# Introduction to Practical Oral Surgery 2026 DENT5310 Dr Richard Hague  DENT5310 Dr Richard Hague Historical illustration depicting a dental extraction procedure. A patient in a green jacket and striped shirt sits in a chair while a dentist (in black coat) performs an extraction with visible force. Caption at bottom reads 'A strong pull, I...'. Illustration serves as visual context for practical oral surgery course DENT5310. * I am a **General Dentist** with an interest and **significant experience in Oral Surgery.** * Working day is Tuesday * Covering the Oral Surgery Module on behalf of Dr Helen Grady * Principal Dentist at All Saints Dental Group in Rockingham * Private GA surgery at Southbank Day Surgery #### Clinical Background and Experience - General Dentist with an interest and significant experience in Oral Surgery - Principal Dentist at All Saints Dental Group in Rockingham - Private GA surgery at Southbank Day Surgery #### Availability and Role - Working day is Tuesday - Covering the Oral Surgery Module on behalf of Dr Helen Grady # Session Outcomes * Appropriately refer a patient to the student extraction clinic * Be aware of factors that complicate extractions * Understand local anaesthetic techniques and doses as they apply to oral surgery * Describe the instruments required for simple exodontia * Understand the principles of mechanics for simple exodontia * Demonstrate the safe use of luxators and forceps * Demonstrate the safe use of sutures #### Clinical Referral and Assessment - Appropriately refer a patient to the student extraction clinic - Be aware of factors that complicate extractions #### Local Anaesthesia and Instrumentation - Understand local anaesthetic techniques and doses as they apply to oral surgery - Describe the instruments required for simple exodontia #### Surgical Principles and Techniques - Understand the principles of mechanics for simple exodontia - Demonstrate the safe use of luxators and forceps - Demonstrate the safe use of sutures Getting a patient to Clinic 5 – Extraction (Exo) Clinic Getting a patient to Clinic 5 – Extraction (Exo) Clinic Chance GO DIRECTLY TO JAIL © 2008 Hasbro. 45644 DO NOT PASS GO, DO NOT COLLECT $200  Chance GO DIRECTLY TO JAIL DO NOT PASS GO, DO NOT COLLECT $200 A Monopoly 'Chance' card illustration showing a man in a suit being arrested by a police officer with a flashlight. The text reads 'Chance', 'GO DIRECTLY TO JAIL', and 'DO NOT PASS GO, DO NOT COLLECT $200'. Copyright information is present at the bottom right. # Extraction Clinic All patients need to meet the criteria below to have the extraction done by DMD students: **• No impacted teeth** **• Do NOT book for extraction of > 3 teeth at any one time*.** **• No patients requiring sedation** **• No patients requiring AB cover** • No patients who have had previous RadioTherapy (RT) to the head and neck • No patients on anti-resorptive agents (e.g. Bisphosphonates or Prolia) • No patients on immunosuppressants (e.g. Azathioprine or Methotrexate) **• Patients on warfarin must have their INR checked within 24 hours prior to the extraction. Patient to bring their INR results to the appointment.** **• No patients on DUAL anti-platelets (e.g. Aspirin and Clopidogrel) or DUAL anti-coagulants (e.g Aspirin and Rivaroxiban)** It is OK to book patients on a single anti-platelet or a new oral anti-coagulant (Aspirin OR on NOAC). All patients must meet the following criteria to have extractions performed by DMD students: #### Clinical Contraindications - No impacted teeth - No patients requiring sedation - No patients requiring antibiotic (AB) cover #### Medical History Restrictions - No patients who have had previous Radiotherapy (RT) to the head and neck - No patients on anti-resorptive agents (e.g., Bisphosphonates or Prolia) - No patients on immunosuppressants (e.g., Azathioprine or Methotrexate) #### Medication and Coagulation Management - **Warfarin:** Patients must have their INR checked within 24 hours prior to the extraction. The patient must bring their INR results to the appointment. - **Anti-platelets and Anti-coagulants:** - No patients on DUAL anti-platelets (e.g., Aspirin and Clopidogrel) or DUAL anti-coagulants (e.g., Aspirin and Rivaroxaban). - It is acceptable to book patients on a single anti-platelet or a new oral anti-coagulant (Aspirin OR a NOAC). #### Appointment Limitations - Do NOT book for extraction of more than 3 teeth at any one time. Extractions and Prosthodontics * If bridge sectioning is required before **extraction(s), please ensure you have done this prior to the patient attending exo clinic.** * Each chair in Exo clinic can accommodate two patients per session, with each appointment being **1hr 45mins.** * Immediate complete and partial dentures can be inserted in Exo clinic, but the review appts will be organized by usual student clinician in CC session. * **Patients must be warned that if the prosthesis fails to fit there is little that can be done in the exo clinic.** #### Clinical Preparation and Scheduling - If bridge sectioning is required before extraction(s), please ensure you have done this prior to the patient attending the exo clinic. - Each chair in the Exo clinic can accommodate two patients per session, with each appointment lasting 1 hour and 45 minutes. #### Immediate Dentures - Immediate complete and partial dentures can be inserted in the Exo clinic. - Review appointments will be organized by the usual student clinician in a CC session. - **Warning:** Patients must be warned that if the prosthesis fails to fit, there is little that can be done in the exo clinic. **What to do if they don’t meet criteria?** 1. Speak to the tutor covering the clinic on the proposed appointment. E.g Multiple teeth. 2. Refer to E Block I. “Add a new waitlist entry” II. “Oral Surgery” III. “Referral to Specialist” IV. Add relevant clinic information. 3. If **urgent**, add the referral on Titanium and then the student clinician is to come IN PERSON to E Block with the patient details and reason for urgency. I. If the referral is not found on Titanium, this will be immediately rejected. If a patient does not meet the standard criteria, follow these protocols: #### Consultation and Internal Referral 1. Speak to the tutor covering the clinic on the proposed appointment date (e.g., for cases involving multiple teeth). 2. Refer to E Block via Titanium: 1. Select "Add a new waitlist entry" 2. Select "Oral Surgery" 3. Select "Referral to Specialist" 4. Add relevant clinic information #### Urgent Referrals - If the case is urgent, add the referral on Titanium first. - The student clinician must then go IN PERSON to E Block with the patient details and the reason for urgency. - **Note:** If the referral is not found on Titanium, it will be immediately rejected. Assessing complexity Is this suitable for DMD extraction? Determine if the case is suitable for DMD (student) extraction. ## Assessing Complexity: Patient Related Factors Should be able to be positioned in the dental chair according to operator needs.  #### Physical Positioning The patient should be able to be positioned in the dental chair according to operator needs. Clinical photo: A full-body shot of an elderly patient walking outdoors with the assistance of a crutch in their right hand and another person supporting them by the arm. The patient is wearing a purple top and patterned trousers. This image visually demonstrates 'Patient Related Factors' relevant to 'Assessing Complexity,' specifically illustrating mobility limitations and the potential difficulty in positioning a patient in a dental chair according to operator needs. # Assessing Complexity ## Patient Related Factors Should be tolerant of longer procedures, especially in the beginning. Must understand that this is student treatment and a learning environment. https://deescalation-training.com/2024/10/dealing-with-angry-patients/  #### Behavioral and Environmental Considerations - Patients should be tolerant of longer procedures, especially during the initial stages of clinical training. - Patients must understand that this is student treatment and a learning environment. Clinical photo showing an elderly male patient holding a crutch with both hands and extending it toward the camera. A medical professional's gloved hand is reaching out to interact with the crutch or the patient. The image illustrates a 'Patient Related Factor' scenario for assessing complexity, likely demonstrating de-escalation techniques or handling difficult interactions in a learning environment as referenced by the text. # Assessing Complexity ## Patient Related Factors Should be able to tolerate dental treatment with sights, sounds and stimulation. Ideally should be able to undergo dental treatment without making loud noises/distractions to the operator.  #### Sensory Tolerance - The patient should be able to tolerate dental treatment, including the associated sights, sounds, and stimulation. - Ideally, the patient should be able to undergo dental treatment without making loud noises or creating distractions for the operator. Clinical photo demonstrating patient-related factors in assessing complexity. The image shows a female patient in a dental chair visibly distressed or anxious during treatment, with her hands covering her mouth and an expression of discomfort. A gloved hand holding dental instruments is visible near her face, illustrating the 'sights, sounds and stimulation' mentioned in the text. This visual supports the context of evaluating whether a patient can tolerate standard dental procedures. Assessing Complexity Tooth Related Factors **Assess for dilacerations**, or evidence of dilacerations. Some curvature is ok https://thefuturedentistry.com/dilaceration/  #### Root Morphology Assess for dilacerations or evidence of dilacerations. While some curvature is acceptable, extreme angles increase complexity. Clinical radiograph (X-ray) showing a tooth root with visible curvature. The image is used to demonstrate assessment of dilacerations or evidence of dilacerations in dental anatomy. # Assessing Complexity ## Tooth Related Factors - Assess the apical ligament space and trace it out. - Be aware of teeth with **bulbosities** or areas of **hypercementosis**.  #### Periodontal and Cementum Assessment - Assess the apical ligament space and trace it out. - Be aware of teeth with bulbosities or areas of hypercementosis. Clinical radiograph (X-ray) of anterior teeth showing root morphology and periodontal ligament spaces. The image demonstrates tooth-related factors such as bulbosities or areas of hypercementosis, which are relevant for assessing complexity in endodontic or surgical procedures. - Assess the apical ligament space and trace it out. - Be aware of teeth where the periapical ligament space is obliterated – risk of **ankylosis**.  #### Ligament Space Integrity - Assess the apical ligament space and trace it out. - Be aware of teeth where the periapical ligament space is obliterated, as this indicates a risk of ankylosis. Clinical radiograph (X-ray) of dental anatomy showing multiple teeth. The image is pertinent for assessing the apical ligament space and identifying conditions where this space is obliterated, indicating a risk of ankylosis as described in the accompanying text. **What do you think of the 36 and 35 when assessing for extraction?**  #### Case Study What do you think of the 36 and 35 when assessing for extraction? Dental panoramic radiograph (OPG) showing the maxillary and mandibular arches. The image includes an overlaid text question: 'What do you think of the 36 and 35 when assessing for extraction?'. Teeth 36 (mandibular left first molar) and 35 (mandibular left second premolar) are visible with restorations; tooth 36 shows a large restoration or root canal filling material. The surrounding bone structure, roots, and adjacent teeth are also visible for anatomical context. # Consent for Oral Surgery **"Informed consent is a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made:** - Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; and - With adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention. At the Commission, we believe informed consent is a key quality and safety issue." Australian Commission on Safety and Quality in Health Care  According to the Australian Commission on Safety and Quality in Health Care, informed consent is a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure, or other intervention that is made: - Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; and - With adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention. Informed consent is considered a key quality and safety issue. Logo of the Australian Commission on Safety and Quality in Health Care. # The way I do it… * “Like with all minor surgery there are some common things that might occur afterwards including bleeding, bruising, swelling, pain and infection” * **IF ON ANTICOAGULANTS:** “Because you take [drug name] we usually find things are a little more oozy afterwards, and you might be prone to more significant bruising. It can sometimes look quite severe, almost like you’ve been in a boxing ring. I’m sure you know how easily you bruise when you knock your arm….” #### General Post-Operative Communication - "Like with all minor surgery there are some common things that might occur afterwards including bleeding, bruising, swelling, pain and infection." #### Communication for Patients on Anticoagulants - "Because you take [drug name] we usually find things are a little more oozy afterwards, and you might be prone to more significant bruising. It can sometimes look quite severe, almost like you’ve been in a boxing ring. I’m sure you know how easily you bruise when you knock your arm…." • This is the part that we tailor to the specific procedure: • e.g upper teeth close to the maxillary sinus: • “this tooth is close to your sinus. Your sinus is this big hollow space inside your cheek. Sometimes the tooth is actually forming part of the floor of this sinus. This means that