OACs and retained roots Flashcards
causes of retained roots
gross caries
trauma
coronectomy
attempted extraction
why do teeth fracture?
- thick cortical bone
- less expansion of socket so harder to ext
- root shape
- divergent, bulbous, apical hooks
- root number
- ankylosis
- often LEs
- chance increases with age - beware with elderly
- caries
- prev RCT
- can make root weaker/more brittle
- alignment
why do retained roots not always need to be removed?
preserve bone height e.g. future implant
near vital anatomical structures e.g. IDC
present for a number of years with the absence of PA pathology
discussing retained roots w pt
give pts the option
can be left alone and monitored to ensure no caries/PA pathology, however if becomes carious or infected recommend removal
- document discussion w pt
general flap design principles
- max access with min trauma
- bigger flap heal just as quickly as smaller ones
- wide -based incision - circulation
- use scalpel in one firm continuous stroke
- no sharp angles
- adequate sized flap
- min trauma to dental papillae
- flap reflection should be down to bone and done cleanly
- no crushing
- keep tissue moist
- ensure that flap margins and sutures will lie on sound bone
- make sure wounds are not closed under tension
- aim for healing by primary intention to minimise scarring
OAF
epithelialised pathological unnatural communication between oral cavity and maxillary sinus
when OAC fails to close spontaneously, remains patent and gets epithelialised
migration of oral epithelium into the defect
epithelialisation usually occurs when the perforation persists for at least 48-72hrs
U3-8
how does an OAC occur?
routine forceps ext surgical ext tuberosity fracture dentoalveolar/periapical infections of molars implant dislodgement into MS trauma maxillary cysts or tumours Osteoradionecrosis dehiscence following implant failure
risk factors for OAC
extraction of upper molars and premolars
close relationship of roots to sinus on radiograph
large bulbous roots
last standing molars
older pt
prev OAC
recurrent sinusitis
pre-op signs of OAC
size of tooth and radiographic position of roots in relation to antrum
peri-op signs of OAC
bone removed at trifurcation bubbling at socket Valsalva test - pt pinches nose and blows gently, see bubbling at socket change in suction sound (high pitched) direct vision
post-op signs of OAC
brown unilateral discharge
fluid from nose when drinking
salty discharge
difficulty smoking/drinking through straw
non-healing socket
radiographic signs of OAC
break in floor of sinus
cloudy sinus
root fragment
management of OAC
inform pt, gain consent to monitor, close or refer
if small (<2mm) may heal spontaneously close (or refer for closure) with buccal advancement flap and ABs if >2mm
conservative advice
consider ABs ( in >2mm, almost always risk of sinusitis)
management of OAC - conservative advice
no nose blowing, do not hold in sneezes do not agitate area HSMW or CHX rinse avoid using straws smoking cessation advice steam inhalations with menthol crystals
management of OAC - decongestant/nasal drops
ephedrine nasal drops 0.5% 10ml - 1 drop 4 times daily
max 7 days
not applicable anymore
