COMPLICATIONS DURING TOOTH EXTRACTION
fracture of the crown or root .1
fracture of alveolar bone .2
Fracture of maxillary tuberosity .3
Fracture of adjacent or opposing tooth.4
Fracture of the mandible .5
.Dislocation of the T.M.J.6
Injury to the Temporomandibular joint (T.M.J.) .7
Displacement of root or tooth into the maxillary sinus .8
Damage to the soft tissue .9
COMPLICATIONS
:fracture of the crown or root due to .1
.a. Badly carious tooth ▪
.b. Improper forceps application ▪
c. Dense bone ▪
d. Ankylosis or gemination of the ▪
.root
e. Dilacerated root ▪
COMPLICATIONS
: fracture of alveolar bone .2
.a. Pathological changes of bone ▪
.b. Divergent roots ▪
.c. Improper forceps application ▪
d. The use of excessive force during ▪
.the extraction procedure
.e. Ankylosed tooth or dense bone ▪
fracture of alveolar bone treatment
a) When the broken part is small and has been separated from the periosteum ▪
After .should remove with forceps and the sharp edges of bone are smoothed
.that, the area is irrigated with saline solution and the wound is sutured
b) If the broken part of the alveolar process is large and still attached to the ▪
periosteum, then the bony segment should be dissected away from the tooth, and
the tooth should be removed in the usual fashion. then we do a stabilization and
.suturing of the mucoperiosteum
COMPLICATIONS
Fracture of maxillary tuberosity .3 ▪
This complication may occur during the extraction of a ▪
posterior maxillary tooth especially the upper third
:molar and is usually due to the following reasons
Weakening of the bone of the maxillary -1 ➢
tuberosity, due to the maxillary sinus pneumatizing into
the alveolar process. In this case, risk of fracture is
increased if the extraction of a molar is performed with
,forceful and careless movements
Ankylosis of a maxillary molar -2 ➢
.Dilacerated roots of the upper third molar -3 ➢
Treatment of maxillary tuberosity fracture
For a small segment of bone dissect the segment-1 ▪
from gingiva and periosteum and extract it with the
tooth and smooth the sharp edges of the remaining
bone and reposition and suture the remaining soft
.tissue
If the bone segment is large and remains-2 ▪
attached to the periosteum, should take measures
to ensure the survival of that bony segment. If
possible, the bony segment should be dissected
away from the tooth, and the tooth should be
removed in the usual fashion. The tuberosity is then
.stabilized with mucosal sutures
Treatment of maxillary tuberosity fracture
If the bone segment is large and is excessively mobile and cannot be -3 ▪
:dissected from the tooth, the surgeon has several options
:a- The first option is to ▪
splint the tooth being extracted to adjacent teeth ❖
.defer the extraction for 6 to 8 weeks, allowing time for the bone to heal ❖
.The tooth is then extracted with an open surgical technique ❖
:b- If the maxillary tuberosity is completely separated from the soft tissue ▪
.remove the fractured segment with the tooth ❖
.then smooth the sharp edges of the remaining bone ❖
.then reposition and suture the remaining soft tissue ❖
COMPLICATIONS
Fracture of adjacent or opposing tooth:- due .4 ▪
to
a. Badly carious tooth ▪
b. Heavily restored tooth with overhang filling ▪
c. The use of adjacent tooth as a fulcrum for the elevator ▪
d. The tooth removed from socket with uncontrolled force ▪
COMPLICATIONS
Fracture of the mandible:- Due to .5 ▪
a. Extraction of isolated lower 2nd & 3rd ▪
molars in edentulous mandible
b. The use of excessive force especially during ▪
the extraction of impacted mandibular third
.molar
c. Pathological cyst or tumor ▪
d. Presence of multiple impacted teeth at the ▪
.same site
e. Fractures may also occur during removal of ▪
impacted teeth from a severely atrophic
.mandible
COMPLICATIONS
.Dislocation of the T.M.J-6 ▪
.The patient is unable to close his mouth (open bite) and movement is restricted ▪
:to avoid such a complication ➢
the mandible must be firmly supported during an extraction •
patients must avoid opening their mouth excessively, especially those with a history •
of
"habitual temporomandibular joint luxation"
This complication occurs due to ➢
.History of recurrent dislocation of T.M.J •
Poor support of mandible •
Treatment of dislocation of the T.M.J
Immediately after the dislocation, the operator should stand in front of the patient and the thumbs are ▪
placed on the occlusal surfaces of the teeth, while the rest of the fingers surround the body of the
mandible right and left Pressure is then exerted downward with the thumbs and simultaneously upwards
and backward with the rest of the fingers, until the condyle is replaced in its original position. After
repositioning, the patient must limit any movement of the mandible that may lead to excessive opening of
.the mouth for a few days
COMPLICATIONS
Injury to the Temporomandibular joint (T.M.J.) .7 ▪
Removal of mandibular molar teeth frequently requires the application of ▪
.a substantial amount of force
If the jaw is not supported during the extraction the patient may ▪
.experience pain in this region
.Controlled force and adequate support of the jaw prevents this ▪
If the patient complains of pain in the T.M.J. immediately after the extraction ▪
,procedure
the surgeon should recommend the use of ▪
moist heat, rest for the jaw, a soft diet, and nonsteroidal anti ▪
.inflammatory drugs or acetaminophen
COMPLICATIONS
Displacement of root or tooth into .8 ▪
the maxillary sinus
This complication occurs during the extraction of ▪
maxillary premolars and molars or surgical
removal of impacted maxillary third molar
the main etiological factor is the close proximity ▪
of the roots of these teeth to the floor of the
maxillary sinus, or when the surgical procedure
.has not been carefully planned
Treatment
The patient should be informed about the ▪
complication. Antibiotic treatment and nasal
decongestants are also administered
The exact position of the tooth or root tip ▪
must be confirmed with radiographic
.examination
Removal of the tooth or root from the ▪
maxillary sinus is usually achieved with a
.Caldwell-Luc approach
COMPLICATIONS
Damage to the soft tissue .9 ▪
A. Gingiva ▪
a. Improper separation of gingiva ▪
b. Slippage of elevator ▪
c. Wrong application of forceps ▪
B. Lower lip May be crushed between the handle of ▪
forceps and lower anterior teeth during extraction
of upper posterior teeth
C. Tongue and floor of mouth ▪
a. Slippage of elevator ▪
b. The tongue may be crushed by the forceps ▪
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