when I remove it, a hole can be left behind between the sinus and the extraction site. If this happens we might need to give you some extra instructions and maybe put in some extra stitches. If it is small it will often close itself. Very rarely it might be significant and in which case we might need to refer you to a specialist to manage. * **Procedure** **specific risks** #### Maxillary Sinus Proximity This section is tailored to specific procedures, such as upper teeth close to the maxillary sinus: - "This tooth is close to your sinus. Your sinus is this big hollow space inside your cheek. Sometimes the tooth is actually forming part of the floor of this sinus. This means that when I remove it, a hole can be left behind between the sinus and the extraction site." - "If this happens we might need to give you some extra instructions and maybe put in some extra stitches." - "If it is small it will often close itself. Very rarely it might be significant and in which case we might need to refer you to a specialist to manage." Procedure specific risks • This is the part that we tailor to the specific procedure: • e.g for teeth where there are large cavities/restorations or crowns adjacent • “Sometimes when we take out teeth, we can find that the tooth next door is compromised. This is sometimes only obvious when we either start to move or remove the tooth. This can sometimes mean that the …[point to x-ray] on this tooth can come off. If this happens we may usually be able to stick it back on or replace it with a temporary solution. Sometimes you might need to come back another day for more dental treatment. #### Compromised Adjacent Teeth or Restorations This section is tailored to specific procedures, such as teeth where there are large cavities, restorations, or crowns adjacent to the site: - "Sometimes when we take out teeth, we can find that the tooth next door is compromised. This is sometimes only obvious when we either start to move or remove the tooth." - "This can sometimes mean that the [restoration/crown] on this tooth can come off. If this happens we may usually be able to stick it back on or replace it with a temporary solution. Sometimes you might need to come back another day for more dental treatment." **Correct Site**  Correct Site Clinical photograph of a patient's lower leg and foot, draped with green surgical cloth. A circular surgical site marking is visible on the anterior aspect of the distal tibia/shin area, annotated with an orientation arrow indicating the intended incision direction. <div style="text-align: center; margin-bottom: 10px;"> <span style="float:left;"><img width="100" max-width="100" height="100" max-height="100" src="https://s3.ap-southeast-2.amazonaws.com/content-assets/content-assets/original/Logo_OH.png?1706032882" title="The University of Western Australia"></span> <span style="float:left;">Oral Health Centre of Western Australia</span> <br><br> </div> # Dental Surgery Safety Checklist Tool ## BEFORE PROCEDURE - Patient identification at the dental chair (Dentist or DCA) * [ ] Patient has confirmed Surname, First Name, Address & DOB * **Comments:** [_________________________________________________] ## BEFORE PROCEDURE COMMENCES - Time out at the dental chair **Dental staff, inclusive of students have:** * [ ] Introduced themselves * [ ] Dentist confirms patient name and procedure * [ ] Outlines procedure * [ ] Discussed concerns if applicable * [ ] Received Consent * [ ] Completed Medical History including allergies **Confirms:** * [ ] Essential radiographs available if applicable * [ ] Essential instruments and equipment available **Comments:** [_________________________________________________] ## BEFORE PATIENT LEAVES CLINIC - Procedure completed **The Dentist/Student has:** * [ ] Confirmed the procedure with the patient * [ ] Discussed post procedure effects and management of these * [ ] Advised of how to contact OHCWA in an emergency * [ ] Directs patient back to Reception [ ] The DCA if available; directs patient back to Reception **Comments** [_________________________________________________] Student Name              Tutor Name [________________________]         [________________________] Student Signature              Tutor Signature [________________________]         [________________________] # Correct site checklist tool * **Must be done for all patients** * **TOHM – eForms – Dental Surgery Safety Checklist Tool – Students** * **Abridged and adapted version of the WHO safety checklist:** * Right patient, procedure and site * X-rays available * Equipment available  #### Dental Surgery Safety Checklist Tool **BEFORE PROCEDURE - Patient identification at the dental chair (Dentist or DCA)** - [ ] Patient has confirmed Surname, First Name, Address & DOB **BEFORE PROCEDURE COMMENCES - Time out at the dental chair** Dental staff, inclusive of students, have: - [ ] Introduced themselves - [ ] Dentist confirms patient name and procedure - [ ] Outlines procedure - [ ] Discussed concerns if applicable - [ ] Received Consent - [ ] Completed Medical History including allergies Confirms: - [ ] Essential radiographs available if applicable - [ ] Essential instruments and equipment available **BEFORE PATIENT LEAVES CLINIC - Procedure completed** The Dentist/Student has: - [ ] Confirmed the procedure with the patient - [ ] Discussed post procedure effects and management of these - [ ] Advised of how to contact OHCWA in an emergency - [ ] Directs patient back to Reception - [ ] The DCA if available; directs patient back to Reception #### Correct Site Checklist Tool - Must be done for all patients - TOHM – eForms – Dental Surgery Safety Checklist Tool – Students - Abridged and adapted version of the WHO safety checklist: - Right patient, procedure and site - X-rays available - Equipment available Dental Surgery Safety Checklist Tool form. The document is structured into three main sections: 'BEFORE PROCEDURE - Patient identification', 'BEFORE PROCEDURE COMMENCES - Time out at the dental chair', and 'BEFORE PATIENT LEAVES CLINIC - Procedure completed'. Each section contains a list of specific tasks with checkboxes (e.g., 'Patient has confirmed Surname, First Name, Address & DOB', 'Introduced themselves', 'Received Consent') and fields for comments. At the bottom, there are signature lines for Student Name/Tutor Name and Student Signature/Tutor Signature.  