Complications of Extraction of Impacted Teeth

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Complications of Extractionof Impacted Teeth
dr shabeel pn
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Outline

1. Soft Tissue Injuries
2. Complications with the Tooth Being Extracted
3. Injuries to Adjacent Teeth
4. Injuries to Osseous Structures
5. Injuries To Adjacent Structures
6. Oroantral Communications
7. Postoperative Bleeding
8. Delayed Healing Infection

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I. Soft Tissue Injuries
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1. Tearing Mucosal Flap

• Causes
• Due to an inadequately sized flap which is
  retracted beyond the tissues ability to stretch.
• As with a short envelope flap when the area of
  surgery is at the apex.

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• Prevention
• -Adequately sized flaps
• -Gentle Retraction
• Management
• Reposition the flap suture
• If the tear is jagged, trim it before suturing

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2. Puncture Wound of Soft Tissue

• Cause
• Instrument Slippage
• Prevention
• Controlled force
• Management
• Suturing to prevent infection allow healing to
  occur

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3. Stretch or Abrasion Injury

• Cause
• Bur shank or retractor injury
• Prevention
• Care
• Management
• Keep it moist ( ointment )
• Heals within 5 10 days

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II. Complications with the tooth Being Extracted
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1. Root Fracture

• Cause
• Long, curved, divergent roots
• Excessive force during extraction
• Prevention
• Proper exposure bone removal

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2. Root Displacement

• Into
• Mandibular Canal
• Lingual Pouch
• Infratemporal Space
• Maxillary Sinus

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III. Injuries to Adjacent Teeth

• Luxation of Adjacent Teeth
• Fracture of Adjacent Restoration
• Cause
• Carelesness
• Prevention
• Judicious use of elevators

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IV. Injuries to Osseous Structures
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1. Fracture of Alveolar Process

• Fracture of the Buccal or Lingual Cortex
• Cause
• Inadequate exposure excessive force
• Prevention
• Adequate bone removal eposure

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2. Fracture of Maxillary Tuberosity

• Cause
• Excessive force
• Prevention
• Proper support and controlled force
• Management
• If still attached dissect and remove the tooth
• If detached smooth bone edges suture

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3. Fracture of the Mandible

• Cause
• Excessive force
• Prevention
• Proper bone removal controlled force

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Photoelastic model of the mandible, showing the
development of stress during a luxation attempt
of the third molar when insufficient bone has
been removed from the tooth peripherally
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V. Injuries to Adjacent Structures
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1. Injury to Inferior Alveolar Nerve

• Cause
• -Excessive extraction force in case of curved
  roots
• -Sectioning the tooth all the way inferiorly
• Prevention
• -Proper exposure bone removal
• -Controlled force
• -Careful setioning, leaving a shell of the tooth

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2. Injury to the Lingual Nerve

• Cause
• -Placement of the retromolar incision far
  lingually
• -Sectioning the tooth all the way to the lingual
  cortex
• Prevention
• -Proper incision
• -Careful sectioning, leaving a shell of the tooth

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3. Injury to the TMJ

• Cause
• Inadequate support of the mandible during
  extraction
• Prevention
• Use of bite block
• Management
• Reduction

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Vi. Oroantral Communication
Cause During extraction of an impacted maxillary
canine -Excessive bone removal -Failure to
locate the tooth Prevention -Proper preoperative
radiographic evaluation -Proper bone
removal -Controlled force
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VII. Postoperative Bleeding
Cause -Bleeding at wound margins -Bleeding at
a bony foramen within the socket -Medical Problem
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• Prevention
• -Good history taking
• (coagulopathy, medicationsetc)
• -Atrumatic surgical extraction
• (clean incisions, gentle management of soft
  tissues, smoothen bony specules, curette
  granulation tissue)
• -Obtain good homeostasis at surgery
• - Postoperative instructions

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• Management
• Local Measures
• Pressure packs
• Suturing
• Ligate bleeding vessels
• Burnish bone
• Apply material to aid in hemostasis (surgicell,
  collaplug)

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VIII. Delayed Healing Infection
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1. Infection

• Cause
• Debris left under the flap
• Prevention
• Irrigation
• Management
• Debridement Drainage

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2. Dry Socket (Alveolar Ostitis)

• Cause
• -Lysis of a fully formed blood clot before the
  clot is replaced with granulation tissue.
• -Higher incidence with smokers patients taking
  oral contaceptives.
• Prevention
• -Presurgical irrigation with antimicrobial
  agents ,e.g chlorhexidine
• -Intraoperative irrigation with saline

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• Management
• Irrigate with warm saline
• Remove old clots
• Place sedative dressing
• Prescribe mild analgesics
• Reassess after 24 to 48 hours