This document discusses complications that can occur during and after tooth extraction surgery. It describes various operative complications related to the tooth, bone, and soft tissues that can happen intraoperatively like tooth fracture, nerve injury, or hemorrhage. Postoperative complications discussed include pain, swelling, dry socket, and osteomyelitis. Throughout the document, each complication is defined, causes are outlined, and management approaches are provided to help prevent or treat issues if they arise from exodontia procedures.

1. COMPLICATIONS OF
EXODONTIA
Dr. Saleh Bakry
Assistant Professor of Oral and
Maxillofacial Surgery

2. PREVENTION OF COMPLICATION
• Prevention of surgical complications is best
accomplished by a thorough preoperative assessment
and comprehensive treatment plan.
• Surgeons must perform surgery that is within their own
ability.
• Thorough review of the patient's medical histo­ry.
• Proper radiograph preoperatively & reviewing them for:
– Root morphology.
– Relation with surrounding anatomic structure.

3. PREVENTION OF COMPLICATION
• The preoperative planning:
– Surgical plan.
– Man­aging patient anxiety and pain.
– Man­aging postoperative recov­ery (Thorough
preoperative instructions the patient to prevent
complications in post­operative period).
• Follow the basic surgical principals:
– Clear visualization:
• Adequate light.
• Ade­quate soft tissue reflection.
• Adequate suction.

4. PREVENTION OF COMPLICATION
• The teeth to be removed must have an unimpeded
pathway for removal:
– Bone removal.
– Teeth sectioning.
• Controlled force during application of elevators.
• Follow the principles of asepsis.
• Atraumatic handling of tissues.
• Hemostasis and debridement of the wound.

5. A. OPERATIVE COMPLICATIONS
I. HARD TISSUES COMPLICATION RELATED TO THE
TOOTH
1. Fracture of the teeth
2. Luxation of adjacent teeth
3. Extraction or injury to an unerupted tooth
4. Fracture of adjacent restoration
5. Forcing a root into soft tissue
6. Tooth passing beyond the pharynx
7. Extraction of wrong teeth
8. Displacement of tooth or roots to max. Sinus

6. A. OPERATIVE COMPLICATIONS
II. HARD TISSUES COMPLICATION RELATED TO THE
BONE
1. Fracture of alveolar process
2. Fracture of maxillary tuberosity
3. Fracture of the jaw
4. Dislocation of the mandible

7. A. OPERATIVE COMPLICATIONS
III. SOFT TISSUES COMPLICATION
1. Gingival laceration
2. Bruising the lip or cheek
3. Wounding the tongue or floor of the mouth
4. Injury to inf alv. Canal
5. Emphysema
6. Injury to temporomandibular joint

8. II. POST OPERATIVE COMPLICATION
1. Hemorrhage
2. Postoperative swelling & pain
3. Alveolar osteitis (dry socket)
4. Osteomyelitis

9. A. OPERATIVE COMPLICATIONS
I. HARD TISSUES
COMPLICATION RELATED TO
THE TOOTH

10. 1. FRACTURE OF THE TEETH
Causes:
•Devitalized or R.C. treated.
•Abnormal tooth formation.
•Abnormal supporting structure.
•Use instrument not suited to tooth to be extracted.
•Misapplication of forceps or levers.
•Extraction movement before completes adjustment of
instrument to the teeth.
•Interference by the pt.

11. 1. FRACTURE OF THE TEETH

12. 1. FRACTURE OF THE TEETH
Management:
Teeth fracture near the neck
•Single rooted: Removed by forceps.
•Multi rooted: Separation of the roots + Remove each root
by forceps or elevator.
Tooth fracture within alveolar socket (2/3 Root)
•Single rooted: Surgical by open method.
•Multi rooted: All root still inside bone → surgical removal.

13. 2. LUXATION OF ADJACENT TEETH
Causes:
•Wrong use of the extraction instruments.
•Use tooth as a fulcrum during application of an elevator.
Management:
•Forced pack the luxated tooth into the socket and
replantation by splinting to the most closely approximating
teeth.

14. 2. LUXATION OF ADJACENT TEETH

15. 3. EXTRACTION OR INJURY TO AN
UNERUPTED TOOTH
Etiology:
•During of deciduous teeth by pushing, forceps beaks
beyond deciduous tooth.
Prevention
•Use fine blade forceps to grip the deciduous tooth.

16. 4. FRACTURE OF ADJACENT
RESTORATION
Causes:
•Slipping of forceps or a lever during extraction.
•Use a tooth with a large filling or an artificial crown as a
fulcrum.
Management:
•Temporary filling.
•Restore restoration.

17. 5. FORCING A ROOT INTO SOFT
TISSUE
Maxillary teeth displaced into:
– Max. Sins.
– Buccal space.
– Infratemporal fossa.
Mandibular teeth displaced into:
– Inf. Alveolar canal.
– Submandibular space.
– Sublingual space.

