2 - Extraction complications Flashcards
What are the different time frames in which extraction complications can occur?
- immediate/peri-operative
- immediate post-operative/short term
- long term post-operative
List the peri-operative complications that can occur during extraction.
- 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
What causes difficult access during extraction?
- trismus
- reduced aperture of the mouth (microstomia/scarring)
- crowed or malpositioned teeth
What causes abnormal resistance during extraction?
- thick cortical bone
- root morphology (eg divergent roots, hooked roots)
- number of roots
- hypercementosis
- ankylosis
What causes tooth/root fracture during extraction?
- caries
- alignment
- size
- root morphology (fused, divergent, extra etc)
What causes alveolar bone fracture during extraction?
- happens when bone is not mobilised properly before expansion
- usually buccal plate, often canines or molars
How do you treat alveolar bone fracture surrounding a canine?
- stabilise
- free the mucoperiosteum
- smooth the edges
How do you treat alveolar bone fracture surrounding a molar?
- periosteal attachment
- suture
- dissect free
What causes jaw fracture during extraction?
- 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
How should you manage a jaw fracture?
- 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
How can the maxillary antrum become involved during extraction?
- loss of root into the antrum can form an OAF or OAC
- fracture tuberosity
- some roots sit within sinus
Define OAF.
- oro-antral fistula
- an OAC that has been present for time, and been covered but a layer of epithelium
Define OAC.
- oro-antral communication
- communication between oral cavity and the maxillary sinus
How do you diagnose an OAC?
- 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
What are the risk factors for OAC?
- 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
How do you manage an OAC?
- inform patient
- if small, encourage clot, suture margins, antibiotic, post op instructions
- if large, close with buccal flap advancement (horizontal mattress suture), post op instructions and nose blowing instructions
- if root lost into antrum, confirm radiographically, decision of retrieval
What causes tuberosity fracture during extraction?
- single standing molar
- unknown unerupted widest tooth
- pathological gemination (germs attached)
- extracting in wrong order
- inadequate alveolar support
How do you diagnose a tuberosity fracture?
- noise
- movement noted both visually or with supporting fingers
- more than one tooth movement
- tear on palate
How do you manage tuberosity fracture?
- dissect out and close wound, or reduce and stabilise
- reduce using forceps or fingers
- rigid fixation is vital, orthodontic buccal arch wore welded using composite
- remove or treat pulp
- ensure occlusion is atraumatic
- antibiotics
- post op instructions
- remove tooth 8 weeks later
