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
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 )
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.