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complications of tooth extraction
1. Complications from dental extractions can include failure of local anesthesia, failure to move the tooth, root fracture, injury to adjacent teeth or structures, bone fractures, root displacement, and losing the tooth in the pharynx or airway. 2. Many complications can be prevented by careful preoperative evaluation and planning, use of proper technique, and knowing the limits of one's own skill level and referring when needed. 3. Common complications are generally manageable but some situations like displaced roots or lost teeth in the airway may require specialty referral.
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complications of tooth extraction
- 1. Complications of dentalextraction 1 Senior lecturer Dr. Haydar Munir Salih Alnamir BDS, PhD (BOARD CERTIFIED)
- 2. Complications of dentalextraction • As in the case of medical emergencies, the best way to manage surgical complications is to 1prevent them from happening. • Even with such planning and the use of excellent surgical techniques, complications still occasionally occur. In situations where the dentist has planned carefully, 2the complication is often predictable and can be managed routinely. • Dentists must perform surgery that is within the limits of their capabilities
- 3. Complications of dentalextraction • The dentist must keep in mind that 3referral to a specialist is an option that should always be exercised if the planned surgery is beyond the dentist’s own skill level • To keep complications at a minimum, the surgeon must always follow basic surgical principles
- 4. Failure of LocalAnesthesia 1. inaccurate placement of the anesthetic solution 2. too small a dosage 3. not waiting long enough for the anesthesia to act before commencing surgery • If anesthesia cannot be secured by using conventional techniques of infiltration or regional block, intra- ligament, intra-osseous or intra-pulpal injections may be indicated • Local anesthetic should not be injected to infected tissues because of the risk of spreading the infection
- 5. Alternative techniques ofanesthesia infiltration Intra ligament Intra pulpal Intra bony
- 6. Failure to MoveTooth • If the tooth does not yield to reasonable displacing forces applied with forceps or elevators, this normally indicates that either the bone texture is dense and inelastic, or that the root shape is obstructing its path of withdrawal • The cause of the obstruction should be find out by taking a radiograph before proceeding to lift a mucoperiosteal flap and remove bone and/or divide the tooth as indicated.
- 7. Failure to MoveTooth
- 8. Failure to MoveTooth Dr. Haydar Munir Salih
- 9. Root Fracture • Themost common problem associated with the tooth being extracted is fracture of its roots. Long, curved, divergent roots that lie in dense bone are the most likely to be fractured. • The main methods of preventing the fracture of roots is to use an open extraction technique and remove bone to decrease the amount of force necessary to remove the tooth Recovery of a fractured root with a surgical approach
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- 17. Fracture or Dislodgmentof an Adjacent Restoration • The most common injury to adjacent teeth is the inadvertent fracture or dislodgment of a restoration or damage to a severely carious tooth while the surgeon is attempting to elevate the tooth to be removed. • If a large restoration exists, the surgeon should warn the patient preoperatively about the possibility of fracturing or displacing it during the extraction.
- 18. Fracture or Dislodgmentof an Adjacent Restoration
- 19. Luxation of anAdjacent Tooth • Inappropriate use of the extraction instruments may luxate an adjacent tooth. Luxation is prevented by judicious use of force with elevators and forceps. • If the tooth to be extracted is crowded and has overlapping adjacent teeth, as is commonly seen in the mandibular incisor region, some thin, narrow forceps may be useful for the extraction • Forceps with broader beaks should be avoided because they will cause injury and luxation of adjacent teeth
- 20. Luxation of anAdjacent Tooth
- 21. Luxation of anAdjacent Tooth • A small amount of luxation of an adjacent tooth frequently occurs and generally causes no damage • Occasionally the luxated tooth is mobile. If this is the case, the tooth should be stabilized with semi- rigid fixation to maintain it in its position
- 22. Luxation of anAdjacent Tooth
- 23. Fracture of theAlveolar Process • The extraction of a tooth usually requires that the surrounding alveolar bone be expanded to allow an unimpeded pathway for tooth removal. However, in some situations, instead of expanding, the bone fractures and is removed still attached to the tooth. • The most likely cause of fracture of the alveolar process is the use of excessive force with the forceps, which fractures the cortical plate
- 24. Fracture of theAlveolar Process
- 25. Fracture of theAlveolar Process • The primary method of preventing these fractures is to perform a careful preoperative examination of the alveolar process both clinically and radiographically • Age is a factor to be considered because the bones of older or larger patients are likely to be less elastic and therefore are more likely to fracture than to expand.
