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BDS3 CLINICAL Oral Surgery > Extraction Complications > Flashcards

Extraction Complications Flashcards

1
Q

What can extraction complications be divided into

A

immediate/intra-operative/peri-operative

immediate post-operative/short term post-op

long term post-op

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2
Q

What are peri-operative complications

A 
difficulty of access
abnormal resistance
fracture of tooth/root
fracture of alveolar plate
fracture of tuberosity 
jaw fracture 
involvement of maxillary antrum
loss of tooth
soft tissue damage
damage to nerves/vessels
hemorrhage 
dislocation of TMJ
damage to adjacent teeth/restorations
extraction of permanent tooth germ
broken instruments
wrong tooth
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3
Q

What can difficulty of access and vision be due to

A

trismus
reduced aperture of mouth
crowded/malpositioned teeth

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4
Q

How does truisms cause difficulty of access

A

px can’t open mouth wide

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5
Q

How does reduced aperture of the mouth cause difficulty of access

A

if its a small mouth and the person can’t open side

some px may have congenital/syndromes e.g microstomia which is scarring and makes it difficult to open

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6
Q

How does crowded/malpositioned teeth create difficulty of access

A

hard to get to desired tooth

may have to opt for surgical extraction due to risk of mobilizing adjacent teeth

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7
Q

What is abnormal resistance due to

A 
thick cortical bone
shape/form of roots
number of roots
hypercementosis
ankylosis
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8
Q

What shapes of roots cause abnormal resistance

A

divergent roots/hooked roots often seen on lower molars as they can trap interradicular bone between the curves making it harder

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9
Q

Why does number of roots cause abnormal resistance

A

3 rooted lower molars - the third root is often spindly and hard to mobilize

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10
Q

What is hypercementosis

A

Extra cementum

see big clumps of cementum and it makes it harder to remove

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11
Q

What can we fracture

A

tooth
alveolus/tuberosity
jaw

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12
Q

What can a tooth fracture be of

A

the crown or root

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13
Q

What can make tooth fracture more likely

A

caries
alignment
size
root

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14
Q

Where do we want forceps to reduce chance of fracture

A

beyond crown root junction to get into bone

sometimes bone won’t allow this and need luxators and elevators

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15
Q

How does root contribute to fracture likelihood

A

if crowns are tiny and roots are large suspect breakage

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16
Q

What are root problems that contribute to fracture

A 
fused
convergent/divergent
extra roots
morphology
hypercementosis
ankylosis
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17
Q

What part of the alveolar bone usually fractures

A

usually the buccal palate as there is a buttress area of thick bone around it
usually around the canines or molars

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18
Q

When fracturing alveolar bone around molars what do we consider

A

does it have periosteal attachment?

or no periosteal attachment?

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19
Q

If there is periosteal attachment what do we do?

A

put it nah and suture in hope it will heal

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20
Q

If there is no periosteal attachment what do we do?

