View
219
Download
10
Category
Tags:
Preview:
Citation preview
Complications of Extractionof Impacted Teeth
Outline
I. Soft Tissue InjuriesII. Complications with the Tooth Being ExtractedIII. Injuries to Adjacent TeethIV. Injuries to Osseous StructuresV. Injuries To Adjacent StructuresVI. Oroantral CommunicationsVII.Postoperative BleedingVIII.Delayed Healing & Infection
I. Soft Tissue Injuries
1. Tearing Mucosal Flap
CausesDue to an inadequately sized flap which is retracted beyond the tissue`s ability to stretch.As with a short envelope flap when the area of surgery is at the apex.
Prevention-Adequately sized flaps-Gentle Retraction
ManagementReposition the flap & sutureIf the tear is jagged, trim it before suturing
2. Puncture Wound of Soft TissueCause
Instrument Slippage
PreventionControlled force
ManagementSuturing to prevent infection & allow healing to occur
3. Stretch or Abrasion InjuryCause
Bur shank or retractor injury
PreventionCare
ManagementKeep it moist ( ointment )Heals within 5 – 10 days
II. Complications with the tooth Being Extracted
1. Root Fracture
CauseLong, curved, divergent rootsExcessive force during extraction
PreventionProper exposure & bone removal
2. Root Displacement
Into:• Mandibular Canal• Lingual Pouch• Infratemporal Space• Maxillary Sinus
III. Injuries to Adjacent Teeth
1.Luxation of Adjacent Teeth2.Fracture of Adjacent Restoration
CauseCarelesness
PreventionJudicious use of elevators
IV. Injuries to Osseous Structures
1. Fracture of Alveolar ProcessFracture of the Buccal or Lingual Cortex
CauseInadequate exposure & excessive force
PreventionAdequate bone removal & eposure
2. Fracture of Maxillary TuberosityCause
Excessive force
PreventionProper support and controlled force
ManagementIf still attached; dissect and remove the toothIf detached; smooth bone edges & suture
3. Fracture of the Mandible
CauseExcessive force
PreventionProper bone removal & controlled force
Photoelastic model of the mandible, showing the development of stress during a luxation attempt of the third molar when insufficient bone has been removed from the tooth peripherally
V. Injuries to Adjacent Structures
1. Injury to Inferior Alveolar NerveCause
-Excessive extraction force in case of curved roots-Sectioning the tooth all the way inferiorly
Prevention-Proper exposure & bone removal-Controlled force-Careful setioning, leaving a shell of the tooth
2. Injury to the Lingual NerveCause
-Placement of the retromolar incision far lingually-Sectioning the tooth all the way to the lingual cortex
Prevention-Proper incision-Careful sectioning, leaving a shell of the tooth
3. Injury to the TMJCause
Inadequate support of the mandible during extraction
PreventionUse of bite block
ManagementReduction
Vi. Oroantral CommunicationCause
During extraction of an impacted maxillary canine
-Excessive bone removal-Failure to locate the tooth
Prevention-Proper preoperative radiographic evaluation-Proper bone removal-Controlled force
VII. Postoperative Bleeding
Cause-Bleeding at wound margins-Bleeding at a bony foramen within the socket-Medical Problem
Prevention-Good history taking
(coagulopathy, medications…etc)-Atrumatic surgical extraction
(clean incisions, gentle management of soft tissues, smoothen bony specules, curette granulation tissue)-Obtain good homeostasis at surgery- Postoperative instructions
ManagementLocal Measures
• Pressure packs• Suturing• Ligate bleeding vessels• Burnish bone• Apply material to aid in hemostasis (surgicell,
collaplug)
VIII. Delayed Healing & Infection
1. InfectionCause
Debris left under the flap
PreventionIrrigation
ManagementDebridement & Drainage
2. Dry Socket (Alveolar Ostitis)Cause
-Lysis of a fully formed blood clot before the clot is replaced with granulation tissue.-Higher incidence with smokers & patients taking oral contaceptives.
Prevention-Presurgical irrigation with antimicrobial agents ,e.g: chlorhexidine-Intraoperative irrigation with saline
Management– Irrigate with warm saline– Remove old clots– Place sedative dressing– Prescribe mild analgesics– Reassess after 24 to 48 hours
Recommended