1.
COMPLICATIONS OF TOOTH
EXTRACTION AND ITS MANAGEMENT
BY MUHAMMAD SHARIQ
FINAL YEAR BDS

2.
PRESENTATION OUTLINE
1)Problems with a tooth being extracted
2)Injuries to adjacent teeth.
3)Post operative bleeding
4)Oroantral communications
5)Injuries to adjacent structures
6)Delayed healing and infection.
7)Injuries to ossoeous structures
8)Soft tissue injuries.
9)Swelling.
10)Fracture of mandible.

3.
PROBLEMS WITH A TOOTH BEING EXTRACTED
1)Root Fracture
2)Root Displacement
3)Tooth loss into Phayrnx

4.
INJURIES TO ADJACENT TEETH
1)Fracture or dislodgement of an adjacent restoration.
2)Luxation of adjacent tooth
3)Extraction of wrong tooth

5.
POST OPERATIVE BLEEDING
PREVENTION:
1)Obtain a history of bleeding
2)Use of atraumatic surgical technique
3)Obtain good hemostasis at surgery.
4)Provide excellent patient instructions.

6.
OROANTRAL COMMUNICATION
Oroantral Communication (OAC) is an abnormal communication between
the maxillary sinus and the oral cavity.
PREVENTION:
1)Conduct a thorough preoperative radiographic examination.
2)Use surgical extraction early and section roots
3)Avoid excessive apical pressure on maxillary posterior teeth.

7.
INJURIES TO ADJACENT STRUCTURES
1)Injury to regional nerves
2)Injury to Temporomandibular joint.

8.
DELAYED HEALING AND INFECTIONS
1)INFECTIONS:
a)Most common cause of delayed wound healing
b)Seen usually which involves reflection of soft tissue flaps and bone removal.
c)Careful asepsis an thorough wound debridement can prevent this
d)Prophylactic antibiotic can be given.
2)WOUND DEHISCENCE:
a)Use aseptic technique
b)Perform atraumatic technique
c)Close the incision over intact bone.
d)Suture without tension.
3)DRY SOCKET(ALVEOLAR OSTEITIS):
a)Severe pain without usual signs of infection(Fever ,erythema etc).
b)Pain develops after 3 or 4 day after removal of teeth(usually lower molar)
c)Fibrinolytic activityLysis of blood clotExposure of bonepain
d)Treatment= Irrigation and placement of medicated dressing(Alvogel)
e)Alvogyl = Eugenol(anesthetic), Benzocaine/Butamben(anesthesia),
Idoform(Antimicrobial)

9.
INJURIES TO OSSEOUS STRUCTURES
1)Fracture of the alveolar process
a)Thorough preoperative clinical and radiographic examinations
b)Donot use excessive force
c)use surgical technique to reduce the force required.
D)buccal corticol plate over maxillary canine an molars, Portions of floor
of maxillary sinus, Labial bone over mandibular incisors.
2)Fracture of maxillary tuberosity
a)Maxilary tuberosity fractures most commonly result from extraction
of the second molar, if it is last tooth in the arch.
b)Finger support can be used during fracture if bone is attached to peri
osteum
c)If mobile Splint the teeth and defer sugery for 6-8 weeks
Section crown from the roots.
D)If completely separated ->smooth sharp edges of remaining bone and
suture remaining soft tissue.

10.
SOFT TISSUE INJURIES
1)TEAR OF A MUCOSAL FLAP:
a)creating adequately sized flaps.
B)Using controlled amount of retraction force.
C)Creating releasing incisions when indicated.
2)PUNCTURE WOUNDS:
If a punture wound does occur in the mucosa the ensuring treatment
is primarily aimed at preventing infection and allowing healing to occur
usually by secondary intention.
3)STRETCH OR ABRASION:
a)By rotating shank of bur or by metal retractor.
B)If in oral mucosaregular oral rinsing heal in 4-7 days.
C)If on skinanbiotic oinment can be used.

11.
SWELLING
1)Extraction of multiple impacted teeth with reflection of soft tissue and
removal of bone may result in moderately large amounts of swelling.
And can reach to its maximum in 36-48 hours after surgery.
2)Increase swelling after third day may be an indication of infection.
3)Initially ice packs and later on on 3rd or 4rth post surgical day heat may
help t oresolve swelling more quickly.
4)Patient reassurance an counselling about edema is necessary.
Reason:
a)Excessive soft tissue manipulation.
B)Bone tissue removal.
C)Extended surgical time.

12.
FRACTURE TO MANDIBLE
Associated almost exclusively with the surgical removal of impacted
third molar.
Usually result of the application of force exceeded that needed to
remove a tooth .
The fracture must be adequately reduced and stabilized.

13.
THANKYOU
ANY QUESTIONS??