A

have to dissect it free so gum isn’t ripped

has to be removed because its a dead bit of bone that will cause pain

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21
Q

Why do we try to save the bone in the canine region

A

as it creates the arch

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22
Q

What do we do if the canine bone region is fractured

A

stabilise
free mucoperiosteum
smooth edges

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23
Q

What jaw is usually fractured

A

mandible

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24
Q

What are risk factors for jaw fracture

A

impacted wisdom tooth, large cyst, atrophic mandible

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25
How can an impacted wisdom tooth increase risk of jaw fracture
may have underestimated how much bone there is in the angle region meaning there is a space in the bone
26
How can a cyst increase risk of fracture
weakens jaw
27
How can an atrophic mandible increase risk of fracture
its thin and the force used may fracture
28
What is the management of jaw fracture
``` inform px post-op radiograph refer (phone call) ensure analgesia stabilise if there's delay then give AB ```
29
What is essential for reducing fracture risk
radiographs to see surrounding structures application of force - always have finger on alveolus if mandible is weakened then remove surgically or decoronate
30
Why may we need to stabilize a jaw fracture
if bone is rubbing against each other and its sore then may need to stabilize with wire that's thin and flexible and rope around teeth on each side of fracture don't do on periodontally compromised teeth
31
What are issues which involve the maxillary antrum
oro-antral fistula oro-antral communication loss of root into antrum fractured tuberosity
32
How do you diagnose an oro-antral communication
size of tooth radiographic positions of roots in relation to antrum bone at trifurcation of roots bubbling of blood nose holding test (careful as can create an OAC) direct vision good light and suction (echo) blunt probe (take care not to create an OAC)
33
What is the difference between OAC and OAF
OAC is immediate acute situation | if goes unnoticed then doesn't heal and become epithelial lined tube then it is a OAF
34
What is the management of an OAC
inform the patient | then manage depending on whether its small or large
35
What should be done if it is small or the sinus is intact
encourage clot suture margins antibiotic post op instructions
36
Why is it a good idea to give antibiotics for a OAC
as there is saliva going up into this area, filled with bacteria
37
What is a large OAC or the lining is torn what should be does
close with buccal advancement flap | give antibiotics and nose blowing instructions
38
What should you do if there is a root in the antrum
confirm radiographically by OPT, occlusal or periapical then make a decision on retrieval
39
What is the procedure for getting a root out of the antrum
you need to do a flap design similar to that for an OAC open fenestration with care then get suction and efficient and narrow bore small curettes to see if it can be grabbed irrigation or ribbon gauze to try and pull it out or move it forward close as for oro-antral communication
40
What is the etiology of a fractured maxillary tuberosity
``` single standing molar unknown unerupted molar wisdom tooth pathological gemination extracting in wrong order ineqduate alveolar support ```
41
Why is a single standing more at risk fo fractured maxillary tuberosity
weaker bone and lots of force on one tooth
42
Why should you extract teeth in the right order to prevent tuberosity fracture
take out from the back forward, don't take out 6,7,8. | take out 8,7,6 bc otherwise you are undermining bone as you go along and leaving yourself with a last standing molar
43
How can you diagnose a tuberosity fracture
noise movement noted both visually or with supporting fingers more than one tooth movement tear on palate
44
What is the management of a fractured tuberosity
dissect out and close wound | or reduce and stabilize via fixation
45
What does reducing the maxillary tuberosity mean
putting it back where it came from | anatomically repositioning it and stabilizing it
46
How can you fixate the reduced tuberosity
orthodontic buccal arch wire spot that is welded with composite splint arch bar
47
What type of fixations o you need for a fractured tuberosity
rigid fixation going to come as anteriorly as you have to until you got rigidity splinted and bone won't be moving about
48
Why is rigid fixation so important
fractured bone doesn't heal by bony union if moving, it will help by fibrous union instead
49
How long should we leave the splint in the place for the tuberosity fracture
8-12 weeks
50
For a fractured tuberosity what do we need to remember to do
``` remove or treat pulp ensure occlusion free antibiotic and antiseptic instructions post-op remove tooth 8 weeks later ```
51
How can damage occur to nerves
``` crush injuries cutting/shredding injuries transection damage from surgery or damage from LA may not know at the time ```
52
What is neurapraxia
contusion of nerve/continuinty of epieneural sheath and axons maintained
53
What is axonotmesis
continuity of axons but not epieneural sheath disrupted
54
What is neurotmesis
complete loss of nerve continuity/nerve transected
55
What is anaesthesia
numbness
56
What is paraesthesia
tingling
57
What is dysaesthesia
unpleasant sensation/pain
58
What is hypoaesthesia
reduced sensation
59
What is hyperesthesia
increase or heightened sensation
60
What vessels can be damaged
``` veins arteries arterioles vessels in muscle vessels in bone ```
61
If you damage a vein what would you expect
a lot of bleeding | waves of bleeding
62
If you damage an artery what would you expect
lots of bleeding and squirting as there is a pulse and muscular walls would see spurting
63
If you damage an arteriole what would you expect
you would expect spurting still
64
What are most bleeds in dentistry due to
local factors such as mucoperiosteal tears or fractures of the alveolar plate or socket wall
65
How should you manage a bleed in soft tissue
``` pressure (mechanical) sutures LA with adrenaline diathermy ligatures/haemostatic forceps (artery clips) for larger vessels ```
66
What is diathermy
cauterise/burn vessels - precipitate proteins, form proteinaceous plug in vessel
67
What are the options for managing a bleed in bone
``` pressure via swab LA on a swab or infected into socket hemostatic agents (surgical or kaltostat) blunt instrument bone wax pack ```
68
What should you do if you dislocate the TMJ
relocate immediately and give analgesia and advice on supported yawning if unable to relocate then try LA into masseter intra orally if still unable to relocate then there should be immediate referral
69
How is it possible to cause damage to adjacent teeth and restorations
by hitting opposing teeth with forceps crack/fracture/move adjacent teeth with elevators crack/fracture/remove restorations/crowns/bridges on adjacent teeth
70
How should you manage damage to adjacent teeth and restorations
temporary dressing/restoration arrange definitive restoration if large restoration next to extraction site then warn px of the risk
71
What should you do about broken instruments such as tips of burs or elevators and luxators
radiograph and retrieve | if unable to retrieve then refer
72
How can you try and prevent taking out the wrong tooth
``` concentrate check clinical situation against notes and radiographs count teeth verify with someone if unsure phone defense union if done ```

BDS3 CLINICAL Oral Surgery (6 decks)

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