Complication of extraction 1
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Complication of extraction 1
- 1. Complication of Extraction Islam Kassem 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. 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. 1-Failure of Anesthesia too small a dose Improper injection technique: Not waiting long enough for anesthesia to act; before commencing the surgery ikassem@dr.com
- 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. 2-Failure to move the tooth ikassem@dr.com
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- 30. 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
- 31. 3-Fracture of the tooth Force, technique, root anatomy Caries Fracture of the alveolus ikassem@dr.com
- 32. • Fracture of : -tooth being extracted -alveolar bone -maxillary tuberosity -adjacent teeth -mandible
- 33. • Damage to: - gum , lips , tongue , palate , floor of the mouth. - inferior dental nerve.
- 34. Fracture of Alveolar Process Fracture of the Buccal or Lingual Cortex Cause Inadequate exposure & excessive force Prevention Adequate bone removal & eposure
- 36. Fracture of Maxillary Tuberosity Cause Excessive force Prevention Proper support and controlled force Management If still attached; dissect and remove the tooth If detached; smooth bone edges & suture
- 38. Fracture of the Mandible Cause Excessive force Prevention Proper bone removal & controlled force
- 39. Photoelastic model of the mandible, showing the development of stress during a luxation attempt of the third molar when insufficient bone has been removed from the tooth peripherally
- 40. Fracture of the maxillary tuberosity Large antrum, large root, fusion 3rd molar with 2nd molar root Small fragments, large segment
- 41. ikassem@dr.com
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- 46. ikassem@dr.com
- 47. 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
- 48. Oro-antral communication Large antrum Lone-standing tooth in an atrophic maxilla Large splayed roots Fracture of tuberosity History of antral involvement
- 49. Cause During extraction of an impacted maxillary canine -Excessive bone removal -Failure to locate the tooth Prevention -Proper preoperative radiographic evaluation -Proper bone removal -Controlled force
- 51. Plastic Closure of Oroantral Fistula
- 53. ikassem@dr.com
- 54. 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
- 55. Displacement of the tooth into: -soft tissues -maxillary sinus -beyond the pharynx
- 56. ikassem@dr.com
- 58. Root Displacement Into: • Mandibular Canal • Lingual Pouch • Infratemporal Space • Maxillary Sinus
- 59. 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
- 60. ikassem@dr.com
- 61. Local Measures: Irrigation of wound with Tranexamic acid
- 62. Local Measures: Suturing the wound
- 63. Local Measures: Pressure with oral packs
- 64. Local Measures: Surgicel (Oxidised Regenerated Cellulose)
- 65. Local measures: Gelfoam with activated thrombin
- 66. Local Measures: Avitene (Microfibrillar Collagen)
- 67. Local Measures: Etik Collagen (Packed collagen)
- 68. Local Measures: Tranexamic acid 5%
- 69. Local Measures: Tranexamic acid 5% in Syringe
- 70. • Excessive bleeding: - during extraction. - postoperatively.
- 71. ikassem@dr.com
- 72. ikassem@dr.com
- 73. Tearing Mucosal Flap Causes 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.
- 74. Prevention -Adequately sized flaps -Gentle Retraction Management Reposition the flap & suture If the tear is jagged, trim it before suturing
- 75. Puncture Wound of Soft Tissue Cause Instrument Slippage Prevention Controlled force Management Suturing to prevent infection & allow healing to occur
- 76. Stretch or Abrasion Injury Cause Bur shank or retractor injury Prevention Care Management Keep it moist ( ointment ) Heals within 5 – 10 days
- 77. 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
- 78. Definition: Locked jaw in open bite with deviation (unilat.) or protrusion (bilat.) The condyle moves forward out of the fossa, does not return back. Mandibular Dislocations
- 80. Clinical features Severe pain Lock jaw in class III position Central ….. (Bilateral). Cross bite …. (Unilateral). Concavity in front of the ear. Dislocation
- 81. 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
- 82. 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
- 83. Injury to Inferior Alveolar Nerve Cause -Excessive extraction force in case of curved roots -Sectioning the tooth all the way inferiorly Prevention -Proper exposure & bone removal -Controlled force -Careful setioning, leaving a shell of the tooth
- 84. Injury to the Lingual Nerve Cause -Placement of the retromolar incision far lingually -Sectioning the tooth all the way to the lingual cortex Prevention -Proper incision -Careful sectioning, leaving a shell of the tooth
- 86. • Contemporary Oral & maxiallofacial surgery • Page 185-199 ikassem@dr.com
- 87. • You can get it form • http://www.slideshare.net/islamkassem