Topic 8: Sudden complications of extraction, therapy

Question 1

The IMMEDIATE complications that can occur during the extraction:

Answer 1

The IMMEDIATE complications that can occur during the extraction:
 Fracture of the tooth (crown, or root/s)
 Loss of the root of the tooth
 Adjacent tooth damage
 Antagonist tooth damage
 Dental alveolar and/or maxillary tuberosity fracture
 Opening of max sinus (distally onwards from upper canine)
 Damage of the mandibular canal
 Jaw fracture
 Soft tissue injuries
 TMJ damage
 Removal of an inappropriate tooth
 Swallowing/ aspiration of the tooth

Question 2

Fracture of the tooth: reasons

Answer 2

Fracture of the tooth: reasons
 Seriously destructed tooth
 Extensive fillings
 Non adapted forceps, or incorrect amount and direction of force applied during use
 Inadequate use of dental elevators
 Extremely dens processus alveolaris
 Because the anatomical configuration of the roots of the tooth it will not budge (e.g. highly divergent, or widening towards apex, or specially curved roots

Question 3

Fracture of the tooth: what to do

Answer 3

Fracture of the tooth: what to do
Root forceps,
careful use of straight elevators, 
separating the roots, 
use of Kerr needles, 
sterile exploration and carve.

Question 4

Loss of the root of the tooth:

Answer 4

Loss of the root of the tooth:
 Most often the roots of upper molars may get dislodged into the maxillary sinus. (less frequent but may also occur in canines and premolars
 Roots may also disappear into periapical granulomas or radicular cyst.

Question 5

Loss of the root of the tooth: reasons

Answer 5

Loss of the root of the tooth: reasons
 Could be due to inappropriate use of dental elevators (pushing it into the sinus)
 Extensive chronic periapical inflammation may cause the sinus bone resorption and thus little effort will be needed to dislocate the root

Question 6

Loss of the root of the tooth: what to do

Answer 6

Loss of the root of the tooth: what to do
 First step is x-ray to get the precise location of the root.
 Exploration of the extraction wound aseptically: elevation and retraction of the flap and make a bone
window.
 Through the window use vigorous irrigation to flush the root from the sinus via the socket or the root can be removed with
a gauze strip.
 Occasionally a small curved curette may be used to remove the root fragment
 Roots resisted to these attempts can be removed via a bony window in the canine fossa.

Question 7

Damage of the mandibular canal: reasons

Answer 7

Damage of the mandibular canal: reasons
Rare complication, usually associated with a periapical disease
or may occur in childhood especially when thin bone located between the root tip and the mandibular canal.

Even more rare example would be if wisdom tooth fracture of the root, dislocates into the floor of the mouth
with the thin lingual cortical injury and broken piece can end up into the parapharyngeal space too.

Question 8

Damage of the mandibular canal: what to do

Answer 8

Damage of the mandibular canal: what to do
 In sterile exploration we remove the broken piece or bone block, even if a new incision is needed.
 If the lingual or alveolar nerve is in the field we cannot put antiseptic gauze into the wound!
 Patient should be made aware of shorter or longer residual numbness
 They must take supplement VITAMIN B!!!
 Very rarely, permanent numbness can occur in the case of a severely damaged nerve.

Question 9

Adjacent tooth damage: reasons

Answer 9

Adjacent tooth damage: reasons
 Can be due to incorrect use of forceps or dental elevators.
 Will damage the tip of the crown which can break,
the tooth can be luxated, in extreme cases the tooth may break off.
 If the adjacent tooth is filled there is a higher chance of the fracture of the crown

Question 10

Adjacent tooth damage: what to do

Answer 10

Adjacent tooth damage: what to do

 Restorative dentistry in general, but if the tooth is luxated then it will be necessary to splint it

Question 11

Antagonist tooth damage: reason

Answer 11

Antagonist tooth damage: reason
 Can occur when too much force is used to remove the tooth, then the forceps may hit the antagonist tooth (or
teeth).
 Due to incorrect adaptation the forceps may slip off.

Question 12

Antagonist tooth damage: what to do

Answer 12

Antagonist tooth damage: what to do

Generally conservative dentistry

Question 13

Fracture of alveolar process:

Answer 13

Usually happens in the upper canines and molars in the buccal bone plate,
Also lower front teeth, the vestibular bone plate can break.
This does not mean that it does not occur anywhere else!!!

Question 14

Fracture of alveolar process: reasons

Answer 14

Fracture of alveolar process: reasons
 Old age, 
 Less elastic calcified bone, 
 Widely divergent roots,
 Thick and heavy cortical plate.
 Bone destruction by malignant progress.

Question 15

Fracture of alveolar process: what to do

Answer 15

Fracture of alveolar process: what to do
 Removed portions of the bone, along with the tooth should not be replaced
 Only smooth the sharp edges and carefully close the wound.
 If the fractured segment remains connected to the soft tissues the fracture will heal.

 With surgical intervention, the tooth must be separated from the fractured bone
 The tooth is removed
 Bone and soft tissues are repositioned and stabilized with sutures.
 Fragments may be fixed with mini or micro plate
osteosynthesis.

Question 16

Fracture of maxillary tuberosity: reasons

Answer 16

Fracture of maxillary tuberosity: reasons
 During extraction of erupted upper 3rd molar (or 2nd if its the last tooth in the arch) or if its a single tooth in an edentulous arch

Question 17

Fracture of maxillary tuberosity: what to do

Answer 17

When we realise the maxillary tuberosity is fractured (following a major crack, the tuber area with the tooth begins to move away) IMMEDIATELY
 suspend the extractions!!
 and we have to fix the tuberosity with a plate