1. Minor surgical
procedures
Instructor – Dr. Jesus George 1

2. Procedures
Extraction
Incision & flap
Incision & drainage
Incisional biopsy
Excisional biopsy
Excision of Mucocele
Marsupilization
Enucleation
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3. Cont.
Frenectomy
Apicoectomy
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4. Extraction
Ideal extraction is the painless
removal of the whole tooth or root or
remaining portion of tooth with mini.
Trauma to investing tissues so that
wound heals uneventfully & no future
problems
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5. Indications
Carious teeth that cannot be
restored
Decay reaching to bifurcation
Primary teeth interfering with normal
eruption & alignment of permanent
tooth
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6. Cont.
Periapical pathology with poor
prognosis
Root # due to trauma & subsequent
infection
Rudimentary supernumerary teeth
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7. Contraindications
Local –
– A/c infections
Stomatitis
Vincent’s infection
Herpetic stomatitis
a/c dentoalveolar abscess (with cellulitis
immediate extraction)
– Malignancy
Trauma enhances growth & spread of
tumor, but before radiation extraction can
be done
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8. Cont.
Systemic – relative
– a/c systemic infections
– a/c or c/c rheumatic heart disease
(congenital heart disease & renal
disease require consultation with
physician if antibiotic prophylaxis is
needed)
– Diabetes mellitus, blood dycrasias –
consult physician
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9. Cont.
Absolute contraindication
– Arteriovenous fistula
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10. Preoperative preparation of parent
Get parental consent
Discuss the treatment plan with the
parent
Reassure the parent about the post
operative problems
Instruct the parent not to discuss
with the child about the treatment
which may make the child fearful
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11. Preparation of child
8-10 years children are told about
the extraction 4-7 days in advance
Younger children should be told on
the day of appointment
Instruments are kept behind the
chair
Never hold the needle in front, it
should be hidden with fingers
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12. Cont.
Before giving LA, explain the child
that sensation of pinching or ant
biting may be there
Explain the sensation of numbness
When checking for LA note the eye
reaction
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13. Technique for removal of primary
teeth
Position of operator
– Maxillary right & left quadrants &
mandibular left quadrant - in front & to
the side of the patient
– Mandibular right quadrants – back &
side of the patient
Basic forces
– Initial apical force to all teeth
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14. Cont.
– Maxillary & mandibular 6 anterior teeth
– labial movement, mesial rotation &
removed in labial direction
– Maxillary & mandibular molars – lingual
& buccal movements & removed
buccally
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15. Trauma to permanent tooth
While extracting primary teeth beaks
of forceps should not be placed high
up on roots as there is increased
possibility of removing partially
formed permanent tooth, if this
happens partially formed tooth
should be separated from primary
roots & permanent tooth along with
bone is replaced into alveolus
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16. Cont.
Soft tissue is then sutured to hold
tooth & bone
Curette should not be used to
remove periapical pathology as it
may cause injury to permanent tooth
bud
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17. Control of hemorrhage
Keep gauze held firmly b/w jaws for
½ hour after extraction
Do not gargle vigorously for 6 hrs
after extraction
If bleeding from vessels a suspected,
use
– Adrenaline on gauze
– Thrombin on gauze
– Gel foam in thrombin
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18. Post operative instructions
For child
– Should not be dismissed until blood clot
is formed
– When changing gauze blood soaked
gauze should be disposed out of sight of
child
– Once clot is formed child is told to hold
a small cotton roll b/w teeth for ½ hr
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19. Cont.
– Child is instructed not to bite lips & not
to disturb the area from where tooth
was removed
– Child should not rinse the mouth
vigorously for 24 hrs after extraction
– should not take juices with straw
For parent
– Reinforce what was told to child
– Soft diet on the day of extraction
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20. Cont.
– Analgesics & antibiotics to be given if
the area was infected
– Blood can appear in the pillow the next
day because blood is mixed with saliva
– Call if undue symptoms appears
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21. Incision & flap
Most commonly on buccal side flap
raised are envelope type
Features of this flap
– Crevicular incision around neck of teeth,
– Edentulous area incision is continued
over ridge
– Base of flap should be broader for good
blood supply.
– No releasing incision is given in palate
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22. Cont.
– Incision is placed in such a way that
complete interdental papilla is included
in flap, for proper interdental suturing.
– All incision lines should be backed by
bone
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23. Incision & drainage
When swelling localizes into soft,
fluctuant, palpable mass, it should be
incised and drained to reduce
swelling and pain.
Area is anaesthetized by IAN or
infiltration not in swollen tissues.
Spray topical anesthetic to swollen
area
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24. Cont.
Using scalpel enter swelling through
center of soft fluctuant mass.
If swelling is hard or indurated bathe
the tissue in saline rinse for 5min.
every hr.
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25. Incisional biopsy
A part of lesion is removed to
confirm Diagnosis
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26. Excisional biopsy
In small lesion, whole lesion with
normal tissue is removed.
Specimen is placed in 10% formalin
for transport to laboratory.
If lesion is benign and do not
interfere with function it can be
removed after child grows.
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27. Excision of Mucocele
Elliptical incision around the lesion
and is excised
First superficial incision is placed
over the lesion. Then lesion is
separated on either sides and is
excised.
In both cases minor salivary gland
around the lesion is excised.
If lesion is deep, tissues are sutured.
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28. Marsupilization
Removal of a part of lining, then
lesion shrinks in size
In case of large cysts or cyst
interfering the vital structures
marsupliazaion should be done.
Lining is sutured to edge of mucosa.
Gauze is placed in the cavity
Patient should keep cavity clean.
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29. Enucleation
Lesion is removed along with lining.
Envelope flap is raised.
If bone is covering cyst, it is removed
Cyst lining is separated from bone and is
removed.
Spoon excavators are used to separate
lining from bone.
If impacted tooth is there it should be
removed
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30. Frenectomy
Frenectomy is done in following
cases
– Gingival recession
– Diastema formation
– Accumulation of debris by opening of
sulcus.
Technique: complete excision.
Incision perpendicular to frenum is
done in mucobuual fold
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31. Cont.
It is extended around frenum in both
direction such that bell shaped defect
is formed.
The incision is carried out in bone.
Tissue is then excised.
If vestibule is not deep enough, it
should be deepened.
Sutured & Periodontal pack can be
given and is removed after 2 weeks.
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32. Apicoectomy
Resection of root
Indications:-
– apical discharge or perforation
– Unsuccessfully treated apical accessory
canal.
Technique:- Determine level at which
the root to be amputated.
Should remove unfilled portion of
root canal.
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33. Cont.
If periapical cyst or granuloma is
there, it should ensure complete
removal.
Mucoperiosteal flap is elevated.
Incision is made up to bone.
Soft tissue should be supported by
healthy bone when replaced.
Make an opening in labial plate with
bur or chisel.
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34. Cont.
Amputate root with cylindrical bur.
Cyst, granuloma are enucleated by
curettes.
Control bleeding by pressure or
cotton pellets in epinephrine.
Suture with silk or catgut
Maintain firm pressure over area to
prevent hematoma.
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