Clinical panoramic radiograph (OPG) of the mandible and maxilla showing multiple teeth with restorations. The image includes overlaid text 'Which tooth?' at the top center. ## Local Anaesthetics ### A quick recap… #### Local Anaesthetics Overview A quick recap of essential principles regarding local anaesthetic application in clinical practice. ```html <table border="1"> <tr> <th>LA Drug</th> <th>Maximum<br>Dose<br>(mg/kg)</th> <th>Maximum<br>Dose of<br>Anaesthetic<br>(mg) (75kg)</th> <th>Weight of<br>anaesthetic in a<br>2.2ml carpule<br>(mg)</th> <th>Weight of<br>adrenaline in a<br>2.2ml carpule</th> <th>Maximum number of<br>2.2mL carpules based<br>on LA drug max dose<br>(weight dependant)</th> </tr> <tr> <td>Lidocaine 2%<br>(1:80,000)</td> <td>7</td> <td>500 (525mg<br>but absolute<br>max dose<br>500mg)</td> <td>44mg</td> <td>27.5mcg</td> <td>11.36</td> </tr> <tr> <td>Articaine 4%<br>(1:100,000)</td> <td>7</td> <td>500 (525mg<br>but absolute<br>max dose<br>500mg)</td> <td>88mg</td> <td>22mcg</td> <td>5.68</td> </tr> <tr> <td>Bupivicaine 0.5%<br>(1:200000)</td> <td>2</td> <td>150 (175mg<br>absolute max<br>dose)</td> <td>(comes in 20mL<br>ampoule) – 100mg</td> <td>(comes in 20mL<br>ampoule) - 100mcg</td> <td>30mL (1.5x20mL<br>ampoule)</td> </tr> <tr> <td>Mepivicaine 3%</td> <td>Not stated in<br>AUS<br>Other<br>countries 4.4</td> <td>Adult:<br>Maximum<br>6.6ml</td> <td>66mg</td> <td>-</td> <td>3 (absolute maximum for<br>adult)</td> </tr> </table> *Stated figures are taken from TGA Therapeutic Guidelines V4 –correct as of January 2026 As per TGA “stated maximums do not take into account vasoconstrictor” ```  #### Comparative Dosage Table | LA Drug | Maximum Dose (mg/kg) | Max Dose (mg) (75kg) | Weight of LA in 2.2ml carpule (mg) | Weight of Adrenaline in 2.2ml carpule | Max 2.2mL carpules (weight dependent) | | :--- | :--- | :--- | :--- | :--- | :--- | | Lidocaine 2% (1:80,000) | 7 | 500 | 44mg | 27.5mcg | 11.36 | | Articaine 4% (1:100,000) | 7 | 500 | 88mg | 22mcg | 5.68 | | Bupivicaine 0.5% (1:200,000) | 2 | 150 | 100mg (20mL ampoule) | 100mcg (20mL ampoule) | 30mL (1.5x20mL ampoule) | | Mepivicaine 3% | Not stated in AUS (Other: 4.4) | Adult Max: 6.6ml | 66mg | - | 3 (Absolute adult max) | *Stated figures are taken from TGA Therapeutic Guidelines V4 – correct as of January 2026. As per TGA, "stated maximums do not take into account vasoconstrictor." A structured table titled 'Local Anaesthetic Considerations – 75KG' listing four local anaesthetic drugs (Lidocaine 2%, Articaine 4%, Bupivicaine 0.5%, Mepivicaine 3%). Columns include Maximum Dose (mg/kg), Maximum Dose of Anaesthetic (mg) for a 75kg patient, Weight of anaesthetic in a 2.2ml carpule (mg), Weight of adrenaline in a 2.2ml carpule, and Maximum number of 2.2mL carpules based on LA drug max dose (weight dependant). The last column is highlighted in red for emphasis. **lidocaine 2% (20 mg/mL)** with adrenaline (epinephrine) 1:80 000 (12.5 micrograms/mL) [NB2] | Parameter | Value | | :--- | :--- | | Maximum mg/kg dose of local anaesthetic [NB3] | 7 mg/kg | | Approximate maximum volume for a 70 kg adult [NB4] | 24.5 mL | | Approximate maximum volume for a 20 kg child [NB4] | 7 mL | **mepivacaine 3% (30 mg/mL)** a maximum mg/kg dose is not specified in the Australian product information. The Australian product information specifies: * child 3 to 6 years – maximum 1.8 mL * child 6 to 14 years – maximum 2.7 mL * adolescent 14 to 17 years – maximum 4.4 mL * adult – maximum 6.6 mL **articaine 4% (40 mg/mL)** with adrenaline (epinephrine) 1:100 000 (10 micrograms/mL) [NB2] | Parameter | Value | | :--- | :--- | | Maximum mg/kg dose of local anaesthetic [NB3] | 7 mg/kg | | Approximate maximum volume for a 70 kg adult [NB4] | 12.25 mL | | Approximate maximum volume for a 20 kg child [NB4] | 3.5 mL | **articaine 4% (40 mg/mL)** with adrenaline (epinephrine) 1:200 000 (5 micrograms/mL) [NB2] *TGA online    #### Specific Drug Guidelines (TGA Online) **Lidocaine 2% (20 mg/mL) with adrenaline 1:80,000 (12.5 micrograms/mL)** - Maximum mg/kg dose: 7 mg/kg - Approximate maximum volume (70 kg adult): 24.5 mL - Approximate maximum volume (20 kg child): 7 mL **Mepivacaine 3% (30 mg/mL)** A maximum mg/kg dose is not specified in the Australian product information. Specified maximums: - Child 3 to 6 years: 1.8 mL - Child 6 to 14 years: 2.7 mL - Adolescent 14 to 17 years: 4.4 mL - Adult: 6.6 mL **Articaine 4% (40 mg/mL) with adrenaline 1:100,000 (10 micrograms/mL)** - Maximum mg/kg dose: 7 mg/kg - Approximate maximum volume (70 kg adult): 12.25 mL - Approximate maximum volume (20 kg child): 3.5 mL **Articaine 4% (40 mg/mL) with adrenaline 1:200,000 (5 micrograms/mL)** Table titled 'lidocaine 2% (20 mg/mL) with adrenaline (epinephrine) 1:80 000 (12.5 micrograms/mL)'. Columns for Parameter and Value. Rows list maximum dose as 7 mg/kg, approximate max volume for a 70 kg adult as 24.5 mL, and for a 20 kg child as 7 mL. Text block detailing Mepivacaine 3% dosing guidelines where no mg/kg dose is specified. Lists specific maximum volumes for children aged 3-6 years (1.8 mL), 6-14 years (2.7 mL), adolescents 14-17 years (4.4 mL), and adults (6.6 mL). Combined table header covering two Articaine formulations (1:100 000 and 1:200 000). Data rows specify the maximum dose as 7 mg/kg, approx max volume for a 70 kg adult as 12.25 mL, and for a 20 kg child as 3.5 mL. **Local Anaesthetic Considerations** **LIGNOSPAN SPECIAL 1/80000 2.2mL injection cartridge (49328)** Listen Print Share **ARTG ID 49328** | ARTG Name | LIGNOSPAN SPECIAL 1/80000 2.2mL injection cartridge | |---|---| | Product name | LIGNOSPAN SPECIAL 1/80000 2.2mL injection | | ARTG Date | 13 July 1994 | | Registration Type | Medicine | | Therapeutic good type | Medicines | | Sponsor | Specialites Septodont Pty Ltd | | Ingredients | adrenaline (epinephrine) lidocaine hydrochloride monohydrate | | Licence category | RE | | Licence status | A | | Summary | [Download PDF] | | Product Information | [Download PDF] | | Consumer Medicine Information | [Download PDF] | **AUSTRALIAN PRODUCT INFORMATION – LIGNOSPAN SPECIAL (LIDOCAINE HYDROCHLORIDE MONOHYDRATE, ADRENALINE (EPINEPHRINE) ACID TARTRATE) SOLUTION FOR INJECTION** 1 NAME OF THE MEDICINE Lidocaine hydrochloride monohydrate with adrenaline (epinephrine) (as acid tartrate) 2 QUALITATIVE AND QUANTITATIVE COMPOSITION | Cartridge | 2.2 mL | 1.8 mL | |---|---|---| | Lidocaine hydrochloride monohydrate | .44 mg | 36 mg | | Adrenaline (epinephrine) (as acid tartrate) | .27.5 μg | 22.5 μg | | Sodium chloride | .14.3 mg | 11.7 mg | | Potassium metabisulfite | .2.64 mg | 2.16 mg | | Disodium edetate | .0.55 mg | 0.45 mg | | Sodium hydroxide solution | (to adjust pH) | (to adjust pH) | | Water for injection q.s. ad | .2.2 mL | 1.8 mL | For single patient use only. Contains no anti-microbial agent. Discard unused contents after use. LIGNOSPAN SPECIAL contains a local anaesthetic of amide type, lidocaine hydrochloride monohydrate (2%), combined with a vasoconstrictor, adrenaline (epinephrine) as acid tartrate (1/80,000). 3 PHARMACEUTICAL FORM LIGNOSPAN SPECIAL is an injection, solution – a clear colourless liquid. 4 CLINICAL PARTICULARS 4.1 THERAPEUTIC INDICATIONS Lidocaine solutions are indicated for the production of local anaesthesia in routine dental procedures and oral surgery by means of infiltration and nerve block techniques. Lidocaine solutions with adrenaline (epinephrine) are recommended for oral surgery requiring prolonged duration of anaesthesia and haemostasis. 