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Questions and Answers
What is a possible solution to prevent damage to adjacent teeth during extraction?
What is a common cause of fracture of the target tooth during extraction?
What is a common type of soft tissue injury that can occur during extraction?
What is a possible management approach for soft tissue injuries during extraction?
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What is a possible cause of fracture of the alveolar bone during extraction?
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What is a possible way to reduce the risk of fracture of the alveolar bone during extraction?
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What is a possible management approach for fracture of the target tooth during extraction?
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What is a possible way to prevent soft tissue injuries during extraction?
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What should be done first in the management of fracture of the mandible?
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Why is it important to preserve the maxillary tuberosity as much as possible?
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What should be done if the bone segment has been completely reflected from the tissues and oro-antral communication occurs?
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What is a common cause of fracture of the mandible?
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What should be done if a bone fragment has lost its periosteal attachment?
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Why is it important to postpone the extraction of the tooth if possible after a fracture of the alveolar bone?
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What is a potential complication of a fracture of the alveolar bone?
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What should be done to a bone fragment that is still attached by periosteum?
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What is a common cause of oro-antral communication?
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What is a radiographic sign of oro-antral communication?
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What is a preventive measure to avoid oro-antral communication?
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What is a management option for a small-sized oro-antral communication?
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What is a sign of oro-antral communication during speech?
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What is a management option for a larger oro-antral communication?
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What is a complication of oro-antral communication?
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What is a preventive measure to avoid luxation of the root tip during a tooth extraction?
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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.
