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Oral Surgery

How Do I Manage Oroantral Communication? Key Points

This Urgent Care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Archie Morrison and is also available through the JCDA Oasis Mobile Oroantral Communication (Oroantral Fistula) Oroantral Communication (OAC) is an abnormal communication between the maxillary sinus and the oral cavity. It may be the result of different pathological processes and often occurs following an extraction. Other causes for OAC include: infection, inflammatory conditions, neoplasm, Paget’s disease, iatrogenic injury, and trauma.  Presentation Population Individuals who recently underwent maxillary posterior tooth extractions. Individuals presenting for extraction of a long-standing lone posterior maxillary molar. Individuals presenting with ...

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oasisImage of the Week: Persistent ‘mucocele’ in a 16 year old boy

A 16 year old boy had a swelling in his right lower lip removed at age 4 while living overseas. At that time the surgeon told the father that it was multiple small mucoceles and that he could not get all of it. The specimen was sent to a general pathologist who confirmed it as a mucocele. Between the ages of 13 and 15, the lesion returned, larger and more sore. It was excised again at age 15 and at that time it was diagnosed as a verruca vulgaris with submucosal capillary ectasia and edema with stromal inflammation. They now ...

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Clinical Case: How do I quantify the risk of nerve injury with wisdom teeth extraction? (VIDEO SOLUTION)

This case is presented by Drs Stephen Cho & Ian Furst at Coronation Dental Specialty Group & Cambridge Memorial Hospital A 56 year old male has a partially impacted wisdom tooth #3.8, communication to the mouth, pericoronitis and a complaint of persistent pain associated with the tooth. You take a panorex and note the overlap of the inferior alveolar nerve. Based on current scientific data, what is the risk, during an extraction, of an intimate association between the tooth and nerve? Is there a scientifically valid way of determining which developing wisdom teeth are likely to become partially impacted? The ...

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oasisImage of the Week: Why can’t he feel his forehead?

A 35-year old man develops a serious infection from an impacted 2.8. The tooth is extracted and the infection is drained but he develops a serious bleed 3 days after surgery (from the internal maxillary artery) which requires neuroradiology embolization. One month later, he has recurrent swelling around the left temple and TMJ but also complains he feels numbness in the entire trigeminal nerve, including V-1. Attached is a slice of the MRI and an intraoperative shot. Why can’t he feel his forehead?

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Misplaced tooth #1.3

Clinical Cases Update: How would you design the surgical flap for this case? The ectopic canine

Ian Furst, Oral & Maxillofacial Surgeon, Coronation Dental Specialty Group The solution we used; The consensus from the comments is that most would have waited for the tooth to erupt.  In this case, the orthodontist had asked that tooth 1.4 be extracted and the 1.3 be further exposed and bonded.  Because we are a multi-disciplinary practice, I had the luxury of having the periodontist I work with take a look as well.  Both of us were concerned that tooth 1.3 would develop recession on traction.  Because there would be a good band of keratinized tissue between 1.3 and the extraction site of 1.4, I ...

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Does use of local antibiotic as an adjunct to flap surgery confer benefit?

(Content under development) The following question was submitted by a practising dentist: What is consensus on using local antibiotic with or without flap involvement? Is raising a flap and using antibiotics significantly better than without? JCDA Editorial Consultant Dr. Debora Matthews of Dalhousie University provided this initial response for consideration: When we talk about using antibiotics for our patients we have to think about the risk/benefit ratio. While the risk of systemic side effects is low, other potential risks exist, including increasing bacterial resistance, and the potential for allergic reactions. It is important to ask ourselves if these risks (for ...

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