Professional Documents
Culture Documents
29/3/2009
our lecture today talks about the most common complications occurring
during or after oral surgical procedures , the later we call them
postoperative complications .
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Prevention of complications:
The best and easiest way to manage complications is to prevent them from
happening by a thorough of a preoperative assessment and comprehensive
treatment plan .
4. Treatment plan .
5. Then you go with your treatment .
After doing all these steps perfectly , if complications occurred you will be
able to manage them .
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Tearing of the mucosal flap usually results from an inadequately sized flap,
which is then forcibly retracted beyond the ability of the tissue to stretch
as the surgeon tries to gain needed surgical access .
For example while you are using the elevator and this elevator suddenly
slipped , it will go into the tissues and puncture them .
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Ex : while you are removing bone in surgical removal of teeth , if you are
not careful enough , the hand piece will injure the mucosa or the lip and
burn it .
Pic : in this pic you see burn to the lip , so you need to focus in
your surgical field .
At the same time the assistant should be aware of the location of the
shank of the bur in relation to the cheek and lips .
– But if this happened ... other than keeping the area clean with
regular oral rinsing , you should advice the patient to apply
antibiotics, ointments and Vaseline ..
• Antibiotics : to protect the patient from getting infected
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So you need to be careful about this , but most of the time small amount
of air may go to the soft tissues and if you press on them or palpate
them, you will feel crackling sound ( FAGAGEE3 ) .
– Causes :
1. Heavily restored tooth
2. Improper technique
3. Ankylosed root 4. Hocked curved root
In the radiograph you can see if the tooth is ankylosed , has hocked roots
or divergent roots , then you can do surgery , divide them or remove bone
to remove them easily without complications .
The amount of bone separating the root from the maxillary sinus is very
small and it is easy to make communication between the sinus and the oral
cavity during extraction , so you should be ready if this happened .
Communication between the the sinus and the oral cavity may occur (as the
doctor said ) due to 2 reasons :
The small and noninfected root tip can be left in place because it is unlikely to cause
any troublesome sequelae . additional surgery in this situation causes more patient
morbidity than leaving the root tip in the sinus . if the root tip is left in the sinus ,
the patient must be informed and given proper follow up instructions for regular
monitoring of the root and the sinus and you should give him the special sinus
precautions ( antibiotics , nasal decongestion , analgesics ) .
The usual method for removal is CALDWELL-LUC approach into the maxillary
sinus in the canine fossa region and then removal of the tooth .
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Note : for implants we need adequate width and height of bone , if this
isn’t available we do bone grafting to provide adequate adequate width and
height .
– We said that the tooth can be displaced into the maxillary sinus ,
and sometimes while you are extracting a maxillary third molar you
might displace it into the infratemporal fossa .
– Behind the maxillary tuborosity is the lateral ptregoid plate and
lateral to it is the ramus so if u displace the tooth in this area and
the ramus is in the other side , you
might affect the mouth opening of the
ramus so you need to remove it , and this pic from the book you
,, I know it’s not clear
have to be careful .
at all bs bemshe 7alha
– If the displacement happen while you are
doing the extraction , if you have
good visibility and access , you can (B) tooth in the try
maxillary sinus is the
to remove the tooth one attempt , if you
maxillary third
can’t do that at one attempt close and
molar .. 8
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refer him , because the tooth may displaced further back and
removing it will be extremely difficult .
– When u refer the patient to a surgeon , if the pt doesn’t have any
problems and the tooth is not infected so why we do anything . bt if
the tooth is interfering with mouth movement and mouth opening so
the surgeon should open and remove it .
– In the maxilla the teeth maybe displaced in the sinus or in the infra
temporal fossa .
– while in the mandible the bone ( the apical bone ) specially on the
lingual side related to the molars is thin ,, so if you apply an elevator
and make a pressure you might displace the root or the tooth into the
submandibular area , so to avoid this you need to avoid the apical
pressure because you are going to push them against the thin lingual
bone which can be fractured and the teeth will go into the
submandibular space ,,,,
if this happened , you can place your thumb lingually and try to push
the tooth , if you can feel it through the socket so back it again ,, if
you can’t , refer him to a maxillofacial surgeon ( need to reflect a
flap lingually to be able to remove the tooth ) .
But the problem is when the patient aspirated the tooth ... the tooth will
go to the airways and close them completely or partially ,, then the pt will
suffer from cyanosis , cough and difficulty in breathing ,, also he may
die !!!!!
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So if the patient aspirated a tooth , you must be sure that the airways
are potent , then you should take chest x-rays .
And you should warn the patient preoperatively about the possibility of
fracturing the restoration during the extraction .
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The most common sites where bone fracture may occur are the buccal
cortical plate in canine region, molars region and lower anterior teeth
region.
– While you extracting the upper first molar and you felt that the
buccal plate is moving, what you should do ?
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– but if you extract the tooth with large amount of bone so here u
can’t replace it again , just do smoothening for the sharp edges of
the bone then suturing , and the most important thing is to inform
the patient .
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- Causes: excessive pressure during extraction and thin bone that slight
pressure can break it .
- Management: TAJBEEER .
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Foreign bodies :
– Foreign bodies : tooth , root , detached fillings may be either
swallowed or inhaled .
– Inhaled foreign bodies which may obstruct the airways can cause
rapidly developing cyanosis and exaggerated respiratory effort ..
immediate steps must be taken to restore potency of the airways .
– Management :
1) ask the pt to cough , because cough action forces the foreign body
to come out ,,, so ask him to cough and split on the floor to be sure
that the FB came out .
2) If this failed hit him on his back .
3) And again if this failed .. Stand behind the pt and put ur hands on
each other below the sternum of the pt then push 3-4 times ( this is
called HEIMLICH MANUVER ) .
4) Failed again .. lie the pt on his abdomen and put ur hands below
his sternum and push ..
5) Failed then la 7wl wala qewata ela belah w ma elu ‘3er rbna
Here the doctor skipped many slides then he started saying : we need to
bypass the area of obstruction by something we called crichothyrotomy .
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other two fingers below adam’s apple , in the area in between we enter
anything to open the area and allow the passage of air ...
1. Dry socket:
A dry socket following a tooth extraction is a common complication in
about 5% of people who have a tooth extracted. The condition occurs when
a blood clot does not form normally in the tooth socket or the blood clot is
washed out or dissolved prematurely. In a dry socket situation, the
underlying bone and nerves are exposed to air and food, causing intense
pain and sometimes bad odor or taste. A dry socket needs to be treated
with a medicated dressing to stop the pain and help healing.
2. Infection:
The wound of the tooth extraction can be a doorway for bacteria causing
an infection, particularly in patients with a weakened immune system. If a
patient has a high risk of infection the dentist will generally prescribe
antibiotics before and after the extraction.
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– My frndz whom i miss sooooo much ( Reem Qudeisat ,, Hala hajeer , Sahar
karasneh , Hanaa Marzooq and Yasmeen Asfoor ) .
– My best frndz :
Maram Bataiha ( o8eru 2na el mzkor a3lah , saken bl 3enwan eyah bltanazol 2dam el
df3a klha yalla 3eshe wel ba2e 3ndek )
Ruba al tawara ( happy birthday ror w 3o2bal e 1000 ya rb ,, bs da5lek shu 25bar el
jorth !!!!! )
Mais Hatamleh ( bma enu el 7yat salaf dean w bma enek katabtele ehda2 fa jmeltek
3la 7alek ,, 3asal walla m3 enu bndal netna2ar )
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