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Complication of Extraction

        Islam Kassem

        ikassem@dr.com


           ikassem@dr.com
Dealing with local complications
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
•   Delayed
•   Exessive pain, swelling, and trismus
•   Bleeding
•   Dry socket
•   A. osteomyelitis
•   Infection
•   Oro-antral fistula
•   Failure of the socket to heal
•   Nerve damage
•   Late
•   Chronic osteomyelitis
•   Osteoradionecrosis
•   Nerve damage
•   Chronic pain
•   Systemic complications
•   Immediate
•   Faint
•   Hypoglycemia
•   Hyperventelation/panic attack
•   Fits
•   MI
•   Addisonian crisis
•   Respiratory obstruction
Causes of difficult extractions

1.   Excessively strong supporting tissues.
2.   Misshapen roots.
3.   Easily detached crowns.
4.   Brittle teeth ( Glass in concrete ).
5.   Sclerosis of the bone.
6.   Burried and impacted teeth.
7.   Ankylosis and geminated teeth.
8.   Inadequate access.
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Complication of extraction 2
Postoperative Bleeding

Cause
  -Bleeding at wound margins
  -Bleeding at a bony foramen within the socket
  -Medical Problem
Prevention
  -Good history taking
           (coagulopathy, medications…etc)
  -Atrumatic surgical extraction
           (clean incisions, gentle management
           of soft tissues, smoothen bony
           specules, curette granulation tissue)
  -Obtain good homeostasis at surgery
  - Postoperative instructions
Management
 Local Measures
    • Pressure packs
    • Suturing
    • Ligate bleeding vessels
    • Burnish bone
    • Apply material to aid in hemostasis (surgicell,
      collaplug)
Cause
           Infection
  Debris left under the flap

Prevention
  Irrigation

Management
 Debridement & Drainage
Dry Socket ( Alveolar osteitis )
(The most frequent painful complication of
 extraction )
Dry Socket
•    Aetiology:
    1. Excessive trauma.
    2. Impaired blood supply lower jaw > Upper jaw
    3. Local anaesthesia.
    4. Oral contraceptive ( oestrogens component
       causes increase in serum fibrinolytic activity)
    5. Osteosclerotic disease.
    6. Radiotherapy.
    7. Smoking.
Dry Socket
•    Pathology:
    –    Destruction of the blood clot either by:
    1.   Proteolytic enzymes produced by bacteria.
    2.   Excessive local fibrinolytic activity.
    –    Anaerobes are likely to play a major role.
    –    Destruction of the clot leaves an open socket,
         infected food and other debris accumulate.
Dry Socket
– Pathology:
  • The necrotic bone lodges bacteria which
    proliferate freely, Leucocytes unable to reach
    them through the avascular material.
  • Dead bone is gradually separated by
    osteoclasts.
  • Healing is by granulation tissue from the base
    of the walls of the socket.
Dry Socket
• Clinical features:
  – Pain usually starts few days after extraction.
  – Sometimes may be delayed for few days or more.
  – Deep – seated, severe and aching or throbbing in
    character.
  – Mucous membrane around the socket is red and
    tender.
  – No clot in the socket ( Dry ).
Dry Socket
• Clinical features:
  – When debris is washed away, whitish, dead bone
    may be seen or may be felt as rough area with a
    probe.
  – Sometimes the socket becomes concealed by
    granulation tissue growing in from the edge.
  – Pain may continues for week or two and rarely
    longer.
Dry Socket
•    Prevention:
    1. Minimal trauma.
    2. Squeezed the socket edge firmly after
        extraction.
    3. In case of dis-impaction of 3rd molars dry socket
        is more common:
       - Minimum stripping of the periosteum.
       - Minimum damage to the bone.
       - Use prophylactic antibiotic.
Dry Socket
•    Prevention:
    4. In patient who have had radiotherapy, every possible
         precaution should be taken.
    5. In osteosclerotic disease:
        • Little damage to bone (surgical extraction).
        • Prophylactic antibiotic.
    6. Stop smoking for two days post extraction.
Dry Socket
•    Treatment:
    – Explain to the patient and warn them.
    – The aim of the treatment is to keep the open
       socket clean and to protect the exposed bone:
    1. Irrigate the socket by antiseptic solution.
    2. Fill the socket with an obtudant dressing
       containing some non irritant antiseptic.
    3. Frequent use of mouth wash.
Dry Socket

