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BDS3 Oral Surgery > Extraction complications > Flashcards

Extraction complications Flashcards

(49 cards)

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1
Q

3 classes of extraction complications

A

immediate/intra-operative/ peri-operative

immediate post-operative/ short term post-operative

long term post-operative

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2
Q

extraction complications around extraction time

A

peri-operative complications

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3
Q

extraction complications after extraction

A

post-operative complications

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4
Q

peri-operative extraction complications

A

Difficulty of access

Abnormal resistance

Fracture of tooth/root

Fracture of alveolar plate

Fracture of tuberosity

Jaw fracture

Involvement of the maxillary antrum

Loss of tooth

Soft tissue damage

Damage to nerves/vessels

Haemorrhage

Dislocation of TMJ

Damage to adjacent teeth/restorations

Extraction of permanent tooth germ
- Leave little primary roots to resorb away naturally – do not dig

Broken instruments

Wrong tooth!!!!!

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5
Q

what are the 2 fundamental needs for extraction

A

good lighting and vision

- access and vision

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6
Q

what can cause difficulty in access and vision for extraction (3 types)

A

trismus

reduced aperture of mouth (congenital syndromes - microstomia; scarring)

crowded/malpositioned teeth

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7
Q

abnormal resistance that can cause peri-operative extraction complications

A

Thick cortical bone

Shape/form of roots e.g. divergent roots/hooked roots

Number of roots e.g. 3 rooted lower molars

Hypercementosis

Ankylosis

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8
Q

3 fracture types that can cause peri-operative complications

A

tooth

alveolus/tuberosity

jaw

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9
Q

tooth fracture that can cause periopertive complicatons

A

crown or root

can be due to:

  • caries
  • alignment
  • size
  • root
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10
Q

how to minimise fracture in extraction

A

get forceps below crown and gum

get beaks on roots - unlikely to break crown
- use luxators and elevators to get in

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11
Q

root problems that can cause peri-operative extraction complications

A
  • fused
  • convergent or divergent
  • ‘extra’ root(s)
  • morphology
  • hypercementosis
  • ankylosis
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12
Q

alveolar bone that is fractured commonly in extraction

A

Usually buccal plate
Usually canines or molars

Molars:

  • Periosteal attachment?
  • Suture
  • Dissect free

Canines:

  • Stabilise
  • Free mucoperiosteum

Don’t squeeze sockets post extraction – old technique – other haemostasis techniques

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13
Q

what to consider in periosteal attachment when extract

A

Size
> large – likely to have blood supply – put back and suture in place – possibility to heal
> small – take out as will cause pain – free up (dissect with scalpel)
- Smooth edges

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14
Q

jaw fracture in extraction

A

Usually mandible

Often impacted wisdom tooth, large cyst or atrophic mandible

Radiograph(s) are essential

Application of force
- Always support mandible

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15
Q

management of jaw fracture

A

Inform patient – do not eat on route

Post-op radiograph

Refer (phone call)

Ensure analgesia

Stabilise?

If delay, antibiotic

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16
Q

involvement of maxillary antrum in extraction can be

A

Oro-antral fistula (OAF)/communication (OAC)

Loss of root into antrum

Fractured tuberosity

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17
Q

why should you always examine extracted tooth post extraction

A

are all roots attached?

any bone or periosteum come out with the tooth?

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18
Q

oro-antral communication

diagnose by

A

Size of tooth

Radiographic position of roots in relation to antrum

Bone at trifurcation of roots

Bubbling of blood

Nose holding test (careful as can create an OAC)

Direct vision

Good light and suction - echo

Blunt probe (take care not to create an OAC)

palate tear - classic sign tuberosity broken

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19
Q

acute maxillary antrum extraction connection

A

oro-antral communication OAC

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20
Q

chronic maxillary antrum extraction connection

Study These Flashcards
A

oro-antral fistula OAF

epithelium lined

21
Q

management of oro-antral communication

Study These Flashcards
A

Inform patient

If small or sinus intact:

  • Encourage clot
  • Suture margins
  • Antibiotic
  • Post-op instructions

If large or lining torn:

  • Close with buccal advancement flap – need tension free – if tight = loose circulation, sutures tear away
  • Antibiotics and nose blowing instructions

