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 &

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

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

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

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:

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