Perioperative Extraction Complications Flashcards
List potential peri-operative complications
- difficulty to access
- abnormal resistance
- fracture of tooth/root
- fracture of alveolar plate
- fracture of tuberosity
- jaw fracture
- involvement of the maxillary sinus (OAF)
- loss of tooth
- soft tissue damage
- damage to nerves or vessels
- haemorrhage
- dislocation of the TMJ
- Damage to adjacent teeth or restorations
- extraction of permanent tooth germ
- broken instruments
- wrong tooth extracted
what can cause difficulty of access and visual difficulty during an extraction
- Trismus: if a patient has trisms or limited mouth opening
- reduced aperture of mouth (congenital syndromes - microstomia or scarring)
- Crowded or malpositioned teeth
define Trismus
Trismus, also sometimes called lockjaw, is a painful condition in which the chewing muscles of the jaw become contracted and sometimes inflamed, preventing the mouth from fully opening.
What can cause abnormal resistance
thick cortical bone - larger males may have this
Shape and form of roots - divergent or hooked roots can cause issues
Number of roots - three rooted lower molars difficult
Hypercementosis - seen in paget’s disease, acromegaly and vitamin a deficiency
Ankylosis - PDL gone due to trauma and bone is fused to roots of teeth
When is a tooth more likely to fracture?
carious
alignment - awkward position or overcrowding
size - small crown and big roots are more likely to fracture
root - shape and size affected whether a tooth may fracture
If a tooth is not moving what do you do
remove surgically, do not use excessive force
when is a root more likely to fracture
- fused roots
- convergent or divergent
- extra roots
- odd morphology
- hypercementosis
- ankylosis
Why might the alveolar bone fracture
- could be fused to the tooth
- tooth was extracted buccally too quickly (before it was made mobile)
If the alveolar bone does fracture, where is it most likely to occur
- buccal plate
- in canine region
- or in molar region
what do you do if you have fractured the alveolar bone in the molar region
- if a large bit of bone is still attached to the periosteum then it still has its blood supply, so you can put it back in place and suture around
- if it is not a large part or does not have a blood supply, take it out as it will become necrotic
- suture
- dissect it free with a scalpel
what do you do if you have fractured the alveolar bone in the canine region
- try to save it as it has a job in creating shape in that area
- stabilise
- free mucoperiosteum
- smooth edges as it is jaggy and may break through the gum
What should you do if you fracture a jaw
- inform the patient
- take a post-operative radiograph
- refer to maxillofacial department or A&E (tell them not to eat on route, incase they go to theatre)
- Ensure analgesia and give advice on keeping clean (chlorohexidine)
- stabilise (if wobbling, splint around crowns of teeth around fracture)
- if delay, give antibiotics
What can cause an oro-antral communication
- loss of root into the antrum - usually the crown fractures and clinician pushes root up into the sinus
- fractured tuberosity - because of its position, beside the sinus, it usually involves a communication with the maxillary sinus
how do you diagnose an OAC
- size of tooth
- radiographic position of roots in relation to sinus
- bone at trifurcation of roots
- bubbling of blood in socket
- nose holding test (careful as can create an OAC)
- direct vision
- good light and gentle suction (hear echo )
- blunt probe
what are acute and chronic OAC
acute is the initial communication
chronic is an epithelial lined OAF
