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

2. Local Complication Of Exodontia & How To Deal With
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Tamer Hamdy Dec.2003

3. 1- Failure To Achieve Analgesia
Due To
Faulty Technique
Too Small Volume Of L.A. Drug
Not Waiting Enough
Local Infection
- Probing & Percation Tests*
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Tamer Hamdy Dec.2003

4. 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

5. 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
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Tamer Hamdy Dec.2003

6. 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
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Tamer Hamdy Dec.2003

7. 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
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Tamer Hamdy Dec.2003

8. 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

9. 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
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Tamer Hamdy Dec.2003

10. 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
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Tamer Hamdy Dec.2003

11. 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
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Tamer Hamdy Dec.2003

12. 8-Collateral Damage To Surrounding Soft Tissues
Can Be Avoided By
Perfect Grip
Good Angulations Of Forceps
Elevators Control
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Tamer Hamdy Dec.2003

13. 9- Thermal Injury To Lips Or Cheek
Continue Use Of Handpiece , Hot Instrument
Rubber Gloves Provide Excellent Thermal Insulators
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Tamer Hamdy Dec.2003

14. 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

15. 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

16. 11- Dislocation Of T.M.J. Result Of Failure To Support The Mandible
History Of Dislocation
Reducing A Dislocated
Mandible
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Tamer Hamdy Dec.2003

17. 12- Fractures Of The Mandible
Rare, Predisposed By Weakness Of The Jaw Such As
Large Cyst
Tumors
Impaction
Osteoporosis
Hyperthyrodism
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Tamer Hamdy Dec.2003

18. 13- Damage To Nerve Uncommon Numbness Of Lower Lip Causes
Anatomical Variation
Careless Use Of Elevators
ttt
Nerve Decompression Operation
Microsurgery
Nerve Regeneration Weeks-6Months
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Tamer Hamdy Dec.2003

19. 14-Excessive Pain, Swelling & Trismus
Analgesics
Careful Instrumentation & Handling Of Tissues
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Tamer Hamdy Dec.2003

20. 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
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Tamer Hamdy Dec.2003

21. 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

22. 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
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Tamer Hamdy Dec.2003

23. 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.
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Tamer Hamdy Dec.2003

24. 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