Complications of Dental Extraction

8/13/2019 Complications of Dental Extraction

1/33

Complications of Dental

Extraction

Ziad malkawi

D.D.S., M.S.C., Max.Fac.S.Cert ., F.F.D.R.C.S.I.

Oral and Maxi l lofacial SurgerySchoo l of Dent istry

Universi ty of Jo rdan


2/33

Healing of Extraction wounds

Formation o f blood clo t fi l ling the socket .

Organizat ion of the clot .

Epithel ial izat ion of the sur face of the

wound.

Formation of woven bone in the c.t . f i ll ing

the socket (1 month 2months in adult ).

Replacement o f woven bone by trabecu larbone and remodel ing of the alveolus.


3/33

( I f all teeth are lost resorption goes

on relatively rapidly at f irst, then

more slowly for some years unti l thealveolar bone is enti rely removed.)


4/33

Delayed healing of extraction wounds

1. Infect ion.

2. Prolonged b leeding due to a clot t ing

defect.

3. Formation of an oro -antral f istu la.

4. Prol i ferat ion of a malignant tumor.

5. Radiotherapy.

6. Immunodef ic iency.

7. Scurvy.


5/33

Complications of dental extraction

Local com pl icat ions.

System ic compl icat ions.

Intraoperative compl icat ion s.

Post operative compl icat ion s ( immediate

or delayed . )

Compl icat ion s related to :

Pat ient factor, surgeon facto r, su rgery or

instrumentat ions.


6/33


7/33

Local complications

3. Damage to so f t t issue:

a. Ins truments sl ips off the tooth.

b. Lower l ip may be crushed between the

teeth.

c. The handles o f the forceps o r pressure of

the hand support ing the jaw can cause

bruis ing.

4. Opening of the maxi l lary antrum .

5. Fractu re of the maxi l lary tuberos ity.


8/33

Local complications

6. Loss o f tooth:

a. Displaced into th e loose t issue on the l ingualside of the lower molar.

b. May be swal low ed.

c. May be inhaled.

7. Removal of a permanent too th germ.

Extract ion o f deciduous molar wi th apicalinfect ion which causes the permanentpremo lar tooth germ to become attached byf ibrous t issue to the per iodontal membrane ofthe over ly ing too th.


9/33

Local complications

8.Excessive bleeding :

a. Tissue damaged careless extract ion .

b. As a resu l t of haemorrh agic disease.

c. In fect ion .

9. Local infection:

a. Lo cal ised ost iet is (dry soc ket ).

b. Osteomyl iet is.


10/33

Local complications

10. Loss of ro ot fragement:

a. Displaced in to th e inferior dental

canal.

b. Displaced into the medu l lary cavi ty .

c. Displaced into the antrum .

d. Displaced in to a cys t ic cavity.


11/33

Intraoperative complications

11. Access:

a. Small mou th.

b. Crowded or mal l -po si t ioned teeth.

c. Trismus .

12. Pain:

a. Has L.A . worked give more i f

needed.

b. Regional bloc k inf i l t rat ion or inter-

l igumentary.


12/33

Intraoperative complications

13. In ab i l ity to move the too th:

X-Ray :

a. Look for bulbous or diverging

roots.

b. Very long roots.

c. Ankylosis or sclerotic bone.

14. Breaking the too th or alveolarbone.

15. Damage to o ther teeth / t issues

and extract ion o f the w rong tooth .


13/33


14/33

Dry Socket

Aet io logy:

1. Excess ive traum a.

2. Impaired b lood supp ly ( lower jaw >

Upper jaw )3. Local anaesthesia.

4. Oral contracept ive ( oestrogens

component causes increase in serum

fibr ino lyt ic act iv i ty)

5. Osteosclerot ic d isease.

6. Radiotherapy.

7. Smoking.


15/33

Dry Socket

Pathology:

Destruct ion of the blood clot either by:

1. Proteoly t ic enzymes produced by

bacteria.

2. Excessive local f ibr inolyt ic act iv i ty .

Anaerobes are l ikely to p lay a major

role.

Destruct ion of the clot leaves an open

socket , infected food and o ther debris

accumulate.


16/33

Dry Socket

Pathology:

The necrot ic bone lodges bacter ia

which pro l i ferate freely, Leucocytes

unable to reach them through the

avascu lar material.

Dead bone is g radually separated by

osteoclasts. Healing is by granu lat ion t issue from

the base of the wal ls of the socket .


17/33

Dry Socket

Clinical features:

Pain usual ly s tarts few days after

extract ion.

Somet imes may be delayed for few daysor more.

Deepseated, severe and ach ing orthrobb ing in character.

Mucous membrane around the socket isred and tender.

No c lot in the socket ( Dry ).


18/33

Dry Socket

Clinical featu res:

When debris is washed away, whi t ish,

dead bone may be seen o r may be felt

as rough area with a p robe.

Somet imes the soc ket becomes

concealed by granu lat ion t issue

grow ing in f rom the edge. Pain may cont inues for week o r two and

rarely longer.


19/33

Dry Socket

Prevent ion:

1. Minimal trauma.

2. Squeezed the socket edge f irm ly after

extract ion.

3. In case of d is-impact ion of 3rdmolars

dry socket is more common:

- Minimum str ipping of the per iosteum .

- Minimum damage to the bone.

- Use prophy lact ic ant ib iot ic.


20/33

Dry Socket

Prevent ion:

4. In patient who have had radiotherapy , every

possib le precaut ion should be taken.

5. In os teosc lerot ic disease: Lit t le damage to bone (su rgical

extraction).

Prophy lact ic ant ib iot ic.

6. Stop smoking for two days post extract ion.


21/33

Dry Socket

Treatment:

Explain to the pat ient and warn them.

The aim of the treatment is to keep the

open socket clean and to p rotect the

exposed bone:

1. Ir r igate the socket by ant isept ic solu t ion.

2. Fil l the socket wi th an obtudant dressing

contain ing some non irr itant ant isept ic.

3. Frequent use of mouth wash .


22/33

Dry Socket

Treatment:

A great var iety o f dry sock et dressing has beenformulated:

1. Iodofo rm - containing preparat ion .2. Alvo gyl which is easy to manipulate.

( The dress ing should be: Obtudant, antiseptic,so f t to adhere to the socket wal ls andabsorbab le ).

In m any cases, i r r igat ion o f the socket andreplacement of the dress ing has to be repeatedevery few days.


23/33

I ndication for extractions

1. Gross caries.

2. Pulpi t is (i f endodon t ic treatment is

impract ical)

3. Apical per iodont i t is ( if the teeth are non

savable )

4. Gross periodontal disease.

5. Fractu red teeth.6. Fractu res o f the jaw.

7. Misp laced and im pacted teeth.

8. Orthodon t ic treatment.


24/33

I ndications for extractions

10. Prosthet ic cons iderat ions .

11. Supernumerary and supplemental teeth.

12. Gross neglect.

13. Pat ient at r isk from certain system ic

diseases.

14. Preparat ion fo r radio therapy.


25/33

Causes of dif f icult extractions

1. Excessively strong supporting tissues.

2. Misshapen roots.

3. Easily detached crowns.

4. Brittle teeth ( Glass in concrete ).

5. Sclerosis of the bone.

6. Burried and impacted teeth.

7. Ankylosis and geminated teeth.

8. Inadequate access.


26/33


27/33


28/33


29/33


30/33


31/33


32/33


33/33

Date post:	04-Jun-2018
Category:	Documents
Upload:	reshma1977
View:	222 times
Download:	5 times

Complications of Dental Extraction

Documents