Complications of Extraction

of Impacted Teeth
 Outline
I. Soft Tissue Injuries
II. Complications with the Tooth Being Extracted
III. Injuries to Adjacent Teeth
IV. Injuries to Osseous Structures
V. Injuries To Adjacent Structures
VI. Oroantral Communications
VII.Postoperative Bleeding
VIII.Delayed Healing & Infection
I. Soft Tissue Injuries
 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.
Prevention
-Adequately sized flaps
-Gentle Retraction

Management
Reposition the flap & suture
If the tear is jagged, trim it before suturing
2. Puncture Wound of Soft Tissue
Cause
Instrument Slippage

Prevention
Controlled force

Management
Suturing to prevent infection & allow healing
to occur
 3. Stretch or Abrasion Injury
Cause
Bur shank or retractor injury

Prevention
Care

Management
Keep it moist ( ointment )
Heals within 5 – 10 days
II. Complications with the tooth
Being Extracted
 1. Root Fracture

Cause
Long, curved, divergent roots
Excessive force during extraction

Prevention
Proper exposure & bone removal
 2. Root Displacement

Into:
• Mandibular Canal
• Lingual Pouch
• Infratemporal Space
• Maxillary Sinus
 III. Injuries to Adjacent Teeth
1.Luxation of Adjacent Teeth
2.Fracture of Adjacent Restoration

Cause
Carelesness
Prevention
Judicious use of elevators
IV. Injuries to Osseous Structures
 1. Fracture of Alveolar Process
Fracture of the Buccal or Lingual Cortex

Cause
Inadequate exposure & excessive force

Prevention
Adequate bone removal & eposure
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
 3. Fracture of the Mandible

Cause
Excessive force

Prevention
Proper bone removal & controlled force
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
V. Injuries to Adjacent Structures
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
 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
 3. Injury to the TMJ
Cause
Inadequate support of the mandible during
extraction

Prevention
Use of bite block

Management
Reduction
 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
 VII. Postoperative Bleeding

Cause
-Bleeding at wound margins
-Bleeding at a bony foramen within the socket
-Medical Problem
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
Management
Local Measures
• Pressure packs
• Suturing
• Ligate bleeding vessels
• Burnish bone
• Apply material to aid in hemostasis (surgicell,
collaplug)
VIII. Delayed Healing & Infection
 1. Infection
Cause
Debris left under the flap

Prevention
Irrigation

Management
Debridement & Drainage
 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
Management
– Irrigate with warm saline
– Remove old clots
– Place sedative dressing
– Prescribe mild analgesics
– Reassess after 24 to 48 hours