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By Mohammad Hussein Zaki
Lecturer Oral & Maxillofacial Surgery Faculty of Dentistry – Minia University
Injuries to
osseous
structures
OA communications
Injuries to
adjacent
structures
Injuries to
adjacent
teeth
Problems with
the tooth being
extracted
Soft tissue
injuries
Emphysema Hemorrhage
Granuloma
Edema
Ecchymosis Hematoma
Trismus
Bleeding
Delayed
healing
Dry
socket Infection
Painful
socket
Puncture Wound.
Inadvertent puncturing of the soft tissues.
Gingiva.
Adjacent soft tissues.
Puncture Wound.
Etiology.
Inadvertent manipulation of instruments.
Puncture Wound.
Puncture Wound.
Prevention.
Controlled force.
Fingers rests.
Puncture Wound.
Tx.
Hemostasis.
Preventing infection.
Healing occurs by secondary intention.
Tear of a Mucosal Flap.
Etiology.
Inadequately sized envelope flap.
Tear of a Mucosal Flap.
Prevention.
Adequately sized flaps.
Controlled amount of retraction force on the
flap.
Creating releasing incisions, when indicated.
Tear of a Mucosal Flap.
Tx.
Flap begins to tear: the hard tissue surgery
should be stopped for lengthening the incision
to gain better access or to create a releasing
incision.
Flap should be carefully repositioned once the
surgery is completed.
Stretch or Abrasion.
Etiology.
Lips, tongue, corners of the mouth, or flaps.
Rotating shank of the bur.
Hot surgical handpiece.
Metal retractors.
Stretch or Abrasion.
Etiology.
Stretch or Abrasion.
Tx.
Keeping the area clean with regular oral
rinsing.
keep the area moist with small amounts of
ointment.
o Antibiotic.
o Vaseline.
Tooth Fracture.
Causes.
Excessive force.
Inappropriate application of force.
A tooth weakened by caries or large
restorations.
Tooth Fracture.
Causes.
Haste.
Long, curved, thin,
divergent roots lie in
dense bone.
Tooth Fracture.
Tx.
Crown Fx.
Tooth Fracture.
Tx.
Retained root.
Surgical Extraction.
Tooth Fracture.
Tx.
Root Apex.
Risk benefit ratio.
Tooth Fracture.
Tx.
Root Apex.
Risk benefit ratio.
Root Displacement.
Maxillary sinus.
• Non infected sinus.
• Non infected root.
• < 3 mm root fragment.
Root Displacement.
Maxillary sinus.
• Chronic maxillary sinusitis.
• Infected root.
• > 3 mm root fragment.
Root Displacement.
Infratemporal space.
Root Displacement.
Infratemporal space.
Root Displacement.
Infratemporal space.
Root Displacement.
Infratemporal space.
Visible through
incisions.
Root Displacement.
Submandibular space.
Sublingual space.
Root Displacement.
Submandibular space.
Root Displacement.
Submandibular space.
Root Displacement.
Submandibular space.
• Single effort to remove.
• Small non infected root.
• Infected or > 3 mm root.
Root Displacement.
Sublingual space.
Root Displacement.
Sublingual space.
Tooth Lost into the Pharynx.
Immediate management.
Encouraged coughing.
Chest X ray.
Abdominal X ray.
Tooth Lost into the Pharynx.
Immediate management.
Aspirated tooth.
Swallowed tooth.
Fracture or Dislodgment of an Adjacent
Restoration.
Fracture or Dislodgment of an Adjacent
Restoration.
Management.
Make sure that the displaced restoration is
removed from the mouth.
Replacement of displaced crown or placement
of a temporary restoration.
Luxation of an Adjacent Tooth.
Risky factors.
Inappropriate use of the extraction
instruments.
Inappropriate instrument selection.
Luxation of an Adjacent Tooth.
Risky factors.
Luxation of an Adjacent Tooth.
Tx goal.
Reposition the tooth into its appropriate
position and stabilize it so that adequate
healing occurs.
Luxation of an Adjacent Tooth.
Tx.
Reposition the tooth into the socket.
Check occlusion.
The need of stabilization.
Luxation of an Adjacent Tooth.
Tx.
Extraction of the Wrong Tooth.
Causes.
Inadequate attention to preoperative
assessment.
Extraction of the Wrong Tooth.
Tx.
Replantation.
The correct extraction
should be deferred for
4 or 5 weeks.
Extraction of the Wrong Tooth.
Tx.
Dental implant–supported
restoration.
Fracture of the Alveolar Process.
Causes.
Use of excessive force with the forceps.
Fracture of the Alveolar Process.
Tx.
If the bone has been completely removed from
the tooth socket along with the tooth.
The bone remains attached to the periosteum.
Fracture of the Maxillary Tuberosity.
Etiology.
Problems.
Fracture of the Maxillary Tuberosity.
Tx.
If the bone has been completely removed from
the tooth socket along with the tooth.
The bone remains attached to the periosteum.
Fracture of the mandible.
Results from the application of a force
exceeding that needed to remove a tooth
such as the forceful use of dental elevators.
Fracture of the mandible.
Fracture of the mandible.
Tx.
1ry stabilization
ORIF.
Injury to Regional Nerves.
Buccal nerve.
