EXODONTIA BLANCO III, Diapositivas de Periodontología

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EXODONCIA III

ACCIDENTS AND COMPLICATIONS Dr. José María Aguado Dra. María Luisa Martínez Dr. Alberto Herranz

EARLY

Generals

Locals

DENTAL

• Root Fractures (Long, curved, divergent roots that lie in dense bone are the most likely to be fractured)
• Luxation of an adjacent tooth or an antagonist
• Fracture or Dislodgment of an adjacent restoration
• Extraction of the wrong tooth

Inadequate

technique

Surgical exodontia

Clinical exam + X-rays

FRACTURES or

LUXATION of

an adjacent

tooth

• Large active part
• Inadequate extraction movements
• Inadequate use of force with elevators and forceps. Wrong use of the straight elevator:
• Dental burs
• Luxation In surgical exodontia:

Treatment

Reposition into its appropriate

position

Stabilization for an adequate healing:

• Simply reposition in the tooth socket.
• Check the occlusion to ensure that it has not been displaced into a hiperocclusion and traumatic occlusion
• If the luxated tooth is mobile, it should be stabilized with hemi- rigid fixation to maintain the tooth in its position along 4 weeks

Prevention of Extraction of Wrong Teeth Focus attention on the procedure. Check with the patient and the assistant to ensure that the correct tooth is being removed. Check, then recheck, images and records to confirm the correct tooth.

INJURIES TO OSSEUS STRUCTURES

• Fracture of the alveolar process
• Fracture of the maxillary tuberosity
• Oroantral communications OR oronasal communications
• Fracture of the mandible
• Injury to the temporomandibular joint

External plate: C and 1M (upper)

Internal plate: lower 3M

• IF SMALL BONE-CHIPS: Eliminate: avoid infectious process (alveolitis or sequestrum).
• IF LARGE (fixed to periosteum): leave and suture. If it is not possible: Reg.
• IF TOO LARGE: mini-plaques and ligations.

Prevention of

fracture of

alveolar

process

Use Use surgical (i.e., open) extraction technique to reduce the force required. Do not use Do not use excessive force. Conduct Conduct thorough preoperative clinical and radiographic examinations.

Complication of a large fracture of bone in the maxillary tuberosity

• Hemorrhage
• An opening to the maxillary sinus can be created: oroantral communication
• The stability of an retentive denture can be compromised.

Treatment

1. Small fracture and no oroantral communication: close mucosa
2. Small fracture and orantral communication: flap procedure
3. Extended fracture: try to dissect the bone from the tooth and remove the tooth
4. Extended facture and excessively mobile of the tuberosity:
   1. splint the tooth being extracted to adjacent teeth and defer the extraction by 6 to 8 weeks, allowing time for bone to heal
   2. section the crown of the tooth from the roots, and allow the tuberosity and tooth root section to heal. 6- 8 weeks later remove the tooth roots in the usual fashion.

Treatment

1. If the opening is moderate (2-6mm)
   1. ensure the maintenance of the blood clot in the area with a suture.
   2. Or place some clot-promoting substance such as gelatine sponche
2. If the opening is large (>7 mm): repair the antrooral communication with a flap

Complications:

1. Postoperative maxillary sinusitis
2. Formation of a chronic oroantral fistula