4.2 DOSE AND METHOD OF ADMINISTRATION The lowest dosage that results in effective anaesthesia for the planned treatment should be used. 1   #### Product Information: Lignospan Special (ARTG ID 49328) **Composition per Cartridge** | Ingredient | 2.2 mL Cartridge | 1.8 mL Cartridge | | :--- | :--- | :--- | | Lidocaine hydrochloride monohydrate | 44 mg | 36 mg | | Adrenaline (as acid tartrate) | 27.5 μg | 22.5 μg | | Sodium chloride | 14.3 mg | 11.7 mg | | Potassium metabisulfite | 2.64 mg | 2.16 mg | | Disodium edetate | 0.55 mg | 0.45 mg | | Sodium hydroxide solution | (pH adjustment) | (pH adjustment) | | Water for injection q.s. ad | 2.2 mL | 1.8 mL | **Clinical Particulars** - **Indications:** Production of local anaesthesia in routine dental procedures and oral surgery via infiltration and nerve block. Solutions with adrenaline are recommended for prolonged duration and haemostasis. - **Administration:** Use the lowest dosage that results in effective anaesthesia for the planned treatment. - **Note:** Contains no anti-microbial agent; for single patient use only. Table listing Australian Register of Therapeutic Goods (ARTG) details for 'LIGNOSPAN SPECIAL 1/80000 2.2mL injection cartridge'. Columns include ARTG Name, Product name, ARTG Date, Registration Type, Therapeutic good type, Sponsor, Ingredients, Licence category, and Licence status. Table titled 'QUALITATIVE AND QUANTITATIVE COMPOSITION' showing ingredients per cartridge size (2.2 mL vs 1.8 mL). Rows list Lidocaine hydrochloride monohydrate, Adrenaline (epinephrine), Sodium chloride, Potassium metabisulfite, Disodium edetate, Sodium hydroxide solution, and Water for injection with corresponding milligram or microgram quantities. # Local Anaesthetic Considerations • Does this really matter? • Generally NO • Think about restorative work – usually giving 1 to 2 carpules • Simple extractions – giving 1 to 2 carpules • Exceptionally YES • Dental clearance – extracting multiple teeth in different quadrants. Upper clearance may require 4 to 5+ carpules • Combine this with a small patient – frail, elderly person OR adolescent (ortho extractions) • Now dosages and timings need to be thought about – LA all at once, or in stages? #### Clinical Significance of Dosage **When Dosage is Generally Not a Concern** - Routine restorative work (typically 1 to 2 carpules). - Simple extractions (typically 1 to 2 carpules). **When Dosage is Critical** - **Dental Clearances:** Extracting multiple teeth across different quadrants. An upper clearance may require 5+ carpules. - **High-Risk Patient Profiles:** - Frail or elderly patients. - Adolescents (e.g., orthodontic extractions). - **Management Strategy:** Consider whether to administer all local anaesthetic at once or in stages. ## Local Anaesthetic Considerations **** ### What do we need to anaesthetise? * Tooth * Surrounding bone * Circumferential gingival tissues.  #### Anatomical Targets for Anaesthesia To achieve complete surgical anaesthesia, the following must be addressed: - The tooth itself. - The surrounding alveolar bone. - The circumferential gingival tissues. Anatomical diagram illustrating local anaesthetic blocks for the Maxilla and Mandible. The top panel (Maxilla) shows regions covered by: Infraorbital nerve block, Anterior superior alveolar block, Nasopalatine block, Middle superior alveolar block, Greater palatine block, and Posterior superior alveolar block. The bottom panel (Mandible) shows regions covered by: Buccal block, Inferior alveolar block, and Incisive block. We have to remove 38 - What LA is needed? - Left Inferior Alveolar Nerve Block (+lingual) - Left long buccal nerve block #### Case Example: Extraction of Tooth 38 Required anaesthetic techniques: - Left Inferior Alveolar Nerve Block (IANB). - Lingual nerve anaesthesia (typically covered by IANB). - Left long buccal nerve block. **Ouch!** Does LA remove the sensation of pressure? #### Pressure vs. Pain Does local anaesthetic remove the sensation of pressure? *Note: Patients often confuse the sensation of pressure with pain during extraction.* **Ouch!** **The patient is still feeling pain when you go to extract. What now?** **• Did you miss (e.g IANB)?** **• Did you partially miss (e.g IANB but not lingual)?** **• Is it infected or inflamed? (e.g. pH reducing efficacy)?** **• Is it weird? (e.g lower 1^(st) molar and mylohyoid innervation)?** #### Managing Persistent Pain During Extraction If the patient experiences pain despite administration, evaluate the following possibilities: - **Technical Failure:** Did the injection miss the target (e.g., IANB)? - **Partial Block:** Was the block only partially successful (e.g., IANB successful but lingual nerve missed)? - **Tissue Environment:** Is the area infected or inflamed? (Lower pH can reduce the efficacy of the anaesthetic). - **Anatomical Variation:** Are there accessory nerve supplies (e.g., mylohyoid innervation for a lower first molar)? # Exodontia - Principles Exodontia - Principles Make the hole bigger or the tooth smaller... Make the hole bigger or the tooth smaller...  Photo of a group of people outdoors in what appears to be a celebratory or social setting. Individuals are shown with raised arms and expressive gestures against a backdrop of trees. Make the hole bigger or the tooth smaller... ^with minimal trauma Make the hole bigger or the tooth smaller... with minimal trauma Today is only simple exodontia.. **More advanced and difficult procedures will be in a later session** Today is only simple exodontia. More advanced and difficult procedures will be in a later session. **Principles of the mechanics** • Lever and fulcrum • **A fulcrum is a support at a point in which a lever turns** • There is a mechanical advantage of a long lever arm • The effort arm must be longer than the resistance arm, with increasing length reducing the force required. DAssociation of Oral and Maxillofacial Surgeons of India   #### Lever and Fulcrum Mechanics - A fulcrum is a support at a point in which a lever turns. - There is a mechanical advantage to using a long lever arm. - The effort arm must be longer than the resistance arm; increasing this length reduces the force required. Labelled diagram of a lever system demonstrating mechanical principles. The image shows a brown beam pivoting on a blue triangle labeled 'fulcrum'. A grey rock representing the 'load' is positioned on the left side with a downward arrow indicating force. On the right side, an arrow pointing down is labeled 'effort', illustrating how effort and load interact around the fulcrum. Set of two diagrams (labeled 'a' and 'b') illustrating dental extraction mechanics. Diagram 'a' shows a generic lever model with a fulcrum, an upward red arrow for resistance, and a downward red arrow for effort. Diagram 'b' depicts a tooth in gum tissue being extracted by a dental instrument (elevator), showing the direction of forces applied during the procedure to displace the tooth. # Principles of the mechanics ## Wedge * A wedge overcomes a larger resistance at right angles to the applied effort. * It can displace a tooth occlusally * Either by wedging the instrument in the long axis of the tooth or by delivering apical pressure with the forceps.   #### Wedge Mechanics - A wedge overcomes a larger resistance at right angles to the applied effort. - It can displace a tooth occlusally. - This is achieved either by wedging the instrument in the long axis of the tooth or by delivering apical pressure with the forceps. Labeled diagram illustrating the mechanics of a wedge applied to a tooth. The drawing shows a cross-section of a tooth with surrounding bone and soft tissue. Red arrows indicate forces: downward force on the instrument (wedge) and outward horizontal forces against the periodontal ligament, demonstrating how the wedge overcomes resistance at right angles to the applied effort. Two-panel procedure illustration showing different methods of applying a wedge. Panel 'a' shows an orange wedge being inserted into a bucket-like structure (representing the tooth socket or long axis) with blue arrows indicating upward displacement and lateral spreading. Panel 'b' shows a dental handpiece holding an orange wedge against a tooth in the mouth, with pink arrows indicating apical pressure and occlusal displacement. Captions credit the Association of Oral and Maxillofacial Surgeons of India. # Principles of the mechanics * Wheel and axle * Effort is applied to the circumference of a wheel, which turns the axle generating the force to raise a weight. * The tooth (or root) is engaged and rotated out.  #### Wheel and Axle Mechanics - Effort is applied to the circumference of a wheel, which turns the axle, generating the force to raise a weight. - The tooth (or root) is engaged and rotated out. Medical diagram illustrating the 'Wheel and axle' principle in dentistry. The image shows two panels: on the left, a tooth extraction tool (elevator) is engaged between teeth to apply rotational force; on the right, a similar setup demonstrates rotation of a tooth within its socket. Arrows indicate the direction of effort applied at the wheel circumference and the resulting rotational movement of the axle (tooth). Text labels include 'Principles of the mechanics', 'Wheel and axle', and 'The tooth (or root) is engaged and rotated out.' Source attribution visible at bottom: 'Association of Oral and Maxillofacial Surgeons of India'. # Dental Anatomy #### Dental Anatomy Assume normal...  Assume normal... Anatomical diagram of human teeth showing two rows: top row displays anterior and premolar teeth (incisors, canines, premolars) with visible roots and crowns; bottom row shows posterior teeth (molars and wisdom teeth). The image is labeled 'Assume normal...' to the left, indicating these are idealized or healthy tooth structures for educational comparison. Basic Armamentarium #### Basic Armamentarium  Clinical photograph of a surgical instrument (likely a bone chisel or similar tool) with three labeled parts: BLADE at the top tip, SHANK in the middle shaft section, and HANDLE at the bottom grip. The image includes black horizontal lines indicating regions corresponding to each label.   Clinical photo labeled 'a' showing a dental instrument with a serrated or fluted working tip and a metal handle. A close-up inset on the left displays the detailed texture of the tip. Clinical photo labeled 'b' showing a similar dental instrument but with a smooth, flat working tip (likely a chisel). An inset on the left shows two separate views of the tip: one straight and one angled. YouTube Video on Luxation https://www.youtube.com/watch?feature=oembed&v=LxfWY7oobOc #### Instructional Resources YouTube Video on Luxation: https://www.youtube.com/watch?feature=oembed&v=LxfWY7oobOc  Clinical photograph of two dental forceps on a blue background. The image includes black lines with text labels pointing to specific parts: 'BEAKS' (top tips), 'HINGES' (pivot points), and 'HANDLES' (grip sections). Both instruments are metallic and show typical features of dental extraction tools. Number 29 Upper Straight Forceps Number 107 Upper Straight (Short) Forceps  #### Straight Forceps - **Number 29**: Upper Straight Forceps - **Number 107**: Upper Straight (Short) Forceps Clinical comparison photo of two dental instruments on a blue background. The image displays 'Number 29 Upper Straight Forceps' on the left (labeled 'a') and 'Number 107 Upper Straight (Short) Forceps' on the right. Both are metal forceps with straight jaws; the number 29 is shown vertically cropped at the top while the number 107 is fully visible horizontally. Number 76 Upper Universal Forceps Number 76N Upper Universal (Fine) Forceps  #### Universal Forceps - **Number 76**: Upper Universal Forceps - **Number 76N**: Upper Universal (Fine) Forceps Clinical photograph showing two dental forceps. The image includes a close-up of the jaws on the left and a full view of the instrument on the right against a blue background. OCR text identifies these as 'Number 76 Upper Universal Forceps' and 'Number 76N Upper Universal (Fine) Forceps', indicating a visual comparison between standard and fine tip variations. **Number 95 Upper Left Molar (Hawk) Forceps** **Number 94 Upper Right Molar (Hawk) Forceps** ‘Beak to cheek’  #### Molar (Hawk) Forceps - **Number 95**: Upper Left Molar (Hawk) Forceps - **Number 94**: Upper Right Molar (Hawk) Forceps **Clinical Note:** - Use the "Beak to cheek" orientation. Clinical photo showing two pairs of dental forceps on a blue background. Top pair (labeled 'c') shows the beak tips in use or close-up; bottom pair shows the full instruments with textured handles. OCR context identifies them as Number 95 Upper Left Molar (Hawk) Forceps and Number 94 Upper Right Molar (Hawk) Forceps, with instruction ‘Beak to cheek’. Upper Bayonet Forceps  #### Bayonet Forceps - Upper Bayonet Forceps Clinical photo of Upper Bayonet Forceps. The image displays two views: top shows the full instrument with serrated handles and bayonet-shaped tips; bottom includes a close-up of the tip on the left and a side profile view showing handle markings ('514') on the right. Number 74 Lower Universal Forceps Number 74N Lower Fine Universal Forceps  #### Universal Forceps - **Number 74**: Lower Universal Forceps - **Number 74N**: Lower Fine Universal Forceps Clinical photo showing two dental extraction forceps labeled 'Number 74 Lower Universal Forceps' and 'Number 7N Lower Fine Universal Forceps'. The image includes a close-up view of the forcep tips on the left and a full-length view of the instrument on the right, set against a blue background. Number 73 Lower Molar (Hawks) Forceps  #### Molar Forceps - **Number 73**: Lower Molar (Hawks) Forceps Clinical photograph of dental instruments on a blue background. The main subject is the Number 73 Lower Molar (Hawks) Forceps, identified by OCR text below. To its left is a partially visible instrument with a similar beak design.  