Complication of extraction 2

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  • 1. Complication of Extraction Islam Kassem ikassem@dr.com ikassem@dr.com
  • 2. Dealing with local complications
  • 3. Complications of tooth extraction• Local complications• Immediate:• Failure of LA• Failure to move the tooth• Fracture of tooth, alveolus, mandible• Oro-antral communication• Displacement in soft tissues• Hemorrhage• TMJ dislocation• Damage to V1,2,3
  • 4. • Delayed• Exessive pain, swelling, and trismus• Bleeding• Dry socket• A. osteomyelitis• Infection• Oro-antral fistula• Failure of the socket to heal• Nerve damage
  • 5. • Late• Chronic osteomyelitis• Osteoradionecrosis• Nerve damage• Chronic pain
  • 6. • Systemic complications• Immediate• Faint• Hypoglycemia• Hyperventelation/panic attack• Fits• MI• Addisonian crisis• Respiratory obstruction
  • 7. Causes of difficult extractions1. 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.
  • 8. Postoperative BleedingCause -Bleeding at wound margins -Bleeding at a bony foramen within the socket -Medical Problem
  • 9. 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
  • 10. Management Local Measures • Pressure packs • Suturing • Ligate bleeding vessels • Burnish bone • Apply material to aid in hemostasis (surgicell, collaplug)
  • 11. Cause Infection Debris left under the flapPrevention IrrigationManagement Debridement & Drainage
  • 12. Dry Socket ( Alveolar osteitis )(The most frequent painful complication of extraction )
  • 13. Dry Socket• Aetiology: 1. Excessive trauma. 2. Impaired blood supply lower jaw > Upper jaw 3. Local anaesthesia. 4. Oral contraceptive ( oestrogens component causes increase in serum fibrinolytic activity) 5. Osteosclerotic disease. 6. Radiotherapy. 7. Smoking.
  • 14. Dry Socket• Pathology: – Destruction of the blood clot either by: 1. Proteolytic enzymes produced by bacteria. 2. Excessive local fibrinolytic activity. – Anaerobes are likely to play a major role. – Destruction of the clot leaves an open socket, infected food and other debris accumulate.
  • 15. Dry Socket– Pathology: • The necrotic bone lodges bacteria which proliferate freely, Leucocytes unable to reach them through the avascular material. • Dead bone is gradually separated by osteoclasts. • Healing is by granulation tissue from the base of the walls of the socket.
  • 16. Dry Socket• Clinical features: – Pain usually starts few days after extraction. – Sometimes may be delayed for few days or more. – Deep – seated, severe and aching or throbbing in character. – Mucous membrane around the socket is red and tender. – No clot in the socket ( Dry ).
  • 17. Dry Socket• Clinical features: – When debris is washed away, whitish, dead bone may be seen or may be felt as rough area with a probe. – Sometimes the socket becomes concealed by granulation tissue growing in from the edge. – Pain may continues for week or two and rarely longer.
  • 18. Dry Socket• Prevention: 1. Minimal trauma. 2. Squeezed the socket edge firmly after extraction. 3. In case of dis-impaction of 3rd molars dry socket is more common: - Minimum stripping of the periosteum. - Minimum damage to the bone. - Use prophylactic antibiotic.
  • 19. Dry Socket• Prevention: 4. In patient who have had radiotherapy, every possible precaution should be taken. 5. In osteosclerotic disease: • Little damage to bone (surgical extraction). • Prophylactic antibiotic. 6. Stop smoking for two days post extraction.
  • 20. Dry Socket• Treatment: – Explain to the patient and warn them. – The aim of the treatment is to keep the open socket clean and to protect the exposed bone: 1. Irrigate the socket by antiseptic solution. 2. Fill the socket with an obtudant dressing containing some non irritant antiseptic. 3. Frequent use of mouth wash.
  • 21. Dry Socket• Treatment: – A great variety of dry socket dressing has been formulated: 1. Iodoform - containing preparation. 2. Alvogyl – which is easy to manipulate. ( The dressing should be: Obtudant, antiseptic, soft to adhere to the socket walls and absorbable ). – In many cases, irrigation of the socket and replacement of the dressing has to be repeated every few days.
  • 22. Study source? ikassem@dr.com
  • 23. • Contemporary Oral & maxiallofacial surgery• Page 185-199 ikassem@dr.com
  • 24. • You can get it form• http://www.slideshare.net/islamkassem
  • 25. •Thank you ikassem@dr.com