Extraction Complications Flashcards
3 types of extraction complications
- peri-operative i.e. immediate
- post-operative i.e. short term post op
- long term post op
peri operative complications
difficult access
abnormal resistance
fracture of tooth/root/alveolar bone/tuberosity
jaw fracture
oroantral communication
soft tissue/nerve damage
haemorrhage
dislocation of TMJ
damage to adjacent teeth/restorations
wrong tooth
peri operative - difficult access
trismus
reduced aperture of mouth (congenital/syndromes - microstomia; scarring)
crowded/malpositioned teeth
can make XLA very difficult - might not get forceps on tooth
peri operative - abnormal resistance
thick cortical bone - bulbous apex can prevent tooth coming out of socket seen more in premolars
shape/form of roots e.g. divergent/hooked roots
no of roots e.g. 3 rooted lower molars
hypercementosis - excess build up of normal cementum on normal roots making XLA more difficult
ankylosis - directly bonded to surrounding bone so no pdl can occur due to previous trauma/pulp necrosis
peri operative - tooth/root fracture
consider caries (more likely to decoronate) /alignment/size
root morphology: fused, convergent/divergent, extra root(s), hypercementosis, ankylosis
these make fracture more likely
peri operative - alveolar bone fracture
usually buccal plate at canines/molars
buttress overlying canine which has large root
molars - periosteal attachment, suture, dissect free
canines - stabilise, free mucoperiosteum, smooth edges
if still attached to periosteum then you can push it in to reattach & suture in place
if you can’t stabilise/no blood supply then remove and it will become sequestrum
peri operative jaw fracture
usually mandible, often large cyst, atrophic mandible or impacted wisdom tooth
what to do if jaw fracture occurs
inform ptx
post op radiograph
refer
ensure analgesia
stabilise
if delay, antibiotic
peri operative - maxillary antrum
oroantral fistula
loss of root into antrum
fractured tuberosity
how to diagnose involvement of maxillary antrum
diagnose by:
size of tooth
radiographic position of roots in relation to antrum
bone at trifurcation of roots
bubbling of blood in socket
nose holding test (valsalva manoeuvre) - careful as can create OAC
direct vision
good light and suction - may echo
blunt probe - careful not to create OAC
risk factors of involvement of maxillary antrum
extraction of upper molars/premolars
close relationships of roots to sinus
last standing molars
large, bulbous roots
older ptx
previous OAC
recurrent sinusitis
management of maxillary antrum involvement
inform ptx
if small or sinus intact -> encourage clot, suture margins, antibiotic, post op instruction
if large or lining torn -> close with buccal advancement flap, antibiotics and nose blowing instructions
root in antrum -> confirm radiographically, decision on retrieval
aetiology of tuberosity fracture
single standing molar
unknown erupted molar wisdom tooth
pathological germination
extracting in wrong order
inadequate alveolar support
diagnosis of tuberosity fracture
noise
movement noted visually or with supporting fingers
more than one tooth movement
tear on palate
why take teeth out back to front
back to front if doing multiple XLA as blood can run back & occlude vision and reduces chances you will fracture tuberosity as bone won’t be as weak
