Extraction Complications 1

Question 1

what can cause difficult access into a mouth

Answer 1

trismus, reduced aperture of the mouth, crowded/ mispositioned teeth

Question 2

what can cause abnormal resistance during xla

Answer 2

thick cortical bone
shape/ form of roots
hypercementosis
ankylosis

Question 3

what aspects of root morphology can cause tooth/ root fractures

Answer 3

fused
convergent or divergent roots
extra roots
hypercementosis
ankylosis

Question 4

what plate of the alveolar bone usually fractures

Answer 4

buccal plate

Question 5

what teeth are usually associated with fracture of the alveolar bone

Answer 5

canines or molars

Question 6

what are the steps to take if an alveolar fracture occurs

Answer 6

inform patient, post op radiograph, refer, ensure analgesia, stabilise, antibiotics

Question 7

what are risk factors for OAFs or OACs

Answer 7

extractions of upper molars and premolars
close relationship of roots to sinus on radiograph
large bulbous roots
older patient
previous OAC
recurrent sinusitis

Question 8

what are the risk factors of a tuberosity fracture

Answer 8

single standing molar
unknown unerupted molar wisdom tooth
pathological gemination
extracting in wrong order
inadequate alveolar support

Question 9

what is hypercementosis

Answer 9

excess build up of normal cementum on the root

Question 10

what is ankylosis

Answer 10

tooth is directly bonded to surrounding bone - no PDL

Question 11

what increases the chances of a tooth fracturing

Answer 11

caries
alignment
size

Question 12

when does fracture of the alveolar bone usually happen

Answer 12

when you take the tooth out too quickly

Question 13

when is the biggest predisposition to fracture of the mandible

Answer 13

an impacted lower 8 or a large cyst
an edentulous mandible

Question 14

how do you try to prevent fracturing of the mandible

Answer 14

by supporting the mandible with your non-dominant hand

Question 15

what type of radiograph should you get for a suspected fractured mandible

Answer 15

OPT

Question 16

what are signs of a fractured mandible

Answer 16

hearing a crack
feeling the mandible is in 2 parts
teeth do not meet in occlusion and they used to

Question 17

what are the three ways an OAC can occur

Answer 17

the roots of the tooth were sitting in the sinus
when going in to get a fractured third root with and elevator you can push the root into the sinus
fractured tuberosity

Question 18

what is an OAC

Answer 18

oro-antral communication - hole between the sinus and the mouth

Question 19

what is an OAF

Answer 19

when the hole between the sinus and the mouth has been left for a while and has become epithelialised and you have a tract that leads from the sinus to the mouth

Question 20

what are signs of creating OAC

Answer 20

if there is a chunk of bone at the roots of the tooth
if pre-op radiograph shows the roots are close to the sinus
bubbling of air at the socket

Question 21

what is the test for confirming presence of an OAC

Answer 21

ask patient to pinch nostrils and blow out with closed nostrils - if there is an OAC it forces the air out into the mouth via the sinus

Question 22

how would you manage an OAC

Answer 22

inform patient
if small OAC - encourage clot and suture margins and prescribe antibiotics
if large OAC - close with buccal advancement flap and prescribe antibiotics

Question 23

how do you try to prevent tuberosity fractures

Answer 23

finger and thumb supporting the alveolar bone

Question 24

what direction should you work in when removing teeth

Answer 24

remove the furthest back teeth first and work forward

Question 25

how is a fractured tuberosity managed

Answer 25

large part of bone - put back in place and use fingers and forceps to hold back in place then use and orthodontic splint