Dental Extraction Complications

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Questions and Answers

What is a possible solution to prevent damage to adjacent teeth during extraction?

Improper selection of the instrument

Taking the adjacent tooth as a fulcrum

Excess bone removal for reducing resistance (correct)

Excessive extraction force

What is a common cause of fracture of the target tooth during extraction?

Improper instrument selection (correct)

Excessive reduction of bone

Proper application of instrument

Improper grip

What is a common type of soft tissue injury that can occur during extraction?

Swallowing of tooth or fragments

Gingival laceration (correct)

Oroantral fistula

Fracture of the alveolar bone

What is a possible management approach for soft tissue injuries during extraction?

Pressure packs Signup and view all the answers

What is a possible cause of fracture of the alveolar bone during extraction?

Hollow maxillary tuberosity Signup and view all the answers

What is a possible way to reduce the risk of fracture of the alveolar bone during extraction?

Conduct thorough preoperative clinical and radiographic examinations Signup and view all the answers

What is a possible management approach for fracture of the target tooth during extraction?

All of the above Signup and view all the answers

What is a possible way to prevent soft tissue injuries during extraction?

Proper caring with soft tissue for proper healing Signup and view all the answers

What should be done first in the management of fracture of the mandible?

Remove the tooth to avoid infection along the line of the fracture Signup and view all the answers

Why is it important to preserve the maxillary tuberosity as much as possible?

To avoid oro-antral communication and bleeding Signup and view all the answers

What should be done if the bone segment has been completely reflected from the tissues and oro-antral communication occurs?

Remove the tooth and smooth the bone before suturing Signup and view all the answers

What is a common cause of fracture of the mandible?

Excessive force with the elevator when an adequate pathway for removal of the impacted tooth has not been created Signup and view all the answers

What should be done if a bone fragment has lost its periosteal attachment?

Remove the bone fragment to prevent necrosis Signup and view all the answers

Why is it important to postpone the extraction of the tooth if possible after a fracture of the alveolar bone?

To allow for healing and reduction of resistance Signup and view all the answers

What is a potential complication of a fracture of the alveolar bone?

Oro-antral communication Signup and view all the answers

What should be done to a bone fragment that is still attached by periosteum?

Relocate, adapt, and fixate with sutures Signup and view all the answers

What is a common cause of oro-antral communication?

Displacement of an impacted tooth or root tip into the maxillary sinus during a removal attempt Signup and view all the answers

What is a radiographic sign of oro-antral communication?

Radiographic evidence of sinus involvement Signup and view all the answers

What is a preventive measure to avoid oro-antral communication?

Careful manipulations with instruments during the luxation of a root tip Signup and view all the answers

What is a management option for a small-sized oro-antral communication?

Trying to establish a blood clot and preserve it in place Signup and view all the answers

What is a sign of oro-antral communication during speech?

Change in speech tone and resonance Signup and view all the answers

What is a management option for a larger oro-antral communication?

Elevating a broad-based muco-periosteal flap Signup and view all the answers

What is a complication of oro-antral communication?

Fluid regurgitation from the nose Signup and view all the answers

What is a preventive measure to avoid luxation of the root tip during a tooth extraction?

Avoiding luxation of the root tip if visualization of the area is hindered by hemorrhage Signup and view all the answers

Study Notes

Complications of Tooth Extraction

Taking an adjacent tooth as a fulcrum instead of bone can lead to damage to the adjacent tooth.

Fracture of the Target Tooth

Causes: improper instrument selection, improper grip, improper extraction movements, and excessive extraction force.
Management: stabilized for approximately 40-60 days, endodontic treatment, and re-restoration of the damaged filling or prosthesis.

Soft Tissue Injuries

Examples: gingival laceration, tearing of the flap during reflection, injury to the lip, tongue, floor, or palate, puncture wound, and abrasion wound.
Causes: improper application of instruments, slippage of instruments, lack of proper soft tissue retraction, and overheated surgical handpiece.
Management: pressure packs, wound debridement, suturing, and dressing for burns/abrasions.

Fracture of the Alveolar Bone

Examples: alveolar bone segmental fracture, fracture of the maxillary tuberosity.
Causes: improper application or selection of instruments, excessive extraction force, and hollow maxillary tuberosity (pneumotization of maxillary sinus).
Management:
- Bone fragment still attached by periosteum: relocate, adapt, and fixate with sutures.
- Bone fragment lost its periosteal attachment: remove the piece of bone, file edges, and suture properly.

Preventive Measures for Fracture of the Alveolar Bone

Conduct thorough preoperative clinical and radiographic examinations.
Avoid using excessive force.
Use surgical (open) extraction technique to reduce the required force.

Fracture of the Mandible

Causes: use of elevators only, excessive force with the elevator, extraction of a deeply impacted tooth, atrophic mandible, and presence of large pathologic lesions in the area.
Management: remove the tooth before any other procedure to avoid infection along the line of the fracture.

Oroantral Communication

Etiology: displacement of an impacted tooth or root tip into the maxillary sinus during removal, injudicious use of instruments, and extensive fracture of the maxillary tuberosity.
Preventive Measures:
- Radiographic examination of the region surrounding the tooth to be extracted.
- Careful manipulation of instruments, especially during the luxation of a root tip of a maxillary posterior tooth.
- Careful debridement of periapical lesions that are close to the maxillary sinus.
- Avoiding luxation of the root tip if visualization of the area is hindered by hemorrhage.

Signs and Symptoms of Oroantral Communication

Antral floor attached to roots apices of extracted tooth or teeth.
Fracture of the alveolar process or the tuberosity.
Evidence of air stream passing from nostril.
Bubbling of blood from the socket.
Change in speech tone and resonance.
Fluid regurgitation from the nose.
Radiographic evidence of sinus involvement.

Management of Oroantral Communication

For small-sized communication:
- Establish blood clot and preserve it in place.
- Ask the patient to bite on gauze pack for 2 hours.
- Instruct the patient to use nasal precautions.
- Place the patient on antibiotics and systemic decongestant.
For larger communication:
- Elevate a broad-based muco-periosteal flap.
- Use a buccal advancement flap.
- Anchor the corner of the flap and approximate the edges using horizontal mattress sutures.
- Follow sinus precautions and medical regimen.

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Description

Test your knowledge of potential complications that can arise during dental extraction, including damage to adjacent teeth, fractures, and soft tissue injuries. Learn how to manage and prevent these complications.