_of dental extraction拔牙并发症课件

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 nFormation of blood clot filling the socket. nOrganization of the clot. nEpithelialization of the surface of the wound. nFormation of woven bone in the c.t. filling the socket (1 month 2months in adult ). nReplacement 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.) Delayed healing of extraction wounds 1.Infection. 2.Prolonged bleeding due to a clotting defect. 3.Formation of an oro-antral fistula. 4.Proliferation of a malignant tumor. 5.Radiotherapy. 6.Immunodeficiency. 7.Scurvy. Complications of dental extraction nLocal complications. nSystemic complications. nIntra operative complications. nPost operative complications ( immediate or delayed. ) nComplications related to: Patient factor, surgeon factor, surgery or instrumentations. Local complications 1.Fracture of the tooth. 2.Fracture of the jaw: a.Isolated molar. b.Buried tooth. c.Thin mandible edentulous. d.Excessive force. Local complications 3. Damage to soft tissue: a. Instruments slips off the tooth. b. Lower lip may be crushed between the teeth. c. The handles of the forceps or pressure of the hand supporting the jaw can cause bruising. 4. Opening of the maxillary antrum. 5. Fracture of the maxillary tuberosity. Local complications 6. Loss of tooth: a. Displaced into the loose tissue on the lingual side of the lower molar. b. May be swallowed. c. May be inhaled. 7. 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 8. Excessive bleeding: a. Tissue damaged careless extraction. b. As a result of haemorrhagic disease. c. Infection. 9. Local infection: a. Localised ostietis (dry socket ). b. Osteomylietis. Local complications 10. Loss of root fragement: a. Displaced into the inferior dental canal. b. Displaced into the medullary cavity. c. Displaced into the antrum. d. Displaced into a cystic cavity. Intra operative complications 11. Access: a. Small mouth. b. Crowded or mall-positioned teeth. c. Trismus. 12. Pain: a. Has L.A. worked give more if needed. b. Regional block infiltration or inter- ligumentary. Intra operative complications 13. In ability to move the tooth: X-Ray : a. Look for bulbous or diverging roots. b. Very long roots. c. Ankylosis or sclerotic bone. 14. Breaking the tooth or alveolar bone. 15. Damage to other teeth / tissues and extraction of the wrong tooth. Dry Socket ( Alveolar osteitis ) (The most frequent painful complication of extraction ) Dry Socket nAetiology: 1.Excessive trauma. 2.Impaired blood supply ( lower jaw Upper jaw ) 3.Local anaesthesia. 4.Oral contraceptive ( oestrogens component causes increase in serum fibrinolytic activity) 5.Osteosclerotic disease. 6.Radiotherapy. 7.Smoking. Dry Socket nPathology: nDestruction of the blood clot either by: 1.Proteolytic enzymes produced by bacteria. 2.Excessive local fibrinolytic activity. nAnaerobes are likely to play a major role. nDestruction of the clot leaves an open socket, infected food and other debris accumulate. Dry Socket nPathology: nThe necrotic bone lodges bacteria which proliferate freely, Leucocytes unable to reach them through the avascular material. nDead bone is gradually separated by osteoclasts. nHealing is by granulation tissue from the base of the walls of the socket. Dry Socket nClinical features: nPain usually starts few days after extraction. nSometimes may be delayed for few days or more. nDeep seated, severe and aching or throbbing in character. nMucous membrane around the socket is red and tender. nNo clot in the socket ( Dry ). Dry Socket nClinical features: nWhen debris is washed away, whitish, dead bone may be seen or may be felt as rough area with a probe. nSometimes the socket becomes concealed by granulation tissue growing in from the edge. nPain may continues for week or two and rarely longer. Dry Socket nPrevention: 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. Dry Socket nPrevention: 4. In patient who have had radiotherapy, every possible precaution should be taken. 5. In osteosclerotic disease: nLittle damage to bone (surgical extraction). nProphylactic antibiotic. 6. Stop smoking for two days post extraction. Dry Socket nTreatment: nExplain to the patient and warn them. nThe 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. Dry Socket nTreatment: nA 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 ). nIn many cases, irrigation of the socket and replacement of the dressing has to be repeated every few days. Indication for extractions 1.Gross caries. 2.Pulpitis (if endodontic treatment is impractical) 3.Apical periodontitis ( if the teeth are non savable