Steam inhalation to help small sinus communications be clean

22
Q

how to deal with chronic OAF - key step

Study These Flashcards
A

need to cut fistula out as otherwise will reform

23
Q

how to confirm root in antrum

Study These Flashcards
A

radiographically

  • OPT
  • Occlusal
  • periapical
24
Q

how to manage root in antrum

Study These Flashcards
A

decision on retrieval after radiograph

  • Flap design – bone nibbler or electrical but – not air rota for cutting bone
  • Open fenestration with care
  • Suction – efficient and narrow bore
  • Small curettes
  • Irrigation or ribbon gauze
  • Close as for oro-antral communication
25
aetiology of fractured maxillary tuberosity
Single standing molar Unknown unerupted molar wisdom tooth Pathological gemination Extracting in wrong order – take back forward so not undermining bone – don’t want left with last standing molar Inadequate alveolar support
26
diagnosis of fractured maxillary tuberosity
Noise Movement noted both visually or with supporting fingers More than one tooth movement Tear on palate
27
management of fractured maxillary tuberosity
dissect out and close wound or reduce and stabilise
28
fixation of fractured maxillary tuberosity
orthodontic buccal arch wire spot - welded with composite arch bar splints - don't want removable as will alter position; need rigid for bone fracture (as many firm teeth included)
29
when managing fractured maxillary tuberosity remember to
remove or treat pulp ensure occlusion free antibiotic and antiseptics instructions post op remove tooth 8 weeks later (SR)
30
lose tooth on extraction
stop check suction radiograph - inhaled/swallowed ? need operation - Maxillary sinus, lingual plate – need further imaging - Need phone radiology department/ hospital - Chest x-ray, abdominal x-ray Contact defence union Hold tooth with fingers when elevating tooth – always be vigilant
31
4 possible damages to nerves on extraction
crush injuries cutting/shredding injuries transection - cut all the way through damage from surgery or damage from LA may not know at time
32
neurapraxia
contusion of nerve/continuity of epineural sheath and axons maintained
33
axontomesis
continuity of axons but not epineural sheath disrupted
34
neurotmesis
complete loss of nerve continuity/nerve transected
35
anaesthesia
numbness
36
paraesthesia
tingling
37
dysaesthesia
unpleasant sensation/pain
38
hypoaesthesia
reduced sensation
39
hyperaesthesia
increased/heightened sensation
40
5 possible damage to vessels on extraction
Veins (bleeding +++) Arteries (spurting/haemorrhage +++) Arterioles (spurting/pulsating bleed) Vessels in muscle Vessels in bone
41
dental haemorrhage
Most bleeds due to local factors – mucoperiosteal tears or fractures of alveolar plate/socket wall Very few bleeds due to undiagnosed clotting abnormalities (haemophilia/von Willebrands) Some due to Liver Disease (alcohol problems) – clotting factors made in liver Some due to medication – Warfarin/ antiplatelet agents (e.g. Aspirin/Clopidogrel) Note: Other anticoagulant drugs – Rivaroxaban (Pradaxa) and Dabigatran (Xarelto) - Check up to date SDCEP
42
how to manage soft tissue bleeding
gums, cheek, tongue Pressure – mechanical (finger, biting on damp gauze) firm, even pressure - 20 mins min Sutures Local anaesthetic with adrenaline (vasoconstrictor) Diathermy (cauterise/burn vessels – precipitate protein from proteinaceous plug in vessel) Ligatures/haemostatic forceps (artery clips) for larger vessels - Can tie of larger vessels pre surgery pre-cut to minimise bleed
43
how to manage bone bleeding
Pressure (via swab) LA on a swab or injected into socket Haemostatic agents - Surgicel/ Kaltostat - Some acidic so be careful if near a nerve/ wisdom tooth area Blunt instrument - shiny non-sharp end excavators, flat plastic Bone Wax - dry, use round ended excavators and smear on – pressure on vessels to stop bleeding – need to be dry Pack
44
dislocation of TMJ in extraction management
Relocate immediately (analgesia and advice on supported yawning) If unable to relocate try local anaesthetic into masseter intaorally If still unable to relocate – immediate referral Lower down than you and support head
45
3 potential damages to adjacent teeth/restorations in extractions
Hit opposing teeth with forceps Crack/Fracture/move adjacent teeth with elevators Crack/fracture/remove restorations/crowns/bridges on adjacent teeth Overhangs – warn pt and that will fix
46
management to damage to adjacent teeth/restoration in extraction
Temporary dressing/restoration Arrange definitive restoration If large restoration next to extraction site warn patient of the risk
47
when could extraction of permanent tooth germs happen
When removing deciduous molars – extraction or damage to developing permanent premolars
48
what to do if break instrument in extraction
E.g. Tips of elevators and luxators E.g. Tips of burs Radiograph/retrieve If unable to retrieve - refer
49
extract wrong tooth?
Concentrate Check clinical situation against notes/radiographs (mislabelling of radiographs/errors in notes can occur!) Count teeth Verify with someone else if still unsure Phone the defence union if you do it!!!!

BDS3 Oral Surgery (8 decks)

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