informations collected by my colleague Dr.Kunal Banerjee

1. BY:
KUNAL BANERJEE
CRI, MADC, CHENNAI

2. CONTENTS:
HEALING
 TYPES OF HEALING
 HEALING OF EXTRACTION WOUNDS AND RELATED COMPLICATIONS
BIOPSY
 TYPES OF BIOPSY
 TECHNIQUES RELATED TO BIOPSY
EXFOLIATIVE CYTOLOGY
 TECHNIQUES
 USES
 LIMITATIONS

3. HEALING
Healing
Replacement of destroyed tissue by living tissue to
restore function.
Repair
Replacement of lost tissue by granulation tissue which
results in scarring.
Regeneration
Replacement of lost tissue by similar type of tissue.

4. TYPES OF HEALING:
Primary Intention
The edge of the wound in which there is no tissue loss are
placed in essentially the same anatomic position they
held before injury.
Secondary Intention
It implies that a gap is present between the edges of an
incision or that tissue loss has occurred in wound that
prevents close approximation of the wound edges.

5. HEALING OF EXTRACTION WOUNDS:
It does not differ from healing in other
wounds of body except that it is
modified by the peculiar anatomic
situation which exists after removal of
tooth.

6. IMMEDIATE REACTION FOLLOWING
EXTRACTION:
Blood coagulation
Vasodilatation
Mobilization of Leucocytes
Collapse of unsupported gingival
tissue into position
Clot contraction

7. First week wound:
Periphery Center
Fibroblast
proliferation Blood clot
Angiogenesis Layering of
leucocytes
Proliferating
Fibroblast
epithelium
infiltrate &
microvasculation
Osteoclastic
activity at crest Granulation tissue

8. Second week wound:
Periphery Center
PDL degenration Organisation
of blood clot
Frayed socket wall
Outwardly extended
osteoid trabeculae
Epithelial proliferation

9. Third week wound
Complete
epithelialisation
Organised clot
Young trabeculae of osteoid bone
at periphery
Crest of alveolar bone rounded
off by resorption

10. Fourth week wound:
Continuous deposition remodelling and
resorption of bone filling alveolar socket
Radiological evidence of bone not prominent
till sixth or eight week after extraction
Radiological evidence of differences in new bone of
alveolar socket and adjacent bone for as long as four
to six months

11. COMPLICATIONS OF EXTRACTION
WOUND HEALING:
A. DRY SOCKET
Other names- Alveolar osteitis, localized acute alveolar
osteomyelitis
Incidence- more in woman and tobacco users
- associated with difficult extractions
Frequency- between 1 and 3.2% of all extractions

12. Factors influencing occurence of dry
socket:

13. Pathogenesis:
Dry socket
Clot Lysis
Anaerobic
bacteria Plasmin

14. CLINICAL FEATURES OF DRY SOCKET:
• Extreme pain
• Low grade fever
• Ipsilateral lymphadenopathy
• Exposed bone necrosis
• Foul odour
• No suppuration

15. Prevention and management:
•Prevention- By care excercised in handling the living
tissues
• Management- Keep extraction socket clean
- Irrigate with mild warm antiseptic
-Then fill with obtundent dressings
- Change dressings every day
• Most patients symptom free after one two dressings
• Other agents inserted into socket with success:
Areomycin, Sulfanilimide, Sulfathiazole, Tetracycline
hydrochloride

16. B. Myospherulosis
C. Fibrous healing of extraction
wounds
D. Implantation cyst

17. BIOPSY
•It is the removal of tissue from the living
organism for purpose of microscopic
examination and diagnosis.
• It also serves as treatment options for
smaller lesions by excising in toto.

18. TYPES OF BIOPSY:
•Excisional biopsy-preferred if size of lesion
is such that it may be removed along with a
margin of normal tissue and the wound
closed primarily.

19. • Incisional biopsy-useful in dealing with
large lesions
which operator suspect may be treated by means other
than surgery.
• Biopsy should include surrounding normal tissue with
adequate depth of underlying connective tissue.

20. METHODS USED FOR OBTAINING BIOPSY:
•Surgical excision using-Scalpel
•Cautery
•Laser
•Biopsy forceps [punch biopsy]
•Aspiration with needle

21. BIOPSY TECHNIQUE:
Biopsy technique
 Do not paint surface of area to be biopsied with iodine or highly
coloured antiseptic.
 If using infiltration anaesthesia inject around periphery
 Use sharp scalpel to avoid tearing lesions
 Remove border of normal tissue with specimen if at all possible
 Use care not to mutilate specimen
 Fix tissue immediately upon in 10%FORMALIN/70% alcohol
 If specimen is thin place it on a piece of glazed paper and drop into
the fixative to prevent curling of tissue

22. EXFOLIATIVE CYTOLOGY:
 This is the study of cells which exfoliated or abrade from
body surface
 When epithlium becomes seat of any pathology, cells
lose their cohesive ness and cells in deeper layers may
shed along with superficial cells

23. SALIENT FEATURES
Cytology is not a substitiute but an adjunct to
surgical healing.
 It is a quick simple painless and bloodless
procedure.
 It is especially helpful in follow up detection of
recurrent carcinoma in previously treated cases.
 It is valuable for screening lesions whose gross
appearance is such that biopsy is not warranted.

24. Preferred technique:
 Cleansing surface of oral lesion of debris and mucin
 Scraping of lesion several times with metal cement
spatula , moistened tongue blade, cytobrush
 Collected material then quickly spread evenly on a
microscopic slide and fixed before specimen dries[
fixative- spray cyte,95% alcohol, equal parts of alcohol
and ether
 Allowed to stand for 30 minute to air dry
 Two smears are prepared for each lesion since
additive staining techniques are frequently employed

25. TYPES OF CYTOLOGIC SMEARS:
CLASS-
I
CLASS CLASS
V II
SMEAR
CLASS CLASS
IV III

26. USES:
•Cancer diagnosis
• Herpes simplex
• Herpes zoster
• Pemphigus vulgaris
• Benign familial pemphigus
• Pernicious sickle anaemia

27. LIMITATIONS:
•Presence/extent of invasion cannot be assesed
• Majority of benign lesions that occur in oral
cavity do not lend themselves to smear test eg
fibroma
• Leukoplakia does not apply for smear test
because of scarcity of viable surface cells in
smears
• Negatively cytology report does not rule out
cancer