Extraction Complications 1&2 Flashcards
Compare and contrast all categories of extraction complications based on their timing.
Peri-operative (Immediate/Intra-operative):
Occur during the procedure
Require immediate management
Examples: fractures, soft tissue damage, hemorrhage
Immediate post-operative/Short-term:
Develop shortly after procedure
May require urgent intervention
Long-term post-operative:
Develop over time
May require delayed intervention
Detail all causes of difficult access during extractions and their clinical implications.
Trismus
Limited jaw opening
May need management before extraction
Reduced mouth aperture
Congenital (microstomia)
Acquired (scarring)
May require modified technique
Dental factors
Crowded teeth
Malpositioned teeth
May need sectioning or alternative approach
Analyze all causes of abnormal resistance during extraction and explain their clinical significance.
Bone-related
Thick cortical bone
Requires careful force application
Root-related
Divergent roots
Hooked roots
Multiple roots (e.g., 3-rooted lower molars)
May need sectioning
Pathological
Hypercementosis
Ankylosis
May require surgical approach
Create a comprehensive diagnostic framework for assessing fracture risk during extraction.
Tooth Structure:
Caries extent
Existing restorations
Overall integrity
Root Morphology:
Fusion status
Direction (convergent/divergent)
Number of roots
Presence of hypercementosis
Ankylosis
Tooth Position:
Alignment in arch
Relationship to adjacent teeth
Access considerations
Size Considerations:
Root length
Root thickness
Crown-root ratio
Compare and contrast management approaches for different types of alveolar bone fractures.
usually buccal plate
Canine Region:
Stabilization required
Mucoperiosteum freed
Edge smoothing essential
Molar Region:
Maintain periosteal attachment
Suturing required
Careful dissection needed
What jaw usually fractures more?
in which scenerios
mandible
*Often impacted wisdom tooth, large cyst oratrophic mandible
What should you do if jaw fracture occurs?
*Inform patient
*Post-op radiograph
*Refer (phone call)
*Ensure analgesia
*Stabilise
*If delay, antibiotic
Detail the complete diagnostic approach for oro-antral communications (OAC) and fistulas (OAF).
Visual Assessment:
Size of tooth
Direct visualization
Blood bubbling
Need for good light and suction
Clinical Tests:
Nose holding test (cautious use)
Echo detection
Blunt probe (careful not to create OAC)
Radiographic Assessment:
Root position relative to antrum
Bone presence at trifurcation
What are the risk factors for maxillary antrum involvement?
- Upper posterior teeth extraction
- Close root-sinus relationship
- Last standing molars
- Large, bulbous roots
- Advanced age
- Previous OAC history
- Chronic sinusitis
Develop a comprehensive management protocol for maxillary antrum complications.
small communication
Small Communication (Intact Sinus):
Patient information
Clot preservation
Margin suturing
Antibiotic prescription
Detailed post-op instructions
Develop a comprehensive management protocol for maxillary antrum complications.
large communication
Large Communication/Torn Lining:
Buccal advancement flap closure
Antibiotic therapy
Modified nose-blowing instructions
Develop a comprehensive management protocol for maxillary antrum complications.
root displacement into antrum
Root Displacement into Antrum:
Radiographic confirmation
* OPG
* Occlusal view
* Periapical
Retrieval decision-making
Specialist referral if needed
What are the risk factors for tuberosity fractures?
anatomical/iatrogenic
Anatomical:
Single standing molar
Unerupted wisdom tooth
Pathological gemination
Iatrogenic:
Incorrect extraction order
Insufficient alveolar support
What are the clinical signs and assessment for diagnosing tuberosity fractures?
Clinical Signs:
Audible noise during extraction
Visual movement
Multiple tooth movement
Palatal tear
Assessment:
Extent of fracture
Stability of fragment
Soft tissue involvement
Detail the complete management protocol for tuberosity fractures.
Initial Decision:
Choice between:
- Complete dissection and wound closure
- Reduction and stabilization
Reduction Technique:
Methods:
- Digital manipulation
- Forceps reduction
Fixation Options:
- Orthodontic buccal wire with composite
- Arch bar placement
- Custom splints
Essential Steps:
- Pulp management/removal
- Occlusal adjustment
- Antibiotic prescription
- Antiseptic protocol
Follow-up:
- Post-op instructions
- Delayed extraction (8 weeks)
- Secondary referral if needed
List five major peri-operative complications of dental extractions.
- Fracture of tooth/root
- Soft tissue damage
- Nerve damage
- Haemorrhage
- TMJ dislocation
What are the immediate steps to take if a tooth is lost during extraction?
Stop, determine location, use suction, take a radiograph.
How can soft tissue damage be prevented during an extraction?
Correct instrument placement, controlled pressure, correct application point, sufficient but not excessive force.
What are the three types of nerve injuries and their definitions?
Neurapraxia: Contusion of nerve with intact epineural sheath and axons.
Axonotmesis: Disruption of axons, but epineural sheath remains.
Neurotmesis: Complete nerve transection.
Define and differentiate anaesthesia, paraesthesia, dysaesthesia, hypoaesthesia, and hyperaesthesia.
Anaesthesia: Complete numbness
Paraesthesia: Tingling sensation
Dysaesthesia: Unpleasant/painful sensation
Hypoaesthesia: Reduced sensation
Hyperaesthesia: Increased sensation
What are the different types of vessels and their associated bleeding patterns?
Veins: Continuous bleeding
Arteries: Spurting haemorrhage
Arterioles: Pulsating bleed
What are the common causes of peri-operative haemorrhage?
Local mucoperiosteal tears
Alveolar fractures
Clotting disorders (haemophilia/von Willebrand)
Liver disease
Anticoagulant medications (Warfarin, Aspirin, Clopidogrel, Rivaroxaban, Dabigatran).
Describe two haemorrhage management strategies for soft tissue and bone bleeds.
Soft tissue: Apply pressure, sutures, local anaesthetic with adrenaline, diathermy, ligatures.
Bone: Apply pressure, use LA-soaked swab, haemostatic agents, blunt instruments, bone wax, pack.
What is the immediate management of TMJ dislocation?
Relocate immediately with analgesia, support yawning. If unsuccessful, try intra-oral LA into the masseter or refer urgently.
What are the risks of adjacent tooth damage, and how is it managed?
Risks include fracture, movement, or dislodgement of restorations. Managed with temporary dressings, definitive restoration, and warning the patient if a large restoration is present.
When is extraction of a permanent tooth germ most likely to occur?
When extracting deciduous molars, potentially damaging the developing permanent premolars.
What are the key steps in managing a broken instrument during extraction?
Identify missing part, take radiograph, retrieve if possible, and refer if retrieval fails.
How can wrong tooth extraction be prevented?
Concentrate, check notes/radiographs carefully, count teeth, verify with another clinician if unsure, and contact defence union if an error occurs.
