Complication of extraction 1

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Oral & Maxillofacial surgery

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Complication of extraction 1

  1. 1. Complication of Extraction Islam Kassem ikassem@dr.com
  2. 2. Dealing with local complications
  3. 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. 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. 5. • Late• Chronic osteomyelitis• Osteoradionecrosis• Nerve damage• Chronic pain
  6. 6. • Systemic complications• Immediate• Faint• Hypoglycemia• Hyperventelation/panic attack• Fits• MI• Addisonian crisis• Respiratory obstruction
  7. 7. 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
  8. 8. 1-Failure of Anesthesiatoo small a doseImproper injection technique:Not waiting long enough for anesthesia to act; before commencing the surgery ikassem@dr.com
  9. 9. 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
  10. 10. 2-Failure to move the tooth ikassem@dr.com
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  13. 13. Ankylosis ikassem@dr.com
  14. 14. ikassem@dr.com
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  16. 16. Warwick James ikassem@dr.com
  17. 17. Coupland chisel ikassem@dr.com
  18. 18. Cryer’s elevator ikassem@dr.com
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  24. 24. ikassem@dr.com
  25. 25. 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
  26. 26. 3-Fracture of the toothForce, technique, root anatomy CariesFracture of the alveolus ikassem@dr.com
  27. 27. • Fracture of : -tooth being extracted -alveolar bone -maxillary tuberosity -adjacent teeth -mandible
  28. 28. • Damage to: - gum , lips , tongue , palate , floor of the mouth. - inferior dental nerve.
  29. 29. Fracture of Alveolar ProcessFracture of the Buccal or Lingual CortexCause Inadequate exposure & excessive forcePrevention Adequate bone removal & eposure
  30. 30. Fracture of Maxillary TuberosityCause Excessive forcePrevention Proper support and controlled forceManagement If still attached; dissect and remove the tooth If detached; smooth bone edges & suture
  31. 31. Fracture of the MandibleCause Excessive forcePrevention Proper bone removal & controlled force
  32. 32. Photoelastic model of the mandible, showing thedevelopment of stress during a luxation attempt ofthe third molar when insufficient bone has beenremoved from the tooth peripherally
  33. 33. Fracture of the maxillary tuberosityLarge antrum, large root, fusion 3rd molar with 2nd molar rootSmall fragments, large segment
  34. 34. ikassem@dr.com
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  39. 39. ikassem@dr.com
  40. 40. 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
  41. 41. Oro-antral communicationLarge antrumLone-standing tooth in an atrophic maxillaLarge splayed rootsFracture of tuberosityHistory of antral involvement
  42. 42. Cause During extraction of an impacted maxillary canine -Excessive bone removal -Failure to locate the toothPrevention -Proper preoperative radiographic evaluation -Proper bone removal -Controlled force
  43. 43. Fracture tubrosity ikassem@dr.com
  44. 44. Plastic Closure of Oroantral Fistula
  45. 45. ikassem@dr.com
  46. 46. 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
  47. 47. Displacement of the toothinto: -soft tissues -maxillary sinus -beyond the pharynx
  48. 48. ikassem@dr.com
  49. 49. Root DisplacementInto:• Mandibular Canal• Lingual Pouch• Infratemporal Space• Maxillary Sinus
  50. 50. 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
  51. 51. ikassem@dr.com
  52. 52. Local Measures: Irrigation of wound with Tranexamic acid
  53. 53. Local Measures: Suturing the wound
  54. 54. Local Measures: Pressure with oral packs
  55. 55. Local Measures: Surgicel (Oxidised Regenerated Cellulose)
  56. 56. Local measures: Gelfoam with activated thrombin
  57. 57. Local Measures: Avitene (Microfibrillar Collagen)
  58. 58. Local Measures:Etik Collagen (Packed collagen)
  59. 59. Local Measures: Tranexamic acid 5%
  60. 60. Local Measures: Tranexamic acid 5% in Syringe
  61. 61. • Excessive bleeding: - during extraction. - postoperatively.
  62. 62. ikassem@dr.com
  63. 63. ikassem@dr.com
  64. 64. Tearing Mucosal FlapCauses 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.
  65. 65. Prevention -Adequately sized flaps -Gentle RetractionManagement Reposition the flap & suture If the tear is jagged, trim it before suturing
  66. 66. Puncture Wound of Soft TissueCause Instrument SlippagePrevention Controlled forceManagement Suturing to prevent infection & allow healing to occur
  67. 67. Stretch or Abrasion InjuryCause Bur shank or retractor injuryPrevention CareManagement Keep it moist ( ointment ) Heals within 5 – 10 days
  68. 68. 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
  69. 69. Mandibular DislocationsDefinition: Locked jaw in open bite with deviation (unilat.) or protrusion (bilat.) The condyle moves forward out of the fossa, does not return back.
  70. 70. DislocationClinical features Severe pain Lock jaw in class III position Central ….. (Bilateral). Cross bite …. (Unilateral). Concavity in front of the ear.
  71. 71. TRISMUS• Trismus is the inability to normally open the mouth• It is a fairly common complication of local anesthesia, particularly while giving pterygomandibular block• Causes :A. Primary Cause Trauma to muscles (medial pterygoid, temporalis, and masseter) during insertion of the needle ikassem@dr.com
  72. 72. 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
  73. 73. Injury to Inferior Alveolar NerveCause -Excessive extraction force in case of curved roots -Sectioning the tooth all the way inferiorlyPrevention -Proper exposure & bone removal -Controlled force -Careful setioning, leaving a shell of the tooth
  74. 74. Injury to the Lingual NerveCause -Placement of the retromolar incision far lingually -Sectioning the tooth all the way to the lingual cortexPrevention -Proper incision -Careful sectioning, leaving a shell of the tooth
  75. 75. Study source? ikassem@dr.com
  76. 76. • Contemporary Oral & maxiallofacial surgery• Page 185-199 ikassem@dr.com
  77. 77. • You can get it form• http://www.slideshare.net/islamkassem
  78. 78. •Thank you ikassem@dr.com

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