Clinical photograph showing two Lower Cowhorn Forceps against a blue background. The forceps feature curved beaks with serrated edges and textured handles for grip. A small label 'd' is visible in the top-left corner of the image. a b Correct and incorrect hand placement for holding a dental forceps   a b Correct and incorrect hand placement for holding a dental forceps Clinical photo labeled 'a' demonstrating correct and incorrect hand placement for holding a dental forceps. The left panel shows a gloved hand correctly gripping the handles with the thumb on one side and fingers on the other (marked with a green checkmark). The right panel shows an incorrect grip where the thumb is placed alongside the index finger or in a compromised position (marked with a red X). Clinical photo labeled 'b' showing two views of a gloved hand holding a dental instrument. The top view displays a correct grip with the thumb and forefinger positioned to control the handle (marked with a green checkmark). The bottom view illustrates an incorrect grip where the thumb is wrapped around the handle improperly, reducing leverage and control (marked with a red X). # Positioning *assuming ambidextrous chair is setup #### Chair Configuration - Assuming an ambidextrous chair setup. **Stand to the [dominant hand]** and in front of the patient when extracting maxillary and mandibular **[non-dominant hand teeth]** For the mandibular **[dominant hand]** stand to the **[dominant hand]** side. #### General Operator Stance - Stand to the dominant hand side and in front of the patient when extracting maxillary and mandibular non-dominant hand teeth. - For the mandibular dominant hand teeth, stand to the dominant hand side. # Maxillary teeth (right handed operator) ## Operator standing - In front and to the right of the patient ## Patient - Elbow height, head tipped 30 degrees up https://pocketdentistry.com/4-extraction-of-teeth/#:~:text=Extraction%20of%20maxillary%20teeth,for%20extraction%20of%20maxillary%20teeth.  #### Right-Handed Operator Requirements - **Operator Standing:** In front and to the right of the patient. - **Patient Positioning:** Elbow height, with the head tipped 30 degrees up. Clinical photo demonstrating the operator position for maxillary teeth extraction by a right-handed operator. The dentist is standing in front and to the right of the patient (as viewed from behind), with hands positioned near the patient's mouth. The patient is reclined in a dental chair with head tipped up approximately 30 degrees at elbow height. Mandibular left teeth (right handed operator) • Operator standing: • In front and to the right of the patient • Patient: • Can be a little lower than elbow height and tipped back slightly more than for maxillary teeth. <img>'tated 提取牙齿  #### Mandibular Left Teeth (Right-Handed Operator) - **Operator Standing:** In front and to the right of the patient. - **Patient Positioning:** Can be a little lower than elbow height and tipped back slightly more than for maxillary teeth. Clinical photo demonstrating the operator position for treating mandibular left teeth with a right-handed operator. The image shows a dentist standing in front and to the right of the patient, who is reclined in a dental chair. This visual corresponds to the text describing the specific positioning required for this procedure.  Clinical photo demonstrating the working position for a right-handed operator treating mandibular right teeth. The image shows a dentist standing behind and to the right of the patient, who is reclined in a dental chair with their head tipped back slightly more than for maxillary procedures. # Mandibular left teeth ## (left handed operator) ### Standing: - Just behind and to the left of the patient ### Patient: - Can be a little lower than elbow height and tipped back slightly more than for maxillary teeth.  #### Mandibular Left Teeth (Left-Handed Operator) - **Operator Standing:** Just behind and to the left of the patient. - **Patient Positioning:** Can be a little lower than elbow height and tipped back slightly more than for maxillary teeth. Clinical photo demonstrating the operator and patient positioning for mandibular left teeth treatment with a left-handed operator. The operator is standing just behind and to the left of the patient, wearing green scrubs, gloves, mask, and protective eyewear, performing an extraction procedure on the patient who is reclined in the dental chair. Movements Movements Apical Pressure + Buccal/Palatal Pressure Apical Pressure + Buccal/Palatal Pressure  Anatomical diagram showing a set of human teeth arranged in two rows (likely representing upper and lower arches). A red dashed rectangle highlights the two central incisors. Above the highlighted region is text reading 'Apical Pressure + Buccal/Palatal Pressure + Rotation', indicating the forces applied to these specific teeth. **Apical Pressure + Rotation**  Apical Pressure + Rotation Diagram showing a selection of anterior teeth (incisors and canines) highlighted by a red dashed box. The text 'Apical Pressure + Rotation' is located above the diagram, indicating the mechanical force applied to these teeth during orthodontic movement. **Apical Pressure + Figure of 8 motion**  Apical Pressure + Figure of 8 motion Diagram showing a set of human teeth in occlusal view. The upper row displays anterior and posterior teeth (incisors, canines, premolars, molars) with visible root structures. The lower row mirrors the arrangement but focuses on the posterior teeth (premolars and molars). A red dashed box highlights three molar teeth in the lower right section, labeled 'Apical Pressure + Figure of 8 motion', indicating the specific area relevant to endodontic instrumentation technique. Youtube Video on Forceps https://www.youtube.com/watch?v=Usu5pTTz2SY #### Instructional Resources Youtube Video on Forceps: https://www.youtube.com/watch?v=Usu5pTTz2SY  Clinical checklist diagram for post-extraction assessment. The visual structure includes two main orange header boxes labeled 'The tooth:' and 'The socket:', each followed by a white rectangular area containing specific clinical questions to check. Under 'The tooth:', the question is 'Are the root apices intact?'. Under 'The socket:', the checklist items are: 'Is there any evidence of OAC (for maxillary teeth in the proximity of sinus?)', 'Is there any mucosal tears?', 'Are there any loose pieces of alveolar bone?', 'Are there any fragments of tooth left attached to the gingivae?', and 'Is there any major bleeding?'. The entire checklist is framed within an orange border. # Post Operative # Instructions  Post Operative Instructions Abstract diagram featuring a solid blue circle on an orange background with dashed blue arcs above it. This visual serves as the graphical element for the 'Post Operative Instructions' slide.   