Peri-operative Complications Flashcards
1
Q
What are peri-operative complications?
A
- immidiate complications
- while taking tooth
- immediately after extraction
2
Q
Provide examples of peri-operative complications
A
- difficult access
- abnormal resistance
- fracture of tooth/root
- fracture of alveolar bone
- jaw fracture
- involvement of maxillary antrum (sinus)
- fracture of tuberosity
- loss of tooth
- soft tissue damage
- damage to nerves/vessels
- haemorrhage
- dislocation of TMJ
- damage to adjacent teeth/restorations
- extraction of permanent tooth germ
- broken instruments
- wrong tooth
3
Q
What can contribute to difficult access?
A
- trismus
- reduced aperture of mouth
- congenital/syndromes (microstmoia)
- scarring
- muscle spasming
- crowding/malpositioned teeth
- unusual eruption
- forceps not useful, luxators and elevators alone
- particularly upper 3s and lower 4s and 5s
4
Q
Why is difficult access a complication?
A
- may not be able to see tooth
- can position patient to improve view
- good lighting
- good operator positioning
- suction may help
- may not be able to position forceps
5
Q
What can contribute to abnormal resistance?
A
- thick cortical bone
- shape/form of roots
- divergent roots
- hooked roots
- bulbous apex common for lower premolars
- number of roots
- e.g. 3 rooted lower molars/ 2 rooted premolars
- hypercementosis
- excess build up of normal cementum on the root
- ankylosis
- tooth fused to surrounding bone
- no periodontal ligament
- may be trauma or pulp necrosis
- cannot be extracted with forceps
6
Q
How can abnormal resistance be managed?
A
- taking a break and trying again
- oedema from first attempt may loosen tooth
- may see new way of attempting extraction
- more force required
- surgical extraction required
7
Q
What can contribute to tooth/root fracture?
A
- caries
- decoronation if carious crown or carious ACJ
- difficult to place forceps - alignment
- size
- small crown with big roots increases decoronation risk
- root morphology
- fused (may have chunk of bone stuck between roots)
- convergent or divergent
- extra roots
- hypercementosis
- ankylosis
8
Q
How can tooth/root fracture be managed?
A
- sometimes inevitable
- must be discussed during consent process
- place forceps beaks on root surface
- if on crown higher chance of decoration
9
Q
What can contribute to fracture of the alveolar bone?
A
- usually buccal plate of canines or molars
- buttress of bone overlying long root of canine
- thicker buccal plate over molars
- inadequate expansion of socket
10
Q
How can fracture of alveolar bone be managed?
A
- preserve as much bone as possible
- especially for implant placement
- fracture can produce thin ridge for dentures
- possible management
- is bone attached to periosteum?
- reattach with sutures where possible
- remove if no blood supply - dissect free if still attached
- surgically extract tooth
- smooth bone edges to avoid wound breakdown
11
Q
What can contribute to jaw fracture?
A
- usually mandible
- often impacted wisdom teeth, large cyst, atrophic mandible
- likely at angle of mandible
- application of force
- fracture can occur post operatively
- not enough bone left
- bumping can cause fracture
- signs of fractured mandible
- cracking sound
- teeth not in occlusion
- trauma to gingiva
12
Q
How can fracture of the jaw be managed?
A
- radiographs must be taken
- pre and post operatively
- assess risk (length of tooth compared to bone)
- OPT to assess fracture
- support the mandible during extraction
- hold forceps in dominant hand
- fingers on either side of alveolus
- thumb under mandible
- inform patient
- of risk
- of suspected fracture
- refer
- phone OMFS
- refrain from eating or drinking (operation on same day)
- ensure analgesia
- sore and swollen
- stabilise
- splint teeth on either side of fracture
- prevents movement which causes pain
- antibiotic
- only if not attending emergency treatment
- will be given IV at hospital
13
Q
How can involvement of the maxillary antrum occur?
A
- oro-antral fistula/communication
- root has developed into sinus
- passage created on extraction
- fistula when left for a while and has epithelialised
- communication when first created
- loss of root into antrum
- usually on multi rooted teeth
- root pushed into sinus
- fractured tuberosity
14
Q
How is involvement of the maxillary antrum diagnosed?
A
- size of the tooth
- radiographic position of roots in relation to antrum
- bone trifurcation of roots
- may be floor of sinus
- bubbling of blood
- at socket
- air passing from sinus to mouth
- nose holding test
- can create OAC
- air passed down through sinus
- patient feels air in mouth - direct vision
- see empty space instead of bone
- good light and suction
- different noise from empty socket
- echo/high pitched noise
- blunt probe
- can create OAC
- fluid passing from mouth to nose
15
Q
What are the risk factors for maxillary antrum involvement
A
- extraction of upper molars and premolars
- close relationship of roots to sinus on radiograph
- last standing molars
- large bulbous roots
- older patient
- sinus gets bigger and moves downwards
- previous OAC
- recurrent sinusitis
- tooth in close proximity to sinus
