1. Complications of Extraction of Impacted Teeth
dr shabeel pn

2. Outline Soft Tissue Injuries
Complications with the Tooth Being Extracted
Injuries to Adjacent Teeth
Injuries to Osseous Structures
Injuries To Adjacent Structures
Oroantral Communications
Postoperative Bleeding
Delayed Healing & Infection

3. I. Soft Tissue Injuries

4. 1. 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.

5. Prevention -Adequately sized flaps -Gentle Retraction Management Reposition the flap & suture If the tear is jagged, trim it before suturing

6. 2. Puncture Wound of Soft Tissue
Cause Instrument Slippage Prevention Controlled force Management Suturing to prevent infection & allow healing to occur

8. 3. Stretch or Abrasion Injury
Cause Bur shank or retractor injury Prevention Care Management Keep it moist ( ointment ) Heals within 5 – 10 days

10. II. Complications with the tooth Being Extracted

11. 1. Root Fracture
Cause Long, curved, divergent roots Excessive force during extraction Prevention Proper exposure & bone removal

12. 2. Root Displacement Into: Mandibular Canal Lingual Pouch
Infratemporal Space
Maxillary Sinus

16. III. Injuries to Adjacent Teeth
Luxation of Adjacent Teeth
Fracture of Adjacent Restoration
Cause
Carelesness
Prevention
Judicious use of elevators

17. IV. Injuries to Osseous Structures

18. 1. Fracture of Alveolar Process
Fracture of the Buccal or Lingual Cortex Cause Inadequate exposure & excessive force Prevention Adequate bone removal & eposure

20. 2. 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

22. 3. Fracture of the Mandible
Cause Excessive force Prevention Proper bone removal & controlled force

23. 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

24. V. Injuries to Adjacent Structures

25. 1. 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

27. 2. 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

28. 3. Injury to the TMJ
Cause Inadequate support of the mandible during extraction Prevention Use of bite block Management Reduction

30. Vi. Oroantral Communication
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

32. VII. Postoperative Bleeding
Cause
-Bleeding at wound margins
-Bleeding at a bony foramen within the socket
-Medical Problem

33. 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

34. Management Local Measures Pressure packs Suturing
Ligate bleeding vessels
Burnish bone
Apply material to aid in hemostasis (surgicell, collaplug)

35. VIII. Delayed Healing & Infection

36. 1. Infection
Cause Debris left under the flap Prevention Irrigation Management Debridement & Drainage

37. 2. Dry Socket (Alveolar Ostitis)
Cause -Lysis of a fully formed blood clot before the clot is replaced with granulation tissue. -Higher incidence with smokers & patients taking oral contaceptives. Prevention -Presurgical irrigation with antimicrobial agents ,e.g: chlorhexidine -Intraoperative irrigation with saline

38. Management Irrigate with warm saline Remove old clots
Place sedative dressing
Prescribe mild analgesics
Reassess after 24 to 48 hours