetic for the procedure at hand.
- – Discuss the properties of articaine and it’s applications for exodontia.
- – Appreciate the controversy surrounding the use of Articaine for lower blocks.
- – Describe the types of topical anesthetic.
- – Demonstrate the proper application of topical anesthetic.
- – Discuss a potent, novel, custom compounded topical agent to employ in your practice.
- – Describe the properties of Oraverse® (phentolamine) and its recommended dosage.
- – Understand when one might use Oraverse®.
- – Explain the significance of the pKa of anesthetics.
- – Understand we have to wait for anesthetic to take effect.
- – Discuss anesthetic buffering and its advantages.
- – Utilize anesthesia in select cases to help diagnose a toothache.
- – Anesthetize pediatric patients with more confidence.
- – Understand how one can safely anesthetize a patient for multiple extractions or a full mouth clearance.
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Module 8 | Surgical Armamentarium
60 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Discuss sterile vs. non-sterile gloves for extractions.
- – Compare and contrast nitrile vs. latex gloves.
- – Safely remove and discard gloves.
- – Discuss the importance of magnification and illumination for exodontia.
- – Respect that oropharyngeal protection is the standard of care during extractions.
- – Identify numerous items and techniques to protect the airway.
- – List various types of bite blocks and demonstrate unique ways of using them.
- – Identify common scalpel blades and handles.
- – Demonstrate the proper grip and scalpel technique.
- – Compare and contrast available surgical handpieces.
- – Appreciate the benefit of a bur guard for a straight handpiece.
- – List common and unique surgical burs.
- – Select the appropriate surgical bur for the situation.
- – Name various types of surgical suctions.
- – Select the appropriate suction for the procedure.
- – Recognize common types of retractors for oral surgery.
- – Properly hold and place these retractors in the mouth.
- – Use the Isolite® or Isodry® system in a novel way.
- – Demonstrate proper use of a periosteal elevator.
- – Distinguish between the ends of a periotome and state their functions.
- – Understand the purpose of a periotome.
- – Demonstrate proper technique for using a periotome.
- – State what luxating hybrid elevators or Proximators™ are.
- – Demonstrate proper technique for using locating hybrid elevators or Proximators™.
- – Sharpen their luxating hybrid elevators or Proximators™.
- – Describe what a luxator is and demonstrate the appropriate technique for using luxators.
- – Demonstrate the appropriate use and grasp of a 301 elevator.
- – Distinguish between the 77R and 46R elevators.
- – List benefits and characteristics of the 77R and 46R elevators.
- – Describe the 303 apexo elevator and list its characteristics.
- – Add the 63 spade elevator to their armamentarium and use it effectively.
- – Demonstrate the wheel and axle movement for proper use of a cryer elevator.
- – List types of cryer elevators and know when it may be advantageous to use them.
- – Distinguish between a Cogswell B and a Crane Pick.
- – Demonstrate the creation of a purchase point.
- – Demonstrate proper use of a Cogswell B or a Crane Pick.
- – Describe a root tip pick.
- – Demonstrate the proper technique for using a root tip pick to retrieve a root fragment.
- – Describe the Stieglitz forceps.
- – Be familiar with the Peet forceps.
- – State how the Stieglitz or Peet forceps can be used for exodontia.
- – Distinguish between English and American forceps.
- – Discuss advantages and disadvantages of English and American forceps.
- – Utilize the 88L and 88R to extract upper molars.
- – Demonstrate the proper technique for the 23 cowhorn forceps.
- – Discuss the benefits and application of the 222 forceps.
- – Distinguish between the 210S and 210H forceps and know when they may be beneficial.
- – Recognize a curette and know when and how to use it.
- – Identify areas to be cautious around when curetting.
- – Describe various types of rongeurs.
- – State when, why, and how a rongeur is used during a surgical procedure.
- – Discuss various types of bone files.
- – Explain why a bone file is used in certain situations.
- – Demonstrate the proper technique for using a bone file.
- – Understand the uses of a hemostat for exodontia.
- – Distinguish between a hemostat and a needle driver.
- – Identify various types of tissue forceps.
- – Appreciate why it is beneficial to use tissue forceps for surgical procedures.
- – Recall various styles of needle drivers including the Castroviejo, Olsen-Hegar, and Mayo-Hegar.
- – State how scissors can be used for surgical procedures.
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Module 9 | Surgical Technique
29 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Position their patients properly when removing teeth in the maxilla.
- – Position their patients properly when removing teeth in the mandible.
- – Demonstrate the appropriate technique for using a straight elevator.
- – Compare and contrast an overhand forceps grasp with an underhand forceps grasp.
- – State the goals of an extraction.
- – List tips to facilitate better and more predictable extractions.
- – Recount the general technique for a simple extraction.
- – Explain what a purchase point is.
- – Realize how we use purchase points to our advantage.
- – Demonstrate how to make a purchase point.
- – Demonstrate the technique to create full thickness flaps.
- – Recite the areas where incisions should not be made.
- – State the fundamentals of proper flap design and reflection.
- – Know when to use envelope flaps.
- – Discuss the benefits of an envelope flap.
