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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
Q

How can an impacted wisdom tooth increase risk of jaw fracture

A

may have underestimated how much bone there is in the angle region meaning there is a space in the bone

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26
Q

How can a cyst increase risk of fracture

A

weakens jaw

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27
Q

How can an atrophic mandible increase risk of fracture

A

its thin and the force used may fracture

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28
Q

What is the management of jaw fracture

A 
inform px 
post-op radiograph
refer (phone call) 
ensure analgesia
stabilise 
if there's delay then give AB
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29
Q

What is essential for reducing fracture risk

A

radiographs to see surrounding structures

application of force - always have finger on alveolus

if mandible is weakened then remove surgically or decoronate

30
Q

Why may we need to stabilize a jaw fracture

A

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
Q

What are issues which involve the maxillary antrum

A

oro-antral fistula
oro-antral communication
loss of root into antrum
fractured tuberosity

32
Q

How do you diagnose an oro-antral communication

A

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
Q

What is the difference between OAC and OAF

A

OAC is immediate acute situation

if goes unnoticed then doesn’t heal and become epithelial lined tube then it is a OAF

34
Q

What is the management of an OAC

A

inform the patient

then manage depending on whether its small or large

35
Q

What should be done if it is small or the sinus is intact

A

encourage clot
suture margins
antibiotic
post op instructions

36
Q

Why is it a good idea to give antibiotics for a OAC

A

as there is saliva going up into this area, filled with bacteria

37
Q

What is a large OAC or the lining is torn what should be does

A

close with buccal advancement flap

give antibiotics and nose blowing instructions

38
Q

What should you do if there is a root in the antrum

A

confirm radiographically by OPT, occlusal or periapical

then make a decision on retrieval

39
Q

What is the procedure for getting a root out of the antrum

A

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
Q

What is the etiology of a fractured maxillary tuberosity

A 
single standing molar
unknown unerupted molar wisdom tooth
pathological gemination
extracting in wrong order
ineqduate alveolar support
41
Q

Why is a single standing more at risk fo fractured maxillary tuberosity

A

weaker bone and lots of force on one tooth

42
Q

Why should you extract teeth in the right order to prevent tuberosity fracture

A

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
Q

How can you diagnose a tuberosity fracture

A

noise
movement noted both visually or with supporting fingers
more than one tooth movement
tear on palate

44
Q

What is the management of a fractured tuberosity

A

dissect out and close wound

or reduce and stabilize via fixation

45
Q

What does reducing the maxillary tuberosity mean

A

putting it back where it came from

anatomically repositioning it and stabilizing it

46
Q

How can you fixate the reduced tuberosity

A

orthodontic buccal arch wire spot that is welded with composite

splint

arch bar

47
Q

What type of fixations o you need for a fractured tuberosity

A

rigid fixation

going to come as anteriorly as you have to until you got rigidity splinted and bone won’t be moving about

48
Q

Why is rigid fixation so important

A

fractured bone doesn’t heal by bony union if moving, it will help by fibrous union instead

49
Q

How long should we leave the splint in the place for the tuberosity fracture

A

8-12 weeks

50
Q

For a fractured tuberosity what do we need to remember to do

A 
remove or treat pulp
ensure occlusion free
antibiotic and antiseptic
instructions post-op
remove tooth 8 weeks later
51
Q

How can damage occur to nerves

A 
crush injuries 
cutting/shredding injuries
transection 
damage from surgery or damage from LA
may not know at the time
52
Q

What is neurapraxia

A

contusion of nerve/continuinty of epieneural sheath and axons maintained

53
Q

What is axonotmesis

A

continuity of axons but not epieneural sheath disrupted

54
Q

What is neurotmesis

A

complete loss of nerve continuity/nerve transected

55
Q

What is anaesthesia

A

numbness

56
Q

What is paraesthesia

A

tingling

57
Q

What is dysaesthesia

A

unpleasant sensation/pain

58
Q

What is hypoaesthesia

A

reduced sensation

59
Q

What is hyperesthesia

A

increase or heightened sensation

60
Q

What vessels can be damaged

A 
veins
arteries
arterioles
vessels in muscle 
vessels in bone
61
Q

If you damage a vein what would you expect

A

a lot of bleeding

waves of bleeding

62
Q

If you damage an artery what would you expect

A

lots of bleeding and squirting as there is a pulse and muscular walls
would see spurting

63
Q

If you damage an arteriole what would you expect

A

you would expect spurting still

64
Q

What are most bleeds in dentistry due to

A

local factors such as mucoperiosteal tears or fractures of the alveolar plate or socket wall

65
Q

How should you manage a bleed in soft tissue

A 
pressure (mechanical)
sutures
LA with adrenaline 
diathermy 
ligatures/haemostatic forceps (artery clips) for larger vessels
66
Q

What is diathermy

A

cauterise/burn vessels - precipitate proteins, form proteinaceous plug in vessel

67
Q

What are the options for managing a bleed in bone

A 
pressure via swab
LA on a swab or infected into socket
hemostatic agents (surgical or kaltostat)
blunt instrument 
bone wax
pack
68
Q

What should you do if you dislocate the TMJ

A

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
Q

How is it possible to cause damage to adjacent teeth and restorations

A

by hitting opposing teeth with forceps

crack/fracture/move adjacent teeth with elevators

crack/fracture/remove restorations/crowns/bridges on adjacent teeth

70
Q

How should you manage damage to adjacent teeth and restorations

A

temporary dressing/restoration
arrange definitive restoration
if large restoration next to extraction site then warn px of the risk

71
Q

What should you do about broken instruments such as tips of burs or elevators and luxators

A

radiograph and retrieve

if unable to retrieve then refer

72
Q

How can you try and prevent taking out the wrong tooth

A 
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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