2 - Extraction complications Flashcards
1
Q
What are the different time frames in which extraction complications can occur?
A
- immediate/peri-operative
- immediate post-operative/short term
- long term post-operative
2
Q
List the peri-operative complications that can occur during extraction.
A
- difficult access
- abnormal resistance
- fracture of tooth, root or alveolar bone
- jaw fracture, or involvement of maxillary antrum
- fracture of tuberosity
- loss of tooth
- soft tissue damage including nerves and vessels
- haemorrhage
- damage to adjacent teeth/restorations
- extraction of permanent tooth germ (when extracting primary teeth)
- broken instrument
- incorrect tooth extracted
3
Q
What causes difficult access during extraction?
A
- trismus
- reduced aperture of the mouth (microstomia/scarring)
- crowed or malpositioned teeth
4
Q
What causes abnormal resistance during extraction?
A
- thick cortical bone
- root morphology (eg divergent roots, hooked roots)
- number of roots
- hypercementosis
- ankylosis
5
Q
What causes tooth/root fracture during extraction?
A
- caries
- alignment
- size
- root morphology (fused, divergent, extra etc)
6
Q
What causes alveolar bone fracture during extraction?
A
- happens when bone is not mobilised properly before expansion
- usually buccal plate, often canines or molars
7
Q
How do you treat alveolar bone fracture surrounding a canine?
A
- stabilise
- free the mucoperiosteum
- smooth the edges
8
Q
How do you treat alveolar bone fracture surrounding a molar?
A
- periosteal attachment
- suture
- dissect free
9
Q
What causes jaw fracture during extraction?
A
- usually mandible
- often occurs with impacted wisdom teeth, large cyst or atrophic mandible
- radiographs are essential
- be cautious with application of force, mandible must always be supported
10
Q
How should you manage a jaw fracture?
A
- inform patient
- post-op radiograph
- refer to max-fac unit (phone call)
- ensure analgesia
- stabilise
- if there is a delay for treatment, split teeth and prescribe antibiotics
11
Q
How can the maxillary antrum become involved during extraction?
A
- loss of root into the antrum can form an OAF or OAC
- fracture tuberosity
- some roots sit within sinus
12
Q
Define OAF.
A
- oro-antral fistula
- an OAC that has been present for time, and been covered but a layer of epithelium
13
Q
Define OAC.
A
- oro-antral communication
- communication between oral cavity and the maxillary sinus
14
Q
How do you diagnose an OAC?
A
- size of tooth
-radiographic position of roots - bone at trifurcation of roots
- bubbling of blood
- nose holding test (valsalva manoeuvre, CAUTION as can create OAC where there was not before)
- direct vision
- good light and suction, can cause an echo
- blunt probe, CAUTION as can create OAC where there was not before
15
Q
What are the risk factors for OAC?
A
- extraction of upper molars and pre molars
- close relationship of roots to sinus on radiograph
- last standing molars
- large bulbous roots
- older patient
- previous OAC
- recurrent sinusitis
