Complications during tooth extraction Flashcards
Perioperative complications
- Crown fracture of adjacent tooth
- Soft tissue injury
- Fracture of alveolar process/maxillary tuberosity/Mandible
- Broken instrument in tissues
- Displacement of root tip into soft tissues
- Displacement of impacted tooth or root into maxillary sinus
- Dislocation of TMJ
- Subcutaneous or submucosal emphysema
- Haemorrhage
- Oroantral communication
- Nerve injury
Causes of fracture of crown or luxation of adjacent tooth
Excessive force and adjacent tooth used as fulcrum
Causes of soft tissue injury during extraction
-Improper instrument use(slippage)
Causes of fracture of alveolar process
- Improper extraction technique
- Ankylosis of tooth in alveolar process
Treatment of fracture of alveolar process
- Small→ broken parts of alveolar process removed w/forceps
- Sharp bone edges smoothed
- Saline irrigation and suturing
- Broken parts still attached to soft tissues may remain after stabilisation and suturing
Causes of fracture of maxillary tuberosity
- Maxillary sinus pneumatising into alveolar process
- Ankylosis of maxillary molars(resistance to movement great)
- Decreased resistance of bone in area
Treatment of fracture of maxillary tuberosity
- Repositioning of fractured segment and suturing when fractured segment not reflected from periosteum
- Tooth removed, bone smoothing and suturing when segment reflected→ Broad spectrum antibiotics and nasal decongestants
Causes of mandible fracture
- Excessive force with elevator
- Inadequate pathway for impacted tooth removal
- Ankylosed tooth
- Atrophic mandible
Treatment of mandibular fracture
- Removal of tooth first
- Stabilisation→ intermaxillary fixation or rigid internal fixation
- Broad spectrum antibiotics
Causes of broken instrument in tissue
- Excessive force during luxation
- Anaesthesia needle may break
Treatment of broken instrument in tissue
- Radiographic localisation
- Broken pieces surgically removed during same appointment
Causes of TMJ dislocation
- Shallow mandibular fossa or temporal bone
- Low anterior articular tubercle
- Round head of condylar process
Unilateral dislocation of TMJ results in
Mandible deviation to healthy side
Bilateral dislocation of TMJ results in
-Mandible sliding forward in prognathic position
Methods to avoid TMJ dislocation
- Firmly support mandible during extraction
- Avoidance of excessive mouth opening
Treatment of TMJ dislocation
- Thumbs placed on occlusal surfaces of teeth and rest of fingers around left and right body of mandible
- Simultaneous downward thumb pressure and upward posterior pressure w/ fingers until condyle in original position
Post op -Limitation of excessive opening movements for afew days
Clinical presentation of subcutaneous emphysema
- Swelling extending to neck and facial area
- Crepitus→ crackling sound during palpation
Treatment of subcutaneous emphysema
- No specific treatment
- Paracentesis may help remove air if large
- Antibiotics sometimes
Causes of haemorrhage
- Vessel trauma or Coagulation problems
- Severe haemorrhage→ severance of inferior alveolar vessels or palatal artery
- Haemorrhage diathesis(haemophilia)
Treatment of haemorrhage
- Compression(10-30 mins)
- Ligation (hemostat)
- Suturing
- Haemostatic materials (vasoconstrictors, alginic acid, desiccated alum)
Cause of displacement of root or root tip into soft tissues
- Eroded buccal/lingual cortical plate and region of root tip
- Perforation of bone
Treatment of displacement of root or root tip into soft tissues
- Palpation to locate and removal
- Clinical and radiographic examination to locate
Causes of Displacement of impacted root or root tip into maxillary sinus
- Commonly maxillary third molar→ impacted
- Close to sinus
- Procedure not properly planned
Treatment of Displacement of impacted root or root tip into maxillary sinus
Immediate(avoid infection)
- Radiographic assessment
- Removal by trephination using Caldwell luxe approach
Signs of oroantral communication
- Instrument enters greater depth than normal
- Valsalva test→ bubbling blood from post extraction socket when breathing through nose
Prevention of oroantral communication
- Radiographic assessment
- Careful instrument manipulation
- Avoid luxation of root tip if visualisation of area hindered by haemorrhage
Treatment of oroantral communication
Small communication→ suture gingiva after filling alveolus w/ collagen
-Large communication→ closure w/ flap
Most common nerves injured
Inferior alveolar, Mental and lingual
Symptoms of nerve injury
Burning sensation
- Pins and needles
- Biting of tongue and lips
- Abnormal chewing
- Burns when consuming food
Conditions of nerve trauma
- Anaesthesia
- Hypesthesia
- Paraesthesia
- Dysesthesia
Classifications of nerve injury
- Neurapraxia
- Axonotmesis
- Neurotmesis
-
Neurapraxia
- Small contact w/ nerve
- Favourable prognosis
- Complete recovery→rapid
Axonotmesis
- Injury without anatomic severance of endoneurium
- Slower recovery than neurapraxia(paraesthesia 6-8 weeks after injury)
- Risk of remaining sensory disturbance