- – Demonstrate the technique to create an envelope flap.
- – Know when to use a three-cornered flap.
- – Demonstrate how to create a three-cornered flap.
- – Know when to use a four-cornered flap.
- – Demonstrate how to create a four-cornered flap.
- – Discuss the technique for completing a buccal advancement flap to repair a sinus perforation.
- – State the advantages and disadvantages of a buccal advancement flap.
- – Confidently section and surgically remove maxillary and mandibular molars.
- – Confidently section premolar teeth or broken roots when appropriate.
- – Understand what bone troughing is and why it is useful in select situations.
- – Be familiar with the equipment and technique necessary to create a trough during an extraction.
- – List reasons why bone is removed during extractions.
- – Discuss the proper approach to conservative bone removal.
- – State the goals of socket debridement.
- – Perform adequate socket debridement after an extraction.
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Module 10 | Extracting Specific Teeth
6 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Describe the anatomy of maxillary and mandibular incisors, canines, premolars, and molars.
- – Recount the technique and instruments necessary to confidently extract maxillary and mandibular incisors, canines, premolars, and molars.
- – Discuss the instruments and approach necessary to remove erupted maxillary or mandibular third molars.
- – List instruments to extract primary teeth more safely and predictably.
- – Appreciate the nuances of extracting teeth in pedodontic patients.
- – Demonstrate the proper technique for removal of all primary teeth.
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Module 11 | Suturing 101
16 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – List various types of suture needles and discuss their properties.
- – Distinguish between monofilament and polyfilament sutures.
- – Distinguish between absorbable and non-absorbable sutures and understand how to select the appropriate kind.
- – Explain why we suture.
- – List common types of sutures and suturing armamentarium.
- – Demonstrate the proper technique for passing a suture through the tissue.
- – Discuss tips, techniques, and materials to simplify the suturing process.
- – Confidently place simple interrupted sutures.
- – Understand the benefits of a figure eight suture.
- – Perform a figure eight suture.
- – Demonstrate a horizontal mattress suture and list indications for this type of suture.
- – Demonstrate a vertical mattress suture and state when you may use this type of suture.
- – Confidently perform a continuous suture and list advantages and disadvantages of this type of suture.
- – Demonstrate a continuous locking suture and understand the benefits of this type of suture.
- – Bury suture knots in select situations.
- – Explain the proper technique for removing sutures.
- – Recite common suturing errors leading to difficult placement and failure of the sutures.
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Module 12 | CLINICAL SITUATIONS & TIPS
28 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- – Recognize the signs and symptoms of pericoronitis.
- – Diagnose and definitively treat pericoronitis.
- – Understand when an intra-oral incision and drainage procedure may be necessary.
- – Appreciate when would you consider referring to an oral surgeon for management of an infection.
- – Explain why incision and drainage is beneficial for resolving infection.
- – State the general approach to incision and drainage procedures.
- – Confidently and predictably extract teeth when there is large buccal or lingual decay present.
- – Extract malaligned teeth presenting with more difficult instrument access.
- – Extract decayed, partially soft tissue covered root tips.
- – Explain how impacted lower third molars can complicate the removal of lower second molars.
- – List common complications when extracting endodontically treated teeth and ways to avoid them.
- – List reasons for extracting endodontically treated teeth.
- – Discuss the general approach to extracting teeth afflicted with hypercementosis.
- – Confidently extract teeth with internal or external resorption.
- – State how you diagnose true ankylosis.
- – List possible etiologies for ankylosis.
- – Recall a method for extracting ankylosed teeth more predictably.
- – Manage and section a maxillary molar with two fused roots.
- – Recover from a failed attempt at sectioning a tooth.
- – Understand the risks of sectioning primary teeth when this may be necessary in select situations.
- – Discuss the nuances of the extraction of a retained primary tooth.
- – Distinguish between primary retention, secondary retention and impaction.
- – Understand strategies for resolving primary or secondary retention in children and adolescents.
- – List causes of oroantral communications.
- – Describe the management of an oroantral communication.
- – List tips to avoid extracting the wrong tooth.
- – Recall tips and strategies for removal multiple teeth in a single appointment.
- – Place gauze properly after the extraction of a tooth.
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Module 13:
Mastering Third Molars
72 Objectives
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Objectives
- Following completion of this course the participant will be able to:
- - Recall the stages and timeline of third molar development.
- - Discuss the phenomenon of third molar agenesis.
- - Recite the main theories of third molar impaction including the orthodontic, pathologic, phylogenic, Mendelian, and endocrinal theories.
- - List other potential contributors to third molar impaction.
- - List the sequelae of retaining impacted third molars.
- - Locate the third molar white paper for future reference.
- - Discuss the key points listed in the third molar white paper that should factor into treatment decisions made regarding third molars. These points include: predicting eruption, the effects of retaining third molars, timing for removal, orthodontic considerations, prosthodontic considerations, imaging techniques, coronectomy procedures, lingual retraction, socket grafting, and nerve damage and its management.
- - Appreciate and understand the A.A.O.M.S. standpoint on the management of third molars.