•    Treatment:
    –    A great variety of dry socket dressing has been
         formulated:
    1. Iodoform - containing preparation.
    2. Alvogyl – which is easy to manipulate.
         ( The dressing should be: Obtudant, antiseptic, soft to
             adhere to the socket walls and absorbable ).
    – In many cases, irrigation of the socket and replacement
         of the dressing has to be repeated every few days.
Study source?




    ikassem@dr.com
• Contemporary Oral &
  maxiallofacial surgery
• Page 185-199



       ikassem@dr.com
• You can get it form

• http://www.slideshare.net/islamkassem
•Thank you


      ikassem@dr.com

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Complication of extraction 2

  • 1. Complication of Extraction Islam Kassem ikassem@dr.com 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. Causes of difficult extractions 1. Excessively strong supporting tissues. 2. Misshapen roots. 3. Easily detached crowns. 4. Brittle teeth ( Glass in concrete ). 5. Sclerosis of the bone. 6. Burried and impacted teeth. 7. Ankylosis and geminated teeth. 8. Inadequate access.
  • 16. Postoperative Bleeding Cause -Bleeding at wound margins -Bleeding at a bony foramen within the socket -Medical Problem
  • 17. Prevention -Good history taking (coagulopathy, medications…etc) -Atrumatic surgical extraction (clean incisions, gentle management of soft tissues, smoothen bony specules, curette granulation tissue) -Obtain good homeostasis at surgery - Postoperative instructions
  • 18. Management Local Measures • Pressure packs • Suturing • Ligate bleeding vessels • Burnish bone • Apply material to aid in hemostasis (surgicell, collaplug)
  • 19. Cause Infection Debris left under the flap Prevention Irrigation Management Debridement & Drainage
  • 20. Dry Socket ( Alveolar osteitis ) (The most frequent painful complication of extraction )
  • 21. Dry Socket • Aetiology: 1. Excessive trauma. 2. Impaired blood supply lower jaw > Upper jaw 3. Local anaesthesia. 4. Oral contraceptive ( oestrogens component causes increase in serum fibrinolytic activity) 5. Osteosclerotic disease. 6. Radiotherapy. 7. Smoking.
  • 22. Dry Socket • Pathology: – Destruction of the blood clot either by: 1. Proteolytic enzymes produced by bacteria. 2. Excessive local fibrinolytic activity. – Anaerobes are likely to play a major role. – Destruction of the clot leaves an open socket, infected food and other debris accumulate.
  • 23. Dry Socket – Pathology: • The necrotic bone lodges bacteria which proliferate freely, Leucocytes unable to reach them through the avascular material. • Dead bone is gradually separated by osteoclasts. • Healing is by granulation tissue from the base of the walls of the socket.
  • 24. Dry Socket • Clinical features: – Pain usually starts few days after extraction. – Sometimes may be delayed for few days or more. – Deep – seated, severe and aching or throbbing in character. – Mucous membrane around the socket is red and tender. – No clot in the socket ( Dry ).
  • 25. Dry Socket • Clinical features: – When debris is washed away, whitish, dead bone may be seen or may be felt as rough area with a probe. – Sometimes the socket becomes concealed by granulation tissue growing in from the edge. – Pain may continues for week or two and rarely longer.
  • 26. Dry Socket • Prevention: 1. Minimal trauma. 2. Squeezed the socket edge firmly after extraction. 3. In case of dis-impaction of 3rd molars dry socket is more common: - Minimum stripping of the periosteum. - Minimum damage to the bone. - Use prophylactic antibiotic.
  • 27. Dry Socket • Prevention: 4. In patient who have had radiotherapy, every possible precaution should be taken. 5. In osteosclerotic disease: • Little damage to bone (surgical extraction). • Prophylactic antibiotic. 6. Stop smoking for two days post extraction.
  • 28. Dry Socket • Treatment: – Explain to the patient and warn them. – The aim of the treatment is to keep the open socket clean and to protect the exposed bone: 1. Irrigate the socket by antiseptic solution. 2. Fill the socket with an obtudant dressing containing some non irritant antiseptic. 3. Frequent use of mouth wash.
  • 29. Dry Socket • Treatment: – A great variety of dry socket dressing has been formulated: 1. Iodoform - containing preparation. 2. Alvogyl – which is easy to manipulate. ( The dressing should be: Obtudant, antiseptic, soft to adhere to the socket walls and absorbable ). – In many cases, irrigation of the socket and replacement of the dressing has to be repeated every few days.
  • 30. Study source? ikassem@dr.com
  • 31. • Contemporary Oral & maxiallofacial surgery • Page 185-199 ikassem@dr.com
  • 32. • You can get it form • http://www.slideshare.net/islamkassem
  • 33. •Thank you ikassem@dr.com