- 26. Fracture of theAlveolar Process • prevention of fractures of large portions of the cortical plate depends on preoperative radiographic and clinical assessments, avoidance of the use of excessive amounts of uncontrolled force, and the early decision to perform an open extraction with removal of controlled amounts of bone and sectioning of multirooted teeth.
- 27. Fracture of theAlveolar Process • Management of fractures of the alveolar bone takes several different forms, depending on the type and severity of the fracture. • If the bone has been completely removed from the tooth socket along with the tooth, it should not be replaced • If the bone remains attached to the periosteum and usually heals if it can be separated from the tooth and is left attached to the overlying soft tissue
- 28. Fracture of theMaxillary Tuberosity
- 29. Fracture of theMaxillary Tuberosity
- 30. Fracture of theMaxillary Tuberosity • Fracture of a large section of bone in the maxillary tuberosity area is a situation of special concern. • The maxillary tuberosity is important for the construction of a stable retentive maxillary denture • If a tuberosity fracture occurs during an extraction, the treatment is similar to that just discussed for other bone fractures • The surgeon must carefully check for an oroantral communication and provide the necessary treatment
- 31. Fracture of theMaxillary Tuberosity
- 32. Fracture of theMandible • Fracture of the mandible may complicate tooth extraction if excessive or incorrectly applied force is used, or pathological changes have weakened the jaw. Excessive force should never be used to extract teeth.
- 33. Injury to theTemporomandibular Joint • Another major structure that can be traumatized during an extraction procedure in the mandible is the temporomandibular joint. • Removal of mandibular molar teeth frequently requires the application of a substantial amount of force • If the jaw is inadequately supported during the extraction to help counteract the forces, the patient may experience pain in this region. Controlled force and adequate support of the jaw prevent this
- 34. Injury to theTemporomandibular Joint • If the patient complains of pain in the temporomandibular joint area immediately after the extraction procedure, the surgeon should recommend the use of heat, resting the jaw, a soft diet, and 600 to 800 mg of ibuprofen every 4 hours for several days. Patients who cannot tolerate nonsteroidal anti- inflammatory drugs may take 500 to 1000 mg of acetaminophen.
- 35. Injury to theTemporomandibular Joint
- 36. Root Displacement • Thetooth root that is most commonly displaced into unfavorable anatomic spaces is the maxillary molar root when it is forced or lost into the maxillary sinus
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- 40. Root Displacement 1. First,the surgeon must identify the size of the root lost into the sinus. It may be a root tip of several millimeters or an entire tooth or root. 2. The surgeon must next assess whether there has been any infection of the tooth or periapical tissues. 3. Finally, the surgeon must assess the preoperative condition of the maxillary sinus. For the patient who has a healthy maxillary sinus,
- 41. If the displacedtooth fragment is a small 2- or 3-mm root tip and the tooth and sinus have no preexisting infection • First, a radiograph of the fractured tooth root should be taken to document its position and size. Once that has been accomplished, the surgeon should irrigate through the small opening in the socket apex and then suction the irrigating solution from the sinus via the socket • If this technique is not successful, no additional surgical procedure should be performed through the socket, and the root tip should be left in the sinus.
- 42. If the toothroot is infected or the patient has chronic sinusitis • the patient should be referred to an oral- maxillofacial surgeon for removal of the root tip via a Caldwell-Luc or endoscopic approach
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- 46. Tooth Lost intothe Pharynx • Occasionally the crown of a tooth, a prosthetic crown, or an entire tooth may be lost in the oropharynx. If this occurs, the patient should be turned toward the surgeon and placed in a position with the mouth facing the floor as much as possible. The patient should be encouraged to cough and spit the tooth out onto the floor
- 47. Tooth Lost intothe Pharynx • In spite of these efforts, the tooth may be swallowed or aspirated. • If the patient has no coughing or respiratory distress, it is most likely that the tooth was swallowed and has traveled down the esophagus into the stomach. However, • if the patient has a violent episode of coughing or shortness of breath, the tooth may have been aspirated through the vocal cords into the trachea and from there into a main stem bronchus.
- 48. Tooth Lost into thePharynx
- 49. Tooth Lost intothe Pharynx
- 50. Tooth Lost intothe Pharynx • If the tooth has been aspirated, consultation with regard to the possibility of removing the tooth with a bronchoscope should be requested. The urgent management of aspiration is to maintain the patient’s airway and breathing. Supplemental oxygen may be appropriate if signs of respiratory distress are observed
- 51. Tooth Lost intothe Pharynx
- 52. Tooth Lost intothe Pharynx •If the tooth has been swallowed, it is highly probable that it will pass through the gastrointestinal tract within 2 to 4 days