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Complications of Impacted Tooth Extraction : Causes and Management

| July 26, 2012 | 0 Comments

Complications of Impacted Tooth Extraction : Causes and Management

These complications may occur during impacted tooth extraction :

I.      Soft Tissue Injuries
II.     Complications with the Tooth Being Extracted
III.    Injuries to Adjacent Teeth
IV.    Injuries to Osseous Structures
V.      Injuries To Adjacent Structures
VI.     Oroantral Communications
VII.   Postoperative Bleeding
VIII. Delayed Healing & Infection
I. Soft Tissue Injuries
1. Tearing Mucosal Flap

Causes

Due to an inadequately sized flap which is retracted beyond the tissue`s ability to stretch.

As with a short envelope flap when the area of surgery is at the apex.

Prevention

-Adequately sized flaps

-Gentle Retraction

Management

Reposition the flap & suture

If the tear is jagged, trim it before suturing

2. Puncture Wound of Soft Tissue

Picture1 Complications of Impacted Tooth Extraction : Causes and Management

Cause

Instrument Slippage

Prevention

Controlled force

Management

Suturing to prevent infection & allow healing to occur

3. Stretch or Abrasion Injury

Picture2 Complications of Impacted Tooth Extraction : Causes and Management

Cause

Bur shank or retractor injury

Prevention

Care

Management

Keep it moist ( ointment )

Heals within 5 – 10 days

II. Complications with the tooth Being Extracted

1. Root Fracture

Cause

Long, curved, divergent roots

Excessive force during extraction

Prevention

Proper exposure & bone removal

 

2. Root Displacement

Picture3 Complications of Impacted Tooth Extraction : Causes and Management

Into:

•Mandibular Canal
•Lingual Pouch
•Infratemporal Space
•Maxillary Sinus
III. Injuries to Adjacent Teeth
1.Luxation of Adjacent Teeth
2.Fracture of Adjacent Restoration

Cause

Carelesness

Prevention

Judicious use of elevators

IV. Injuries to Osseous Structures

1. Fracture of Alveolar Process

Fracture of the Buccal or Lingual Cortex

Cause

Inadequate exposure & excessive force

Prevention

Adequate bone removal & eposure

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

3. Fracture of the Mandible

Picture4 Complications of Impacted Tooth Extraction : Causes and Management

Cause

Excessive force

Prevention

Proper bone removal & controlled force

V. Injuries to Adjacent Structures

1. Injury to Inferior Alveolar Nerve

Picture5 Complications of Impacted Tooth Extraction : Causes and Management

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

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

3. Injury to the TMJ

Cause

Inadequate support of the mandible during extraction

Prevention

Use of bite block

Management

Reduction

Vi. Oroantral Communication

Picture7 Complications of Impacted Tooth Extraction : Causes and Management

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

VII. Postoperative Bleeding

Cause

-Bleeding at wound margins

-Bleeding at a bony foramen within the socket

-Medical Problem

Prevention

-Good history taking (coagulopathy, medications…etc)

-Atrumatic surgical extraction (clean incisions, gentle management   of soft tissues, smoothen bony   specules, curette granulation tissue)

-Obtain good homeostasis at surgery

– Postoperative instructions

Management

Local Measures

•Pressure packs
•Suturing
•Ligate bleeding vessels
•Burnish bone
•Apply material to aid in hemostasis (surgicell, collaplug)
VIII. Delayed Healing & Infection
1. Infection

Cause

Debris left under the flap

Prevention

Irrigation

Management

Debridement & Drainage

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

Management

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