Notes

Dental Surgery and Implantology in the Palms
Dental surgery and implantology in the palms are often complex procedures, due to their location, asymmetry, and small dimensions. However, the results of this type of treatment are highly satisfactory and provide the patient with excellent aesthetics and function.

Dupuytren’s contracture is a fibrositis of the palmar fascia that causes a thickening of the palmar tissue, and, in some cases, the fingers. This condition is a chronic and progressive disorder with no known cause, although it appears to run in families.

Surgical management is difficult, because the small size of the bone and the difficulty in placing implants make the procedure challenging for many surgeons. A number of techniques have been developed to improve the treatment of this condition.

The most important step in the treatment of this disease is to debride the necrotic tissue, followed by a complete open reduction and internal fixation. It is also important to stabilize the fractured bones temporarily with a continuous stout loop interdental wire.

Implants are used to restore the esthetic and functional appearance of the mouth, as well as improving chewing ability, speech, and overall oral health. Several types of implants are available, depending on the patient’s needs and the surgeon’s preference.

An important step in the placement of an implant is to mark the insertion point on soft tissue, using a periodontal probe (figure 22). This will allow the vertical reference line which bisects the interdental area parallel to the axes of the proximal teeth to be marked on the soft tissues, and the correct angle of insertion to be determined.

After this, the patient is placed in a position for the perforating and guiding stages. The hand driver handle should be gripped correctly, according to the stage of the procedure and its purpose (figures 13 and 14). For example, a palm grip (a) is recommended for the perforating stage and the guiding stage, as it provides greater stability and control. A pen grip (b) is not suitable because it allows unwanted lateral movement during the procedure.

Clinica dental torres en las palmas During the perforating stage, care should be taken not to change the insertion angle during its passage through cortical bone, as this could lead to a tip fracture. In order to avoid this, it is advisable to pre-drill the implant before inserting it, using an ORLUS surgical drill. This will increase the efficiency of drilling and reduce the risk of cortical bone injury. It is also advisable to use a blade holder during this stage, as it will allow the operator to feel the resistance of the cortical bone and prevent traumatic injury to it. A frenectomy should be performed if the site of the implantation has a frenum.
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