Clinical photo showing a sterile gauze pad packaged in clear plastic, placed on a speckled countertop surface. Educational pamphlet or figure from The University of Western Australia titled 'Advice following dental e oral surgery and oral mu'. It serves as an instructional guide accompanying the medical supplies shown. # Post Operative Instructions * Bleeding * Pain * Wound Care * Sutures * Emergency --- * * * #### Patient Recovery Guidelines - Bleeding - Pain - Wound Care - Sutures - Emergency Common* Emergencies Common Emergencies # Syncopy (Fainting) * "I feel dizzy" // "I feel light headed" * Recognise EARLY – colour changes to lips * Lie patient as far back as the chair will allow as fast as possible. * Caution 'you might feel like I'm tipping you upside down' * Send for tutor * Monitor * Cold compress to forehead can help * Occasionally may present as tonic-clonic syncope * Recovery should be quick – offer sugary/electrolyte drink #### Syncope (Fainting) - **Patient Presentation**: Often reports feeling dizzy or light-headed. - **Early Recognition**: Monitor for early signs, such as color changes to the lips. - **Immediate Action**: - Lie the patient as far back as the chair will allow as quickly as possible. - Advise the patient: "You might feel like I'm tipping you upside down." - Send for a tutor. - **Management and Monitoring**: - Monitor the patient's condition. - Apply a cold compress to the forehead to assist recovery. - Note: Occasionally, this may present as tonic-clonic syncope. - **Recovery**: Recovery should be rapid. Offer the patient a sugary or electrolyte drink. Palpitations - Reassure patient it should pass and continue to monitor for deterioration. Take a moment to review medical history in case missed. - Send for tutor - Consider intravascular injection as cause - Sometimes anxiety around procedure spikes adrenaline #### Management of Palpitations - Reassure the patient that the sensation should pass. - Continue to monitor for any signs of deterioration. - Send for a tutor. - Review the patient's medical history to ensure no relevant conditions were overlooked. #### Potential Causes - Consider the possibility of an accidental intravascular injection. - Anxiety regarding the procedure can cause a spike in adrenaline. #### Less commonly - **Hypoglycaemia** - **Asthma** - **Epileptic Seizure** - **Cardiac emergencies** - **Stroke** - **Anaphylaxis**  #### Less Common Emergencies - Hypoglycaemia - Asthma - Epileptic Seizure - Cardiac emergencies - Stroke - Anaphylaxis List diagram categorizing 'Less commonly' occurring medical conditions. Items include: Hypoglycaemia, Asthma, Epileptic Seizure, Cardiac emergencies, Stroke, and Anaphylaxis. # Practical Exercise: Extractions #### Practical Exercise: Extractions ## Mount the models * **Using high speed drill dimple into the base using large round bur (1)** * **Must be deep enough to accommodate the mannequin pin (5mm)** * **A second dimple (2) may be required to mount flush.**  #### Mounting the Models - Using a high-speed drill, dimple into the base using a large round bur (1). - The dimple must be deep enough to accommodate the mannequin pin (5mm). - A second dimple (2) may be required to mount the model flush. Clinical procedure image showing a cross-section of a dental model base with two labeled regions. Region (1) indicates the area where a dimple is drilled into the center of the base to accommodate a mannequin pin (depth 5mm). Region (2) points to a second dimple on the upper surface that may be required for flush mounting. The visual demonstrates the physical preparation steps described in the OCR text. # Practical Exercise 1 * Extract premolars and canines (15 14 13 23 24 25) * Luxate – at least 20 seconds – make sure observed by tutor and then remove tooth with forceps. * Head to be positioned and stabilised by group member * **Everyone** to extract 2 teeth * If crown snaps – to attempt further luxation to remove the root #### Extraction Procedure - Extract premolars and canines (15, 14, 13, 23, 24, 25). - Luxate for at least 20 seconds; ensure this is observed by a tutor before removing the tooth with forceps. - The head must be positioned and stabilized by a group member. - Every participant is to extract two teeth. - If a crown snaps, attempt further luxation to remove the remaining root. # Practical Exercise 2 * Suture the extraction sites: * **Everyone must:** * Place one simple interrupted suture across a socket * Place one figure of eight suture across a socket. #### Suture Requirements Suture the extraction sites. Every participant must perform the following: - Place one simple interrupted suture across a socket. - Place one figure-of-eight suture across a socket. **Basic Safety** **Never pass or leave sutures mounted like this!**  #### Basic Safety Never pass or leave sutures mounted in this manner. Clinical close-up photo demonstrating a safety hazard in suturing. A metallic surgical needle holder is shown gripping a suture thread that is mounted on the tip of the instrument with the needle itself protruding from the top. The image illustrates an unsafe configuration where the needle is exposed and improperly positioned relative to the suture mount, as warned by the text 'Never pass or leave sutures mounted like this!'. Basic Safety Control your sharps!  #### Basic Safety Control your sharps! Close-up photo demonstrating basic safety: a pair of pliers holding a bent needle. The text 'Basic Safety' is in the top left and 'Control your sharps!' is at the bottom.  Clinical photograph showing a gloved hand demonstrating safe handling of a sharp instrument (needle). The needle is positioned between fingers to prevent accidental sticks. Text overlay 'Basic Safety' and 'Control your sharps!' provides context for the safety demonstration. **Basic Safety** When finished dispose of the needle into the sharps container. **Will you be my ACCOUNTABLIBUDDY?** <i>Imgflip.com</i>  #### Basic Safety and Accountability - When finished, dispose of the needle into the sharps container. - Will you be my ACCOUNTABLIBUDDY? Meme image featuring two characters from South Park (Stan Marsh and Kyle Broflovski) asking 'WILL YOU BE MY ACCOUNTABILIBUDDY?'. The meme is used in the context of a safety instruction about disposing needles into sharps containers. Video on removing a suture from the packet Video on removing a suture from the packet Video on simple interrupted suture # Practical Exercise 2 - Suture the extraction sites: - Everyone must: - Place one simple interrupted suture across a socket - Place one figure of eight suture across a socket. - Retractors are available to hold the cheeks out of the way - Take it in turns to suture, retract and cut  Text-based slide titled 'Practical Exercise 2' outlining a suturing procedure. It lists required actions: placing one simple interrupted suture and one figure-of-eight suture across sockets, using retractors to hold cheeks out of the way, and taking turns to suture, retract, and cut. Finalizing Off • Dispose the suture needle in the sharps bin • Ensure everyone in your group has disposed of the sharps • Remove the bone model from the head • Replace the plate ready for the PM CSSL Class  A list of finishing steps for a procedure, including disposing of sharps in the bin, ensuring group compliance, removing the bone model from the head, and replacing the plate ready for the PM CSSL class. 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