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 Maxillofacial Surgery School of Dentistry University of Jordan

Healing of Extraction wounds
 Formation of blood clot filling the socket.

 Organization of the clot.
 Epithelialization of the surface of the

wound.  Formation of woven bone in the c.t. filling the socket (1 month → 2months in adult ).  Replacement of woven bone by trabecular bone and remodeling of the alveolus.

( If all teeth are lost resorption goes on relatively rapidly at first, then more slowly for some years until the alveolar bone is entirely removed.)

2. Prolonged bleeding due to a clotting defect. Immunodeficiency. Scurvy. 7. Proliferation of a malignant tumor. Formation of an oro-antral fistula. . 6. 5. Infection. 3. Radiotherapy. 4.Delayed healing of extraction wounds 1.

surgery or instrumentations.Complications of dental extraction      Local complications. . Systemic complications. Intra – operative complications. Post – operative complications ( immediate or delayed. ) Complications related to: Patient factor. surgeon factor.

Fracture of the jaw: 1. Excessive force. 2. Thin mandible – edentulous. Buried tooth. a.Local complications Fracture of the tooth. d. Isolated molar. . c. b.

Local complications 3. Instruments slips off the tooth. b. Opening of the maxillary antrum. 5. . c. Fracture of the maxillary tuberosity. The handles of the forceps or pressure of the hand supporting the jaw can cause bruising. Lower lip may be crushed between the teeth. 4. Damage to soft tissue: a.

Loss of tooth: a. Removal of a permanent tooth germ. Extraction of deciduous molar with apical infection which causes the permanent – premolar tooth germ to become attached by fibrous tissue to the periodontal membrane of the overlying tooth.Local complications 6. b. May be inhaled. 7. . Displaced into the loose tissue on the lingual side of the lower molar. c. May be swallowed.

. 9. As a result of haemorrhagic disease. Localised ostietis (dry socket ). Osteomylietis. b. c. b. Excessive bleeding: a. Tissue damaged – careless extraction. Infection.Local complications 8. Local infection: a.

d. Displaced into a cystic cavity. c.Local complications 10. . Displaced into the medullary cavity. Displaced into the antrum. b. Displaced into the inferior dental canal. Loss of root fragement: a.

. Trismus. Regional block – infiltration or interligumentary. Pain: a. Crowded or mall-positioned teeth. b. c. b. worked – give more if needed.A. Has L. 12. Small mouth. Access: a.Intra – operative complications 11.

c. Breaking the tooth or alveolar bone. Look for bulbous or diverging roots. 15. Ankylosis or sclerotic bone. b. Damage to other teeth / tissues and extraction of the wrong tooth.Intra – operative complications 13. Very long roots. . 14. In ability to move the tooth: X-Ray → : a.

Dry Socket ( Alveolar osteitis ) (The most frequent painful complication of extraction ) .

Local anaesthesia.Dry Socket  Aetiology: 1. 6. . 2. Osteosclerotic disease. Impaired blood supply ( lower jaw > Upper jaw ) 3. Smoking. 4. 7. Excessive trauma. Radiotherapy. Oral contraceptive ( oestrogens component causes increase in serum fibrinolytic activity) 5.

2. Proteolytic enzymes produced by bacteria.Dry Socket  Pathology:  Destruction of the blood clot either by: 1. .  Anaerobes are likely to play a major role. Excessive local fibrinolytic activity.  Destruction of the clot leaves an open socket. infected food and other debris accumulate.

Dry Socket  Pathology: The necrotic bone lodges bacteria which proliferate freely.  Dead bone is gradually separated by osteoclasts.  Healing is by granulation tissue from the base of the walls of the socket. Leucocytes unable to reach them through the avascular material.  .

.Dry Socket  Clinical features:  Pain usually starts few days after extraction.  No clot in the socket ( Dry ).  Sometimes may be delayed for few days or more. severe and aching or throbbing in character.  Mucous membrane around the socket is red and tender.  Deep – seated.

Dry Socket  Clinical features:  When debris is washed away. dead bone may be seen or may be felt as rough area with a probe. .  Sometimes the socket becomes concealed by granulation tissue growing in from the edge.  Pain may continues for week or two and rarely longer. whitish.

Squeezed the socket edge firmly after extraction.Minimum damage to the bone.Dry Socket  Prevention: 1. .Use prophylactic antibiotic. . . 3.Minimum stripping of the periosteum. In case of dis-impaction of 3rd molars dry socket is more common: . Minimal trauma. 2.

5. . 6. In patient who have had radiotherapy. every possible precaution should be taken. In osteosclerotic disease:  Little damage to bone (surgical extraction).  Prophylactic antibiotic. Stop smoking for two days post extraction.Dry Socket  Prevention: 4.

Frequent use of mouth wash. The aim of the treatment is to keep the open socket clean and to protect the exposed bone: Irrigate the socket by antiseptic solution. Fill the socket with an obtudant dressing containing some non irritant antiseptic. . Explain to the patient and warn them. 2. 3.Dry Socket  Treatment:   1.

soft to adhere to the socket walls and absorbable ). 2.  In many cases. Alvogyl – which is easy to manipulate.containing preparation.Dry Socket  Treatment: A great variety of dry socket dressing has been formulated: 1. ( The dressing should be: Obtudant.  . irrigation of the socket and replacement of the dressing has to be repeated every few days. Iodoform . antiseptic.

. 2. Orthodontic treatment. 5.Indication for extractions 1. 7. 3. Fractures of the jaw. 4. 8. Gross caries. Fractured teeth. Pulpitis (if endodontic treatment is impractical) Apical periodontitis ( if the teeth are non savable ) Gross periodontal disease. 6. Misplaced and impacted teeth.

11. 14. Prosthetic considerations. Preparation for radiotherapy. 13.Indications for extractions 10. Gross neglect. Patient at risk from certain systemic diseases. 12. . Supernumerary and supplemental teeth.

6. Burried and impacted teeth. 8. . Brittle teeth ( Glass in concrete ). Ankylosis and geminated teeth.Causes of difficult extractions 1. Inadequate access. Excessively strong supporting tissues. Easily detached crowns. 3. 4. 5. 2. Misshapen roots. 7. Sclerosis of the bone.