Extraction Complications

Question 1

Peri-op XLa complications

Answer 1

Tooth fracture
Alveolar plate fracture
Tuberosity fracture
Jaw fracture
Root in sinus
ST damage
Damage to adjacent teeth
Damage to nerves

Question 2

Define an OAC

Answer 2

Communications between maxillary sinus and oral cavity
Can lead to fistula if not healed

Question 3

Define an OAF

Answer 3

Epithelial lined tract between the maxillary sinus and the oral cavity

Question 4

How is an OAC diagnosed

Answer 4

Bubbling of blood
Bone at trifurcation of roots
Nose holding test
Good light direct vision - shimmer of sinus
Ech under suction
Blunt probe - can create OAC

Question 5

Management of an OAC

Answer 5

Inform patient
If small <2mm leave or sinus intact
- Encourage clot to form
- Suture margins
- ABX
- Post op
- avoid smoking/using straw/singing/wind instruments/nose blowing
- Reassure that most small OACS <2mm heal with normal blood clot formation
- Review

If large or lining torn >2mm
- Close with buccal advancement flap or palatal flap
- ABx and nose blowing instructions

Question 6

How is an OAC diagnosed postop based on pts symptoms?

Answer 6

Salty discharge
Fluid from nose when drinking
Non healing socket
Difficulty smoking

Question 7

How is a root in sinus diagnosed

Answer 7

Confirm radiographically by OPT, occlusal or PA (+/- CBCT to plan for removal
Check apices
Suction + irrigation to visually access
Make decision on retrieval or refer

Question 8

Management of a root in sinus

Answer 8

Inform patient
Refer pt - Caldwell luck approach + buccal advancement flap
CBCT (cilia can push root into diff place)

Question 9

When can you leave a root in the sinus?

Answer 9

If it is wedged between the lining of the sinus and the alveolar bone

Question 10

Aetiology of fractured tuberosity

Answer 10

Single standing molar
XLa in wrong order
Inadequate alveolar support

Question 11

How is a fractured tuberosity diagnosed?

Answer 11

Noise - crack
Tear in paalte
Movement visually + with supporting fingers
Mobility of more than 1 tooth

Question 12

Management of fractured tuberosity

Answer 12

Reassure
Reduce + stabilise with ortho buccal arch wire and composite

Ensure out of occlusion to avoid occlusal load
Postop instructions
ABX
Remove or tx pulp XLa after 8wks

Question 13

How is a fracture of roots diagnosed?

Answer 13

Check apices + socket
Check radiographically

Question 14

Management of fractured roots

Answer 14

Reassure + tell pt
Advise may come to surfacer
If <2mm can leave as may resorb
If >2mm or pathology related must remove
May attempt retrieval if visible and on surface
May require referral if chance may become surgical

Question 15

Predisposing factors to a jaw fracture

Answer 15

Impacted wisdom teeth
On bisphosphonates/denosumab
Atrophic mandible
Large cyst

Question 16

Management of a jaw fracture

Answer 16

Inform patient
Post op radiograph
Refer
Analgesia
Stabilise with ortho wire or splint wire
Tie around crowns of a few teeth
If delay give abx
Dont eat or wont get a GA
Keep it clean

Question 17

What type of fracture are jaw fractures usually?

Answer 17

Compound fractures
Gum is ripped
Bacteria gets in to them

Question 18

Why do we no longer squeeze a socket after an XLa?

Answer 18

Reduces bone vol for implants

Question 19

How does damage to nerves occur?

Answer 19

Crushing
Cutting/shredding
Transection
Damage from surgery/LA

Question 20

What can damage to nerves cause?

Answer 20

Anaesthesia
Paraesthesia
Hypoaesthesia
Hyperaesthesia
Dysaesthesia

Question 21

Tx for dislocation of TMJ

Answer 21

Relocate immediately
Analgesia + advice on yawning
If unable to relocate try LA into masseter
If still unable to relocate - immediate referral