- - Understand current literature on the topic of prophylactic third molar removal.
- - Identify two major publications arguing against the prophylactic removal of third molars.
- - Describe what a germectomy is.
- - Discuss reasons why prophylactic third molar removal is beneficial.
- - Discuss reasons why prophylactic third molar removal could be detrimental.
- - Understand how the anatomy influences the various aspects of the removal of impacted mandibular third molars.
- - Describe the key anatomical considerations for mandibular third molar removal including: bony anatomy, nerves, vessels, the buccal fat pad, potential spaces, and muscle attachments.
- - Explain what a tooth follicle is.
- - Discuss when follicular tissue should be sent for histopathologic examination.
- - Appreciate current thinking regarding CBCT imaging vs. panoramic images as they pertain to third molar removal.
- - Recall studies citing surgical outcomes comparing the two aforementioned imaging modalities.
- - State when the IAN is at higher risk for injury during third molar removal by correctly identifying its relationship to the tooth roots.
- - Use proper terminology when describing the relationship of the IAN to the third molar roots including: superimposition, notching, grooving, perforation, and deflection.
- - Recite the Pell & Gregory difficulty classification for impacted third molars.
- - Recite Archer’s difficulty classification for upper impacted third molars.
- - Understand how Winter’s lines can be used to gauge the difficulty of an impaction.
- - Outline ways to identify confidence-building third molar cases to start tackling in your office.
- - State a logical progression for advancement into more difficult third molar cases.
- - Differentiate between implied consent and express or informed consent.
- - Recall how age, drug addiction, and mental capacity factors into the informed consent process.
- - Develop a template for more comprehensive treatment notes.
- - List the 5 main components of a proper informed consent process.
- - Learn how to anesthetize a patient sufficiently for the removal of four third molars.
- - State useful tips to apply when anesthetizing for all four third molars.
- - Discuss the factors that influence flap design.
- - Compare and contrast the envelope flap vs. the triangular flap when accessing third molars.
- - List helpful tips for designing and executing proper flaps.
- - Explain how you prepare the surgical site for an incision.
- - Outline the four main objectives of a third molar flap incision.
- - Recall the steps require to plan your incision line.
- - Demonstrate the appropriate technique for creating a successful third molar flap incision.
- - Demonstrate how to create a proper releasing incision.
- - Demonstrate the appropriate steps to elevate a clean third molar flap.
- - Understand the concept of physiologic dead space and how it applies to flap reflection.
- - Discuss how you would free the distolingual or lingual tissues if they are in the path of withdrawal when delivering a third molar.
- - List 3 common instruments that can be be used to retract third molar flaps.
- - Describe the proper technique for third molar flap retraction.
- - Explain why troughing and/or bone removal is necessary when removing impactions.
- - Recollect the goals of effective troughing and bone removal.
- - Describe nuances for an assistant to help with irrigation, suction, and isolation when removing impactions.
- - Purchase the appropriate equipment (handpieces, motors, burs, etc.) for bone removal and understand the rationale for the equipment recommended.
- - Discuss properties of surgical burs and list a few recommended burs for accurate troughing and bone removal.
- - Demonstrate the proper technique for troughing a third molar impaction.
- - Touch upon possible complications associated with bone removal and troughing in addition to ways to minimize the incidences of these complications.
- - Demonstrate how to create or utilize a purchase point for elevation.
- - State the goal of, and rationale for sectioning third molars.
- - List several tips to simplify sectioning and minimize failed sectioning attempts.
- - Demonstrate how to safely section a third molar.
- - Describe the appropriate way to elevate third molars to minimize complications and maximize success.
- - Describe how to properly debride the third molar surgical site following tooth delivery.
- - Discuss proper flap closure in the third molar region including: suture choice, suturing method, and tissue modification.
- - Recall what is known about suture-less flaps.
- - Demonstrate approaches and instruments for the successful removal of mesioangular mandibular third molar impactions.
- - Demonstrate approaches and instruments for the successful removal of horizontal mandibular third molar impactions.
- - Demonstrate approaches and instruments for the successful removal of vertical mandibular third molar impactions.
- - Demonstrate approaches and instruments for the successful removal of distoangular mandibular third molar impactions.
- - List tips for determining the degree of access to maxillary third molar sites.
- - Demonstrate approaches and instruments for the successful removal of maxillary third molar impactions.
- - Explain a protocol for assessing and managing postoperative bleeding.
- - Recall meta-analyses looking at the effect of antibiotics on the incidence of alveolar osteitis and post-op infection following third molar removal.
- - Understand situations where antibiotics may be recommended and how to appropriately integrate the use of chlorhexidine mouth rinses into your preoperative and postoperative regimen.
- - Discuss the effects of intra-socket medicament immediately following third molar removal.
- - Describe a coronectomy procedure and appreciate its difficulty to perform.
- - Understand current thinking on the application of the coronectomy procedure in select third molar cases.
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Module 14:
Coming Soon!
-- Objectives
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Objectives
- Course objectives will be disclosed when the module is published.
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Module 15:
Coming Soon!
-- Objectives
x
Objectives
- Course objectives will be disclosed when the module is published.
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