18. 6. TOOTH PASSING BEYOND THE
PHARYNX
• The tooth may be swallowed and passesinto the
alimentary canal.
• May pass through trachea → the lung → lung abscess.
Management:
• The tooth may be swallowed or aspirated.
• If aspirate → Patient suffering from continuous
coughing & respiratory distress → supply o2 → chest x-
ray to verify position → removing the tooth with a
bronchoscope.
• If swallowed → pass through the gastrointestinal (GI)
tract within 2 to 4 days.

19. 7. EXTRACTION OF WRONG TEETH
Prevention:
•Focus attention on procedure.
•Check and recheck that correct tooth is to be removed.
Management:
•If the wrong tooth is extracted → the tooth should be
replant it immediately + call the orthodontics → wait for 4 or
6 weeks → reassess → if the tooth gain attachment →
extract proper tooth.

20. 8. DISPLACEMENT OF TOOTH OR
ROOTS TO MAX. SINUS
Causes:
•Teeth project into the sinus
(sinus approximated tooth) No
considerable bone between the
floor of the sinus and the root
apices.
•Apical infection → perforation
between sinus and root.
•Apical fracture root removed by
not skill operator and pushed
into the sinus.

21. 8. DISPLACEMENT OF TOOTH OR
ROOTS TO MAX. SINUS
Test of sinus involvement:
•Use the nose-blowing test: Ask the patient to blow air into
the nose while holding the nostril together, if air comes
through extraction wound → perforation.
•If a com-munication exists, there will be passage of air
through the tooth socket and bubbling of blood in the
socket area.

22. 8. DISPLACEMENT OF TOOTH OR
ROOTS TO MAX. SINUS
Treatment:
•Less than 2mm → spontaneously closed without surgery.
•More than 2mm → surgical closure.
•Recent communication → Immediate closure
•Old Fistula →Irrigation of the sinus + delayed closure after
removal of fistula.

23. A. OPERATIVE COMPLICATIONS
II. HARD TISSUES
COMPLICATION RELATED TO
THE BONE

24. 1. FRACTURE OF ALVEOLAR
PROCESS
Causes:
•Use of excessive force with forceps.
•Improper support of the alveolar bone.
Management:
•If attached to mucoperiosteum → leave it and suturing.
•If Detached from periosteum → lose its blood supply →
remove it as it could sequestrate → suturing of
Mucoperiosteum.

25. 2. FRACTURE OF MAXILLARY
TUBEROSITY

26. 2. FRACTURE OF MAXILLARY
TUBEROSITY
Predisposing factors
•Pneumatization of max, tuberosity with max. Sinus.
•Ankylosed max. Molar.
•When tuberosity is prominent.
Management:
•If tuberosity attached to periosteum → dissected from the
tooth → stabilized it with sutures.
•If the maxillary tuberosity is completely separated from the
soft tissue → replace and suture the remaining soft tissue.

27. 3. FRACTURE OF THE JAW
• Excessive force in removing deeply impacted tooth.
• hypercementosed tooth.
• intrabony lesion.
Treatment:
• Reduction and fixation.

28. 4. DISLOCATION OF THE MANDIBLE
• It is dislodgment of the condylar head from its seat in
the glenoid fossa.
Causes:
• Using too much pressure during extraction and
inadequate support to the mandible.
Prevention
• The left hand should stabilize the jaw during extraction.
Treatment:
• Reduction & Restriction.

29. 4. DISLOCATION OF THE MANDIBLE

30. A. OPERATIVE COMPLICATIONS
III. SOFT TISSUES
COMPLICATIONS

31. 1. GINGIVAL LACERATION
Causes:
•Slipping or Misapplication of an instrument.
Treatment:
•It should be corrected by suturing.

32. 2. BRUISING THE LIP OR CHEEK
Causes
•Dry and chopped lip.
•Small mouth opening.
•Chewing the lip following
inferior alveolar nerve
block (in children).
Preventions
•Proper protection by the
left hand.

33. 3. WOUNDING THE TONGUE OR
FLOOR OF THE MOUTH
Causes
•Careless extraction.
•Slippage of an elevator.
Management:
•Controlled by suturing.

34. 4. INJURY TO INF ALV. CANAL
• Lower third molar with root around
the mandibular canal.
• In deeply impacted tooth.
Causes:
• Careless curetting.
• The most common S & S of nerve
injury is numbness Or paresthesia
of half of the lower lip & chin.
• In most cases nerve regeneration
in six weeks to six month
according to extent of trauma.

35. 5. EMPHYSEMA
• Accumulation of air into the connective tissue of
intramuscular or facial planes.
Causes:
• After using air turbin in removing bone or tooth sectioning
for removal of impacted third molar.
Management:
• It takes from 1-2 weeks to absorb.

36. 6. INJURY TO
TEMPOROMANDIBULAR JOINT
Causes:
•No support during extraction.
•Excessive force.
Management:
•Analgesics + Anti-inflammatory.
•Moist heat on the area of TMJ.
•Soft food.

