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Complications of Dental
Extraction
Ziad malkawi
D.D.S., M.S.C., Max.Fac.S.Cert ., F.F.D.R.C.S.I.
Oral and Maxi l lofacial SurgerySchoo l of Dent istry
Universi ty of Jo rdan
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Healing of Extraction wounds
Formation o f blood clo t fi l ling the socket .
Organizat ion of the clot .
Epithel ial izat ion of the sur face of the
wound.
Formation of woven bone in the c.t . f i ll ing
the socket (1 month 2months in adult ).
Replacement o f woven bone by trabecu larbone and remodel ing of the alveolus.
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( I f all teeth are lost resorption goes
on relatively rapidly at f irst, then
more slowly for some years unti l thealveolar bone is enti rely removed.)
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Delayed healing of extraction wounds
1. Infect ion.
2. Prolonged b leeding due to a clot t ing
defect.
3. Formation of an oro -antral f istu la.
4. Prol i ferat ion of a malignant tumor.
5. Radiotherapy.
6. Immunodef ic iency.
7. Scurvy.
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Complications of dental extraction
Local com pl icat ions.
System ic compl icat ions.
Intraoperative compl icat ion s.
Post operative compl icat ion s ( immediate
or delayed . )
Compl icat ion s related to :
Pat ient factor, surgeon facto r, su rgery or
instrumentat ions.
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Local complications
3. Damage to so f t t issue:
a. Ins truments sl ips off the tooth.
b. Lower l ip may be crushed between the
teeth.
c. The handles o f the forceps o r pressure of
the hand support ing the jaw can cause
bruis ing.
4. Opening of the maxi l lary antrum .
5. Fractu re of the maxi l lary tuberos ity.
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Local complications
6. Loss o f tooth:
a. Displaced into th e loose t issue on the l ingualside of the lower molar.
b. May be swal low ed.
c. May be inhaled.
7. Removal of a permanent too th germ.
Extract ion o f deciduous molar wi th apicalinfect ion which causes the permanentpremo lar tooth germ to become attached byf ibrous t issue to the per iodontal membrane ofthe over ly ing too th.
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Local complications
8.Excessive bleeding :
a. Tissue damaged careless extract ion .
b. As a resu l t of haemorrh agic disease.
c. In fect ion .
9. Local infection:
a. Lo cal ised ost iet is (dry soc ket ).
b. Osteomyl iet is.
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Local complications
10. Loss of ro ot fragement:
a. Displaced in to th e inferior dental
canal.
b. Displaced into the medu l lary cavi ty .
c. Displaced into the antrum .
d. Displaced in to a cys t ic cavity.
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Intraoperative complications
11. Access:
a. Small mou th.
b. Crowded or mal l -po si t ioned teeth.
c. Trismus .
12. Pain:
a. Has L.A . worked give more i f
needed.
b. Regional bloc k inf i l t rat ion or inter-
l igumentary.
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Intraoperative complications
13. In ab i l ity to move the too th:
X-Ray :
a. Look for bulbous or diverging
roots.
b. Very long roots.
c. Ankylosis or sclerotic bone.
14. Breaking the too th or alveolarbone.
15. Damage to o ther teeth / t issues
and extract ion o f the w rong tooth .
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Dry Socket
Aet io logy:
1. Excess ive traum a.
2. Impaired b lood supp ly ( lower jaw >
Upper jaw )3. Local anaesthesia.
4. Oral contracept ive ( oestrogens
component causes increase in serum
fibr ino lyt ic act iv i ty)
5. Osteosclerot ic d isease.
6. Radiotherapy.
7. Smoking.
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Dry Socket
Pathology:
Destruct ion of the blood clot either by:
1. Proteoly t ic enzymes produced by
bacteria.
2. Excessive local f ibr inolyt ic act iv i ty .
Anaerobes are l ikely to p lay a major
role.
Destruct ion of the clot leaves an open
socket , infected food and o ther debris
accumulate.
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Dry Socket
Pathology:
The necrot ic bone lodges bacter ia
which pro l i ferate freely, Leucocytes
unable to reach them through the
avascu lar material.
Dead bone is g radually separated by
osteoclasts. Healing is by granu lat ion t issue from
the base of the wal ls of the socket .
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Dry Socket
Clinical features:
Pain usual ly s tarts few days after
extract ion.
Somet imes may be delayed for few daysor more.
Deepseated, severe and ach ing orthrobb ing in character.
Mucous membrane around the socket isred and tender.
No c lot in the socket ( Dry ).
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Dry Socket
Clinical featu res:
When debris is washed away, whi t ish,
dead bone may be seen o r may be felt
as rough area with a p robe.
Somet imes the soc ket becomes
concealed by granu lat ion t issue
grow ing in f rom the edge. Pain may cont inues for week o r two and
rarely longer.
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Dry Socket
Prevent ion:
1. Minimal trauma.
2. Squeezed the socket edge f irm ly after
extract ion.
3. In case of d is-impact ion of 3rdmolars
dry socket is more common:
- Minimum str ipping of the per iosteum .
- Minimum damage to the bone.
- Use prophy lact ic ant ib iot ic.
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Dry Socket
Prevent ion:
4. In patient who have had radiotherapy , every
possib le precaut ion should be taken.
5. In os teosc lerot ic disease: Lit t le damage to bone (su rgical
extraction).
Prophy lact ic ant ib iot ic.
6. Stop smoking for two days post extract ion.
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Dry Socket
Treatment:
Explain to the pat ient and warn them.
The aim of the treatment is to keep the
open socket clean and to p rotect the
exposed bone:
1. Ir r igate the socket by ant isept ic solu t ion.
2. Fil l the socket wi th an obtudant dressing
contain ing some non irr itant ant isept ic.
3. Frequent use of mouth wash .
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Dry Socket
Treatment:
A great var iety o f dry sock et dressing has beenformulated:
1. Iodofo rm - containing preparat ion .2. Alvo gyl which is easy to manipulate.
( The dress ing should be: Obtudant, antiseptic,so f t to adhere to the socket wal ls andabsorbab le ).
In m any cases, i r r igat ion o f the socket andreplacement of the dress ing has to be repeatedevery few days.
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I ndication for extractions
1. Gross caries.
2. Pulpi t is (i f endodon t ic treatment is
impract ical)
3. Apical per iodont i t is ( if the teeth are non
savable )
4. Gross periodontal disease.
5. Fractu red teeth.6. Fractu res o f the jaw.
7. Misp laced and im pacted teeth.
8. Orthodon t ic treatment.
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I ndications for extractions
10. Prosthet ic cons iderat ions .
11. Supernumerary and supplemental teeth.
12. Gross neglect.
13. Pat ient at r isk from certain system ic
diseases.
14. Preparat ion fo r radio therapy.
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Causes of dif f icult 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.
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