Osseous Surgery

Osseous Surgery is done when a patient has infection after implant placement.

            Preparations:
- Endogain gel
- Prefgel ( both the gels from the refrigerator that is in a box)
- Perio surgery cassette
- Hydrogen Peroxide
- Clindamycin
- Endo syringe 2
- # 15
- Chromic gut suture 18"
- Donated bone tissues ( RMTB ) box
- Hemostat (cassette should have this one)
- 2 metal cups
- Normal saline
- Anesthetics & needle + syringe (cassette should have syringe)
- Resorbable collagen membrane (graft box )
- Calcium ( very small bottle )
- Sterilized 2/2
- Scalpel (cassette should have this one)

- Prepare 2 disposable dampen dishes and 2 micobrushes to be autclaved
- Surgical suction

                Procedure:
Pass the anesthesia. Wait for awhile. Doctor cuts the infected area creating a flap with #15. After the gum is open pass the endo curette . When the area is being curetted keep on suctioning. When done curetting pass Chlorhexidine to rinse along with suctioning. After rinsing mix 1 capsule of Clindamycin in minimal amount of normal saline . Soak for ~ 5 minutes.  Rinse with normal saline. Keep suctioning. Clean the area and pass the Prefgel in a dampen dish enough to apply the uncovered area along with a small brush and rinse with normal saline . After applying Prefgel pass small amount of Emdogain just enough to apply on the uncovered bone and root with the brush ( this application helps in bonding of the bone tissues that we will apply (in fact helps bone and connective tissue bond to the root surface ) .  Pass the bone tissues. Then pass 2/2 to dry blood without suctioning. When it's dry pass the collagen membrane in a small piece according to shape of the uncovered area, so that it can fit and fully cover the defect. To reshape the size the membrane can be cut again but the cut part should be folded and passed. Help to stretch both the flap and the membrane all over bony part. When all covered pass the 18" chromic gut suture and stitch it. Clean the patient's face if needed and then escort the patient.

Suniti....

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Xin Wei, DDS, PhD, MS 1st edition 09/22/2013, last revision 09/22/2013