PRESENTED BY:Shalini Thakur GUIDED BY:Dr. T. Ramakrishna.

Introduction Definition

of complication Prevention of complications in general Various complications Causes Prevention Management Bibliography

Tooth extraction is the painless removal of the whole tooth or tooth root with minimal trauma to the investing tissues so that the wound heals uneventfully and no postoperative prosthetic complication occurs.

complication may be defined as any deviation from the normally expected pattern during or after treatment.

 Operative/

post operative. Immediate/ delayed. Iatrogenic/ non-iatrogenic.

The possible complications are: Failure to:1. 2.

Secure anesthesia Remove the tooth with either forceps or elevator. Crown of tooth being extracted Roots of tooth being extracted Alveolar bone Maxillary tuberosity Adjacent or opposing tooth Mandible Adjacent tooth TMJ Into the soft tissues Into the maxillary antrum Under general anesthesia in the dental chair

Fracture of:1. 2. 3. 4. 5. 6.

Dislocation of :1. 2.

Displacement of a root:
1. 2. 3.

Excessive haemorrhage:
1. 2. 3.

During tooth removal On completion of the extraction Post operatively Gums Lips Inferior alveolar nerve Lingual nerve Tongue and floor of the mouth Damage to hard and soft tissues Dry socket Acute osteomyelitis
Oedema Haematoma Infection

Damage to:1. 2. 3. 4. 5.

Postoperative pain due to

1. 2. 3.

Postoperative swelling due to:1. 2. 3.

Trismus Oro antral communication Syncope Respiratory arrest Cardiac arrest Anesthetic emergencies.

PREVENTIO N

PREOPERATIVE

INTRAOPERATIVE

POSTOPERATIVE

TEARING OF MUCOSAL FLAPS

CAUSES Inadequately sized flap Improper reflection and retraction of flap

PREVENTION Create adequate sized flap with releasing incisions when reqd Use small amount of retraction force.

MANAGEMENT Careful suturing Excising jagged edges

CAUSES

PREVENTION

MANAGEMENT

 Stretch

or abrasion injury

CAUSES

PREVENTION

MANAGEMENT

1. 2.

3.
4.

FRACTURE OF CROWN FRACTURE OF ROOT DISPLACEMENT OF ROOT/ TOOTH IN:Maxillary sinus Submandibular space Infratemporal space oropharynx

CAUSES
Grossly decayed tooth RC treated teeth Improper application of forceps Improper application of forces

PREVENTION
Proper instrumentation Plan for open method if required

MANAGEMENT
If possible, remove with use of elevators and forceps In case of multi rooted teeth roots can be removed separately Open method if required

CAUSES
Brittle teeth Improper force applied Long curved divergent roots

MANAGEMENT

PREVENTION
Careful planning , pre extraction radiographs to be taken Open method can be planned

If the root piece is large it should be removed using a straight elevator or root forceps or root pick elevators. Open method can also be carried out If root piece is small i.e less than 5 mm it can be left behind under certain cercumstances

CAUSES
Roots of teeth too close to the floor of maxillary sinus Application of apical pressure while removing a root piece

MANAGEMENT PREVENTION
Pre operative radiographs to be taken and assessed Open extraction to be undertaken Avoid application of apical pressure Avoid removing of root piece Determine if the maxillary sinus or the tooth displaced was infected Radiographs should be taken in order to determine the exact location of root in the sinus. If root piece is 2-3 mm irrigate and suction. Caldwell luc operation if required Nasal decongestants and sinus prevention

CAUSES

PREVENTION

MANAGEMENT

LUXATION OF ADJACENT TOOTH

EXTRACTING THE WRONG TOOTH FRACTURE OF ADJACENT RESTORATION

 Fracture

of maxillary tuberosity Fracture of mandible Fracture of alveolar bone

CAUSES

PREVENTION

MANAGEMENT

CAUSES

PREVENTION

MANAGEMENT

CAUSES

PREVENTION

MANAGEMENT

CAUSES

PREVENTION

MANAGEMENT

CAUSES
Laceration of mucogingiva Injury to underlying vessels Bleeding from bone Underlying systemic diseases

TYPES
Primary-occurring at the time of extraction and just after extraction Reactionary- within the next 24 hours Secondary- occurring as a result of infection after 72 hours

PREVENTION AND MANGAEMENT

Collagen plug

Microfibrillar collagen
Regenerated oxidized cellulose Collagen tape Absorbable gelatin sponge

CAUSES

MANAGEMENT

 Dry

socket Infection Wound dehiscence

SYNONYMS
Alveolar osteitis Alveolitis sicca dolorosa Fibrinolytic alveolitis

RISK FACTORS
Traumatic extraction Patients on oral contraceptives History of pericoronitis or ANUG with associated tooth Immunosuppressant drugs such as steroids, cyclosporine, methtrexate Smoking Increased density of bone

SIGNS AND SYMPTOMS

Severe, throbbing, radiating pain about 3-5 days after extraction Grayish necrotic bone present in socket Foul odour maybe present Disintegrated clot may also be seen On probing of the socket bare bone can be felt

NORMAL HEALING OF AN EXTRACTION SOCKET

PATHOPHYSIOLOGY OF DRY SOCKET

MANAGEMENT

CAUSES
Improper handling of tissues Traumatic extractions Surgical extractions requiring removal of bone Haematoma formation due to LA injection

PREVENTION
Proper handling of tissues Application of cold post extraction Application of pressure bandage

MANAGEMENT
Icepacks intermittently for the first 24 hrs followed by hot fermentation Enzymatic formulations and corticosteroid administration

CAUSES

PREVENTION

MANAGEMENT

CAUSES

DIAGNOSIS PREVENTION
Examination of the tooth extracted Nose blowing test

MANAGEMENT
Small communication i.e lesser than 2 mm Mid sized communication i.e 2-6 mm Large communications ie above

6mm

Contemporary oral and maxillofacial surgery- Peterson, Ellis, Hupp Oral and maxillofacial surgery- volume 2, Daniel M Laskin Extraction of Teeth Geoffrey Howe Minor oral surgery- Geoffrey Howe, 3rd edition Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases Lipa Bodner et al Modern concepts in understanding and management of the dry socket syndrome:comprehensive review of literature- Ahmad Reza Noroozi et al. Retrieval of a displaced 3rd molar using navigation and active image guiding . Andrew Campbell et al. JOMS Vol 68. Pg 480-485 Sensory nerve impairment following third mandibular molar surgery. Anwar B Bataineh et al JOMS Vol 59 Pgs 1012-1017 www.exodontia.info www.google.com for images www.wikipedia.com

THANK

YOU

 Suture

material- classification, definition and fate By:Gaurav Khutwad