37. II. POST OPERATIVE
COMPLICATIONS

38. 1. HEMORRHAGE

39. 1. HEMORRHAGE
Hemorrhage is the escape of blood outside the vascular
system.
HEMORRHAGE CLASSIFIED:
•According to the site
• External: if blood escape outside the body
• Internal: Inside one of the body cavities e.g. peritoneal
cavity" or in one of the facial spaces e.g.
submandibular, sublingual.

40. 1. HEMORRHAGE
HEMORRHAGE CLASSIFIED:
According to the vessels
•Arterial (spurting of pumping nature bright red).
•Venous (continuous flow, dark bluish red).
•Capillary (continuous oozing).

41. 1. HEMORRHAGE
HEMORRHAGE CLASSIFIED:
According to the time
•Primary: At the time of operation or accident.
•Intermediary: With the first 24 h. after primary bleeding has
been controlled. Due to lose tie, subjected to force of blood
pressure.
•Secondary: Occur at any time after the first post-operative
day or as late as two-week post-operative. Due to
disintegration of blood clot by action of infection.

42. 1. HEMORRHAGE
CAUSES:
A. Local Causes:
•Interference with clot e.g. smoking, sucking, spitting, early
M.W, Putting tip of the tongue or finger, etc.
•Improper use of pressure Pack.
•Laceration of the gingiva.
•Remaining root and failure of blood clot to form on the top
of it.
•Large Nutrient canals (bony canals that contain blood
supply), and failure of blood clot to form on the top of it.

43. 1. HEMORRHAGE
CAUSES:
B. Systemic Causes:
•Vascular defects.
•Platelet defect.
•Coagulation defects Hemophilia A (VIII), B (IX), C (XI)
Parahemophilia (V), or Pseudohemophila.
Differential Diagnosis between local and systemic
causes: By examination of blood in patient mouth:
•If blood is clotted → local cause
•If blood is not clotted → systemic cause → hospitalized
and Iab. inv.

44. 1. HEMORRHAGE
MANAGEMENT:
I. Local therapy:
•In case of patient interference with clot: use pressure
pack.
•In case of gingival laceration: proper suturing.
•In case of remaining root in the socket: remove the root.
•In case of large nutrient canal close it by:
•Bone wax.
•Curettage and crushing some spongy bone and press it
into bleeding points using blunt instrument.

45. 1. HEMORRHAGE
MANAGEMENT:
Local hemostatic measures:
•Pressure pack.
•Ice packs.
•Suturing e.g. Figure of eight suturing.
•Clamping and legation of B.V.
•Use local hemostatic agents:
•Fibrin foam.
•Gel Foam (absorbable gelatin sponge)
•Oxidized cellulose (surgical or oxicell).

46. 1. HEMORRHAGE
MANAGEMENT:
II. Systemic therapy:
•Patient should be hospitalized
•Platelet abnormality Õ Packed platelets concentrate or
fresh blood transfusion.
•Plasma factor abnormalities:
•F.F.P (fresh frozen plasma).
•Factor concentrate.

47. 2. POSTOPERATIVE SWELLING &
PAIN
• It is more common when teeth are removed by the open
method due to the surgical trauma.
• Cold applications to the face will prevent or reduce
swelling.
• Sedatives are used for relief of pain.
CONTROL OF POSTOPERATIVE PAIN:
• First dose of analgesics should be taken before the
effect of L.A is gone.
• Use of long acting L.A to cover the peak time of
postoperative pain (Articaine 9-12 hrs.).

48. 2. POSTOPERATIVE SWELLING &
PAIN
DOSES:
•Mild pain
Aspirin → 500-1000 mg× 4.
•Moderate pain:
NSAID → 400-800 mg× 4.
Codeine → 30-60 mg + Aspirin 500mg.
•Severe pain:
Oxycodone or hydrocodone → 5-10 mg + Asporaceta
500 mg.

49. 3. ALVEOLAR OSTEITIS (DRY
SOCKET)

50. 3. ALVEOLAR OSTEITIS (DRY
SOCKET)
Predisposing factors:
•Pre-existing periapical or pericoronal infection.
•Excessive trauma during extraction.
•Use of unsterile instrument for extraction.
•Pressure type local anesthesia (periodontal injection).
•Smoking.
Signs and symptoms:
•Pain (dull aching, throbbing).
•Gingival inflammation.
•Halitosis.

51. 3. ALVEOLAR OSTEITIS (DRY
SOCKET)
Management
•Irrigate the socket.
•Pack the socket loosely with a sedative dressing as
iodoform gauze saturated with eugenol or alveogel.
•The procedure is repeated daily for 3-5 days-
.
•Sedative should be prescribed.

52. 4. OSTEOMYELITIS
Infection of bone, bone marrow and
periosteum.

53. THANK YOU