Complications Of Surgical Dentistry

Question 1

List the complications of Surgical Dentistry

Answer 1

1) IDN injury
2) Lingual nerve injury
3) Infection
4) Secondary hemorrhage
5) Damage to adjacent teeth
6) Peridontal problems
7) Displacement of teeth
8) Temporomandibular joint disorders
9) Alveolar Osteitis
10) Mandible fracture
11) Maxillary tuberosity fracture
12) Oro-antral communication

Question 2

Describe the factors causing IDN injury

Answer 2

• surgeons experience
• proximity of tooth relative to IDN canal
• difficulty of surgery

Question 3

How to test degree of IDN injury?

Answer 3

Mechanoreceptive:
1) brush stroke
- directional brush stroke to discern normal from abnormal areas
- stroke across skin in 1cm area (ask if can perceive sensation + direction)
- >90% of attempts = normal
- medial, paramedial, mental foramen sections of chin, lower lip vermillion

2) static light touch
- von-frey monofilaments (evaluates A-beta and pressure perception: values of 1.65-2.36 normal)
- wisp of cotton + stoke gently

3) 2-point discrimination
- ECG caliper
- performed and repeated in 2mm increments until patient no longer perceives 2 distinct points

4) vibrational sense

Nociceptive:
1) pain stimuli
- assess free nerve endings innervated by lightly myelinated A-delta and unmyelinated C fibres
- use a sterile dental needle (prick)
- use a pressure algesiometer at 25g of pressure

2) thermal discrimination
- ethyl chloride on cotton applicator for unmyelinated C fibres
- heated GP for A-delta fibres
- minnesota thermal discs

Question 4

Describe the classification of IDN injury

Answer 4

First degree: neurapraxia (segmental demyelination)
Second degree: Axonotmesis (Axon severed but endoneurium intact
Third degree: Axonotmesis (Axon discontinuity, endoneurial tube discontinuity, perineurium and fascicular arrangement preserved
Fourth degree: Axonotmesis (loss of continuity of axons, endoneurial tubes, perineurium and fasciculi, epineurium intact)
Fifth degree: Neurotmesis (loss of continuity of entire nerve trunk)

Question 5

List the 7 radiographical signs which are related to nerve injury

Answer 5

1) darkening of root (1/4 chance)
2) deflection of root
3) narrowing of root
4) bifid root apex
5) diversion of root (1/3 chance)
6) narrowing of root
7) interruption of white line of canal (1/4 chance)

Question 6

Describe the factors causing LN injury

Answer 6

• incisions placed far too lingually or breach of lingual cortex
• lingual angulation of third molar
• vertical sectioning
• prolonged operating time
• surgeons experience

Question 7

Describe the clinical signs of LN injury

Answer 7

• drooling
• tongue biting
• thermal burns
• changes in speech
• swallowing and taste perception alterations
• atrophy of lingual papillae

Question 8

Can alveolar osteitis be prevented?

Answer 8

• systemic AB DOES NOT prevent AO

Recommendations:
- existing pericoronitis to be treated adequately pre-op
- OH to be satisfactory pre-op
- Atraumatic with copious irrigation
- Intra-alveolar medications (tetracycline may be beneficial)
- Chlorhexidine gel/mouthwash on day of surgery + several days after

Question 9

Where can infection take place?

Answer 9

Maxillary 3rd molar: maxillary vestibule, buccal space, deep temporal space, infratemporal fossa

Mandibular 3rd molar: mandibular vestibule, buccal space, submasseteric space, pterygomandibular space, parapharyngeal space, submandibular space

Question 10

Which tooth has a higher risk of fracture?

Answer 10

• with large restorations or caries
• maxillary mesioangular with a pell and Gregory class b
• mandibular vertical impactions

Question 11

List the places where the tooth can be displaced to

Answer 11

1) lingual space (common)
2) submandibular space
3) IDN canal
4) infra-temporal fossa
5) lungs
6) stomach

Question 12

Describe the risk factors for mandibular fracture

Answer 12

• increased age
• mandibular atrophy
• cyst or tumour
• osteoporosis
• deeply impacted teeth
• excessive bone removal
• excessive force applied

Question 13

List the risk factors for oro-antral communication

Answer 13

• maxillary molars (1st>2nd>3rd)
• widely divergent or abnormally long roots
• maxillary sinus greatly pneumatised
• little or no bone between root and sinus
• adjacent to edentulous space
• destruction of sinus floor by PA lesions
• injudicious use of instruments leading to perforation of floor/sinus membrane
• difficult extraction

Question 14

What is the treatment for OAC?

Answer 14

<2mm: no need treatment (decongestants, antibiotics and sinus precautions)
2-6mm: surgicel, decongestants and AB
>6mm: stitch up (buccal advnacment flap for premolars and molars)