3. Complications of tooth extraction
• Local complications
• Immediate:
• Failure of LA
• Failure to move the tooth
• Fracture of tooth, alveolus, mandible
• Oro-antral communication
• Displacement in soft tissues
• Hemorrhage
• TMJ dislocation
• Damage to V1,2,3
4. • Delayed
• Exessive pain, swelling, and trismus
• Bleeding
• Dry socket
• A. osteomyelitis
• Infection
• Oro-antral fistula
• Failure of the socket to heal
• Nerve damage
7. Causes of difficult 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.
8.
9.
10.
11.
12.
13.
14.
15.
16. Postoperative Bleeding
Cause
-Bleeding at wound margins
-Bleeding at a bony foramen within the socket
-Medical Problem
17. 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
18. Management
Local Measures
• Pressure packs
• Suturing
• Ligate bleeding vessels
• Burnish bone
• Apply material to aid in hemostasis (surgicell,
collaplug)
19. Cause
Infection
Debris left under the flap
Prevention
Irrigation
Management
Debridement & Drainage
20. Dry Socket ( Alveolar osteitis )
(The most frequent painful complication of
extraction )
22. Dry Socket
• Pathology:
– Destruction of the blood clot either by:
1. Proteolytic enzymes produced by bacteria.
2. Excessive local fibrinolytic activity.
– Anaerobes are likely to play a major role.
– Destruction of the clot leaves an open socket,
infected food and other debris accumulate.
23. Dry Socket
– Pathology:
• The necrotic bone lodges bacteria which
proliferate freely, Leucocytes unable to reach
them through the avascular material.
• Dead bone is gradually separated by
osteoclasts.
• Healing is by granulation tissue from the base
of the walls of the socket.
24. Dry Socket
• Clinical features:
– Pain usually starts few days after extraction.
– Sometimes may be delayed for few days or more.
– Deep – seated, severe and aching or throbbing in
character.
– Mucous membrane around the socket is red and
tender.
– No clot in the socket ( Dry ).
25. Dry Socket
• Clinical features:
– When debris is washed away, whitish, 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.
26. Dry Socket
• Prevention:
1. Minimal trauma.
2. Squeezed the socket edge firmly after
extraction.
3. In case of dis-impaction of 3rd molars dry socket
is more common:
- Minimum stripping of the periosteum.
- Minimum damage to the bone.
- Use prophylactic antibiotic.
27. Dry Socket
• Prevention:
4. In patient who have had radiotherapy, every possible
precaution should be taken.
5. In osteosclerotic disease:
• Little damage to bone (surgical extraction).
• Prophylactic antibiotic.
6. Stop smoking for two days post extraction.
28. Dry Socket
• Treatment:
– Explain to the patient and warn them.
– The aim of the treatment is to keep the open
socket clean and to protect the exposed bone:
1. Irrigate the socket by antiseptic solution.
2. Fill the socket with an obtudant dressing
containing some non irritant antiseptic.
3. Frequent use of mouth wash.
29. Dry Socket
• Treatment:
– A great variety of dry socket dressing has been
formulated:
1. Iodoform - containing preparation.
2. Alvogyl – which is easy to manipulate.
( The dressing should be: Obtudant, antiseptic, soft to
adhere to the socket walls and absorbable ).
– In many cases, irrigation of the socket and replacement
of the dressing has to be repeated every few days.