Nasopalatine nerve.
Mental nerve.
Lingual nerve.
Inferior alveolar nerve.
Injury to the Temporomandibular Joint.
Pain in the TMJ area immediately after the
extraction procedure.
Moist heat.
Rest the jaw.
Soft diet.
Analgesics.
Injury to the Temporomandibular Joint.
Dislocation of Temporomandibular Joint.
Injury to the Temporomandibular Joint.
Dislocation of Temporomandibular Joint.
Injury to the Temporomandibular Joint.
Dislocation of Temporomandibular Joint.
Communication between the oral cavity
and the maxillary sinus.
Problems.
Maxillary sinusitis.
OA fistula.
Diagnosis.
Examine the extracted tooth.
Nose blowing test.
Tx.
Small perforation.
Additional measures to ensure the
maintenance of the blood clot in the area,.
Sinus precautions.
medications to reduce the risk of maxillary
sinusitis.
Tx.
Large perforation.
Surgical repair.
Sinus precautions.
Medications to reduce the risk of maxillary
sinusitis.
Air entering the loose connective tissue.
Clinically.
Tx.
• Usually subsides spontaneously after 2–4
days.
• Paracentesis.
• Antibiotics.
Causes.
Trauma of the vessels.
Problems related to blood coagulation.
Prevention.
Medical history.
Coagulation profile.
Less traumatic surgery.
Tx.
• Compression for 10 - 30 minutes.
• Sterile bone wax.
• Suturing over gauze pack.
• Electrocoagulation.
Tx.
• Hemostatic materials.
Vasoconstrictors.
Enhancements of blood clotting.
Gelatin sponges.
Oxidized regenerated cellulose.
Collagen.
Causes.
The tissues of the mouth and jaws are highly
vascular
The extraction of a tooth leaves an open
wound, which allows additional oozing&
bleeding;
Causes.
Impossible to apply dressing material with
enough pressure and sealing to prevent
additional bleeding during surgery.
Patients tend to explore the area of surgery with
their tongues and occasionally dislodge blood
clots and creating small negative pressures
before it has organized.
Prevention.
Pt. history.
Preoperative investigations.
Tx.
Instruct the patient to rinse the mouth gently
with chilled water and then to place
appropriate-sized, damp gauze over the area
and bite firmly on it.
Tx.
The patient should repeat the cold rinse and
bite down on a damp tea bag.
Tx.
Return to clinic.
o All blood, saliva, and fluids should be suctioned
from the mouth.
o Observe the bleeding site carefully under
effective lighting.
o Damp gauze held in place with firm pressure by
the surgeon’s finger for at least 5 minutes.
Tx.
Return to clinic.
o Administer LA.
o Gentle curettage of the extraction socket and
suction all areas of the old blood clot.
o Hemostatic agent is inserted into the socket held
in position with a figure-of-eight stitch reinforced
with firm pressure from damp gauze pack.
Tx.
Return to clinic.
o Monitoring the patient for at least 30 minutes.
o Additional laboratory screening tests.
Due to prolonged capillary hemorrhage.
Tx.
1st few hours postoperatively.
o Cold packs during the first 24 h.
o Heat therapy.
o Antibiotics.
o Analgesics.
It is the result of extravasation of fluid by
the traumatized tissues because of
destruction or obstruction of lymph vessels,
resulting in the cessation of drainage of
lymph, which accumulates in the tissues.
Swelling reaches a maximum within 48–72
h after the surgical procedure.
Clinically.
Tx.
Small-sized edema.
o No therapeutic management.
Severe edema.
o Heat therapy.
o Fibrinolytic medication.
o Antibiotics.
Restriction of the mouth opening due to
spasm of the masticatory muscles.
Causes.
Repeated injections during inferior alveolar
nerve block.
Inflammation of the postextraction wound
Hematoma.
Postoperative edema.
TX.
Hot mouth rinses.
Heat therapy.
Gentle massage of the temporomandibular
joint area.
TX.
Analgesics.
Anti-inflammatory.
Muscle relaxant.
Physiotherapy.
Antibiotics.
Sharp bony spicules injure the soft tissues
of the postextraction socket, resulting in
severe pain and inflammation at the
extraction site.
Tx.
Smoothing of the bone margins of the wound.
Tx.
Analgesics.
Gauze impregnated with eugenol for 36 to 48
h.
Postoperative complication appears 2– 3
days after the extraction.
Pathophysiology.
Clinically.
Tx.
Gentle irrigation.
Gauze impregnated with eugenol replaced
frequently every 24 h.
Collagen paste.
Avoid mastication on the affected side.
Good oral hygiene.
Cause.
Use of infected instruments.
Immunocompromised diseases.
Bad oral hygiene.
Prevention.
Prophylactic antibiotics.
Tx.
Antibiotic therapy.
4–5 days after the extraction of the tooth
and is the result of the presence of a
foreign body in the alveolus.
Tx.
Debridement of the alveolus
Removal of every causative agent.
Causes.
Infection.
Wound dehiscence.
Wound dehiscence.
Unsupported flap edges.
Sutures under tension.
Severe edema.
Prevention.
o Aseptic technique.
o Atraumatic surgery.
o Close the incision over intact bone.
o Suture without tension.