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Complications of Extraction of Impacted Teeth

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Complications of Extraction of Impacted Teeth Management Local Measures Pressure packs Suturing Ligate bleeding vessels Burnish bone Apply material to aid in ... – PowerPoint PPT presentation

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Title: Complications of Extraction of Impacted Teeth


1
Complications of Extractionof Impacted Teeth
dr shabeel pn
2
Outline
  • Soft Tissue Injuries
  • Complications with the Tooth Being Extracted
  • Injuries to Adjacent Teeth
  • Injuries to Osseous Structures
  • Injuries To Adjacent Structures
  • Oroantral Communications
  • Postoperative Bleeding
  • Delayed Healing Infection

3
I. Soft Tissue Injuries
4
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.

5
  • Prevention
  • -Adequately sized flaps
  • -Gentle Retraction
  • Management
  • Reposition the flap suture
  • If the tear is jagged, trim it before suturing

6
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

9
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II. Complications with the tooth Being Extracted
11
1. Root Fracture
  • Cause
  • Long, curved, divergent roots
  • Excessive force during extraction
  • Prevention
  • Proper exposure bone removal

12
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

17
IV. Injuries to Osseous Structures
18
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

23
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
24
V. Injuries to Adjacent Structures
25
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

28
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
33
  • 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

34
  • Management
  • Local Measures
  • Pressure packs
  • Suturing
  • Ligate bleeding vessels
  • Burnish bone
  • Apply material to aid in hemostasis (surgicell,
    collaplug)

35
VIII. Delayed Healing Infection
36
1. Infection
  • Cause
  • Debris left under the flap
  • Prevention
  • Irrigation
  • Management
  • Debridement Drainage

37
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

38
  • Management
  • Irrigate with warm saline
  • Remove old clots
  • Place sedative dressing
  • Prescribe mild analgesics
  • Reassess after 24 to 48 hours
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