COMPLICATIONS of extraction Flashcards
How do you know you encountered dentoalveolar fracture or tuberosity fracture during exo?
When you try to move tooth and tooth adjacent moves together
What are risk factor of dentoalveolar fracture or tuberosity fracture
Lone standing tooth Single isolated tooth Bulbous diverging roots Dilacerated roots Excessive uncontrolled force
How would you manage such encounter - tuberosity fracture or dentoalveolar fracture?
- Stop and stabilize the tooth and bony fragment with splint or wires for 4-6 weeks, reattempt exo after 6-8 weeks.
- If still indicated for immediate extraction, surgical removal of tooth by sectioning roots and sepetate tooth from fragments while stabilizing the bone. Elevation towards buccal taking caution to avoid palatal mucosal tear as it may cause tearing of the greater palatine vessels and nerve as well. Suture overlying mucosa. Then stabilize the fractured fragments.
Consequences of tuberosity fracture
Bleeding from pterygoid plexus or greater palatine nerve
OAC
Infection - sinus or socket infection
How to prevent maxillary tuberosity or dentoalveolar #
- Adequate finger support on buccal and palatal alveolus
- Tooth sectioning on diverging tooth roots
- Socket expansion buccally with elevators
- Extracting from most distal tooth if multiple teeth exo
What are complications u may encounter during MOS third molar (INTRAOPERATIVE complication)
- Fractured root
- Displaced tooth/roots
- Aggressive bleeding
- Aspiration
- Broken instruments
What are risk factors for root fracture?
Curved roots
Dense bone
Long thin roots
In what situations do you keep fractured tooth roots
Noninfected roots
<2mm length of root tip
If risk of other complications when attempting to remove tooth roots is more and causing permanent/unwanted side effect (e.g. nerve injury, displace roots into potential spaces like submandibular, infratemporal, max sinus)
Where would a lower molar fractured root be displaced to?
Mandibular canal
Submandibular space
How to determine location of displaces mandibular roots
Direct visualization from the socket
Radiographic
- PA to see extend and depth of root in vertical
- mandibular occlusal to see location of roots in buccal or lingual side
- CBCT for 3D visualization of the root
Whats ur next step after determining displaced root
- immediately place fingers on the medial surface and apply upwards pressure motion
- If seen thru socket, attempt retrieval using suction tip, root pick, small hemostat
- If unable to see, open lingual gingival flap extending anteriorly to canine. Careful subperiostal flap reflection all the way to below mylohyoid attachment or until root is visualised
- If unable to retrieve (d/t patient distress, bleeding, too deep), allow 3-4 weeks for soft tissue to heal with fibrosis and to allow stabilization, then attempt secondary procedure.
When can u leave displaced roots unremoved
displaced into mandibular canal without paraesthesia, root infection, asymptomatic, small .
Whats ur next attempt when roots displaced into max sinus
Placing patient upright to prevent posterior displacement of roots
Ask patient to blow while closing the nostrils to help push the roots towards opening of sinus
Suction at opening to bring the roots into extraction site
Sinus lavage and suction to flush root out
If attempt fail, caldwell luc at canine fossa.
What is caldwell luc approach
1.
Postop management of sinus surgery
Sinus precaution
Nasal decongestants to keep ostium open
Antibiotics to prevent sinus infection
Analgesias
