بسم الله الرحمن الرحيم 10:14 PM Tamer Hamdy Dec.2003

Local Complication Of Exodontia & How To Deal With 10:14 PM Tamer Hamdy Dec.2003

1- Failure To Achieve Analgesia Due To Faulty Technique Too Small Volume Of L.A. Drug Not Waiting Enough Local Infection - Probing & Percation Tests* 10:14 PM Tamer Hamdy Dec.2003

2-Failure To Move The Tooth - Due To Bone Texture Is Dense & Inelastic Root Shape Is Obstructing Its Path Of Withdrwal Using Greater Forces Is Likely To Results In Fracture Of The Tooth ttt : Radiograph & Mucoperiosteal Flap 10:14 PM Tamer Hamdy Dec.2003

3- Fracture Of The Tooth Happens To Even The Most Experienced Exodontists !! Causes Are Excessive Force A Tooth Weakened By Caries Or Large Restoration Improper Application Of Force Reassess The Situation Weather To Proceed Or Abort The Ext. Attempt & Refer For Oral Surgeon In General Root Fragment Of Vital Tooth >5mm Can Be Safely Left In The Jaw Of Healthy Pt. ,Larger One & Those With Necrotic Pulps Or Periapical Radiolucency Should Be Removed Unless The Risk Of So Outweighs The Potential Of Gain Immunocompremised Pt. Or At Risk Of Infective Endocarditis All Potential Cause Of Infection Should Be Removed Whenever Possible 10:14 PM Tamer Hamdy Dec.2003

4-Fracture Of The Alveolus Due To Excessive Force With Forceps ,So If Extraction Need Excessive Force Soft Tissue Flap Should Be Elevated ttt Of Fractures Depends On Type & Severity Of Fracture 10:14 PM Tamer Hamdy Dec.2003

Relation Of Bone To Periosteum So,Bone Removed To Avoid Necrosis & Forgin Body Reaction Small Piece Large Piece Replaced In Position & Suturing Replaced In Position & Wiring 10:14 PM Tamer Hamdy Dec.2003

Fracture Of Maxillary Tubrosity Predisposed by Pneumatization Of Max. Sinus Ankylosis ttt Small Fragments: Removed By Raising a Buccal Flap & Then Dissecting The Bone Free From Any Remaining Soft Tissue, Tooth & Bone Fragment Are Then Removed Together Large Segment: Abandon The Ext., Give Antibiotics & Analgesics Then Wait For 8-10 Weeks For Fracture To Heal Before The Tooth Is Removed By Surgical Approach 10:14 PM Tamer Hamdy Dec.2003

5- Oro-Antral Communication Predisposed by Pneumatization Resistant Wisdom Management Any Root In Antrum Require Removal By Oral Surgeon Ideal Way Of Management Is To Close It Immediately Before Passage Of Infected Material & Cause Sinusitis A Three-Sided Mucoperiosteal Flap Is Raised Avoid Apply Forceps to a Root Unless Sufficient Exposure Of The Root Remove The Apical Part Of Fractured Palatal Root Of Max. Molar Unless There Is Contraindication To Leave It 10:14 PM Tamer Hamdy Dec.2003

6-Displacement Of The Tooth Or Root Escape To Lung Or Stomach Sent To Hospital Pushed Into Antrum Refer To Oral Surgeon Displacement Into a Soft Tissue Spaces …….. Still In Socket 10:14 PM Tamer Hamdy Dec.2003

7- Fracture Or Subluxation Of An Adjacent Tooth No Force Should Be Applied To Tooth Other Than The One Being Removed Inadvertent Damage To Other Teeth More Likely As In Overhanging Rest. In Adjacent Teeth Bulbous Full Crown Rest. On Adjacent Tooth Of Ext. Is A Bridge Abutment 10:14 PM Tamer Hamdy Dec.2003

8-Collateral Damage To Surrounding Soft Tissues Can Be Avoided By Perfect Grip Good Angulations Of Forceps Elevators Control 10:14 PM Tamer Hamdy Dec.2003

9- Thermal Injury To Lips Or Cheek Continue Use Of Handpiece , Hot Instrument Rubber Gloves Provide Excellent Thermal Insulators 10:14 PM Tamer Hamdy Dec.2003

10- Haemorrhage Tooth Ext. Is A Stringent Test Of Haemostasis Type Of Bleeding Primary Reactionary Secondary Cheek The Medical & Bleeding History Careful Handling Of Tissues 10:14 PM Tamer Hamdy Dec.2003

ttt A Gauze Pack (10Min. )With Steady Pressure Instruct Pt. Not To Disturb The Clot Injection Of Further L.A. Suturing Pack Coagulation Diathermy Post Operative Bleeding Reduce Anxiety Stop Bleeding Antibiotics NSAID ( Anti-Platelets Action ) 10:14 PM Tamer Hamdy Dec.2003

11- Dislocation Of T.M.J. Result Of Failure To Support The Mandible History Of Dislocation Reducing A Dislocated Mandible 10:14 PM Tamer Hamdy Dec.2003

12- Fractures Of The Mandible Rare, Predisposed By Weakness Of The Jaw Such As Large Cyst Tumors Impaction Osteoporosis Hyperthyrodism 10:14 PM Tamer Hamdy Dec.2003

13- Damage To Nerve Uncommon Numbness Of Lower Lip Causes Anatomical Variation Careless Use Of Elevators ttt Nerve Decompression Operation Microsurgery Nerve Regeneration 6Weeks-6Months 10:14 PM Tamer Hamdy Dec.2003

14-Excessive Pain, Swelling & Trismus Analgesics Careful Instrumentation & Handling Of Tissues 10:14 PM Tamer Hamdy Dec.2003

15- Dry Socket (Alveolar Osteitis) A Condition In Which Blood Clot Disintegrates & Falls Leaving The Boney Socket Bare Of Granulation Tissue Acute Pain , Foul Odour Predisposing Factors Mouth Wash Use Of L.A. Containing V.C. Tissues Damage Smoking ttt : Irrigation & Dressing 10:14 PM Tamer Hamdy Dec.2003

16-Post Operative Infection If Pus Formed …….. I.&D. Is Required 17-Failure Of Socket To Heal Uncommon, It Indicate Presence Of : Infected R.R. Or Piece Of A Dead Bone ( Sequestrum ) Or Malignancy , osteomylitis Oro-Antral Fistula 10:14 PM Tamer Hamdy Dec.2003

18- Osteomyelitis It IS Extensive Infection Involving The Bone & Bone Marrow & Periosteum & Affect A Large Area Of The Entire Bone Intense Penetrating Bone Pain , Prolonged Healing Of The Socket , Anaesthesia Of The Lower Lip & General Malaise Are The Symptoms Acute Phase Signs Of Spreading Infection & Fever High Dosage Of Antibiotics Chronic Phase Suppuration & Swelling Surgical Depridement Of The Affected Area To Remove Any Sequestra Of A Dead Bone 10:14 PM Tamer Hamdy Dec.2003

19- Ostoeradionecrosis Is An Extremely Serious Complication Of Radiotherapy To The Jaw That Can Be Triggered By Tooth Ext. All Teeth In The Anticipated Radiation Field That May Require Ext. Should Be Ideally Be Removed Before The Pt. Has Radiotherapy TTT. 10:14 PM Tamer Hamdy Dec.2003

Thank You References: Contemporary Oral & Maxillofacial Surgery Dental Therapeutics & Medicaments Tooth Extraction A Practical Guide Prepared By: Tamer M. Hamdy Dec.2003 10:14 PM