By Mohammad Hussein Zaki

Lecturer Oral & Maxillofacial Surgery Faculty of Dentistry – Minia University

Injuries to

osseous

structures

OA communications

Injuries to

adjacent

structures

Injuries to

adjacent

teeth

Problems with

the tooth being

extracted

Soft tissue

injuries

Emphysema Hemorrhage

Granuloma

Edema

Ecchymosis Hematoma

Trismus

Bleeding

Delayed

healing

Dry

socket Infection

Painful

socket

Puncture Wound.

Inadvertent puncturing of the soft tissues.

Gingiva.

Adjacent soft tissues.

Puncture Wound.

Etiology.

Inadvertent manipulation of instruments.

Puncture Wound.

Puncture Wound.

Prevention.

Controlled force.

Fingers rests.

Puncture Wound.

Tx.

Hemostasis.

Preventing infection.

Healing occurs by secondary intention.

Tear of a Mucosal Flap.

Etiology.

Inadequately sized envelope flap.

Tear of a Mucosal Flap.

Prevention.

Adequately sized flaps.

Controlled amount of retraction force on the

flap.

Creating releasing incisions, when indicated.

Tear of a Mucosal Flap.

Tx.

Flap begins to tear: the hard tissue surgery

should be stopped for lengthening the incision

to gain better access or to create a releasing

incision.

Flap should be carefully repositioned once the

surgery is completed.

Stretch or Abrasion.

Etiology.

Lips, tongue, corners of the mouth, or flaps.

Rotating shank of the bur.

Hot surgical handpiece.

Metal retractors.

Stretch or Abrasion.

Etiology.

Stretch or Abrasion.

Tx.

Keeping the area clean with regular oral

rinsing.

keep the area moist with small amounts of

ointment.

o Antibiotic.

o Vaseline.

Tooth Fracture.

Causes.

Excessive force.

Inappropriate application of force.

A tooth weakened by caries or large

restorations.

Tooth Fracture.

Causes.

Haste.

Long, curved, thin,

divergent roots lie in

dense bone.

Tooth Fracture.

Tx.

Crown Fx.

Tooth Fracture.

Tx.

Retained root.

Surgical Extraction.

Tooth Fracture.

Tx.

Root Apex.

Risk benefit ratio.

Tooth Fracture.

Tx.

Root Apex.

Risk benefit ratio.

Root Displacement.

Maxillary sinus.

• Non infected sinus.

• Non infected root.

• < 3 mm root fragment.

Root Displacement.

Maxillary sinus.

• Chronic maxillary sinusitis.

• Infected root.

• > 3 mm root fragment.

Root Displacement.

Infratemporal space.

Root Displacement.

Infratemporal space.

Root Displacement.

Infratemporal space.

Root Displacement.

Infratemporal space.

Visible through

incisions.

Root Displacement.

Submandibular space.

Sublingual space.

Root Displacement.

Submandibular space.

Root Displacement.

Submandibular space.

Root Displacement.

Submandibular space.

• Single effort to remove.

• Small non infected root.

• Infected or > 3 mm root.

Root Displacement.

Sublingual space.

Root Displacement.

Sublingual space.

Tooth Lost into the Pharynx.

Immediate management.

Encouraged coughing.

Chest X ray.

Abdominal X ray.

Tooth Lost into the Pharynx.

Immediate management.

Aspirated tooth.

Swallowed tooth.

Fracture or Dislodgment of an Adjacent

Restoration.

Fracture or Dislodgment of an Adjacent

Restoration.

Management.

Make sure that the displaced restoration is

removed from the mouth.

Replacement of displaced crown or placement

of a temporary restoration.

Luxation of an Adjacent Tooth.

Risky factors.

Inappropriate use of the extraction

instruments.

Inappropriate instrument selection.

Luxation of an Adjacent Tooth.

Risky factors.

Luxation of an Adjacent Tooth.

Tx goal.

Reposition the tooth into its appropriate

position and stabilize it so that adequate

healing occurs.

Luxation of an Adjacent Tooth.

Tx.

Reposition the tooth into the socket.

Check occlusion.

The need of stabilization.

Luxation of an Adjacent Tooth.

Tx.

Extraction of the Wrong Tooth.

Causes.

Inadequate attention to preoperative

assessment.

Extraction of the Wrong Tooth.

Tx.

Replantation.

The correct extraction

should be deferred for

4 or 5 weeks.

Extraction of the Wrong Tooth.

Tx.

Dental implant–supported

restoration.

Fracture of the Alveolar Process.

Causes.

Use of excessive force with the forceps.

Fracture of the Alveolar Process.

Tx.

If the bone has been completely removed from

the tooth socket along with the tooth.

The bone remains attached to the periosteum.

Fracture of the Maxillary Tuberosity.

Etiology.

Problems.

Fracture of the Maxillary Tuberosity.

Tx.

If the bone has been completely removed from

the tooth socket along with the tooth.

The bone remains attached to the periosteum.

Fracture of the mandible.

Results from the application of a force

exceeding that needed to remove a tooth

such as the forceful use of dental elevators.

Fracture of the mandible.

Fracture of the mandible.

Tx.

1ry stabilization

ORIF.

Injury to Regional Nerves.

Buccal nerve.

Nasopalatine nerve.

Mental nerve.

Lingual nerve.

Inferior alveolar nerve.

Injury to the Temporomandibular Joint.

Pain in the TMJ area immediately after the

extraction procedure.

Moist heat.

Rest the jaw.

Soft diet.

Analgesics.

Injury to the Temporomandibular Joint.

Dislocation of Temporomandibular Joint.

Injury to the Temporomandibular Joint.

Dislocation of Temporomandibular Joint.

Injury to the Temporomandibular Joint.

Dislocation of Temporomandibular Joint.

Communication between the oral cavity

and the maxillary sinus.

Problems.

Maxillary sinusitis.

OA fistula.

Diagnosis.

Examine the extracted tooth.

Nose blowing test.

Tx.

Small perforation.

Additional measures to ensure the

maintenance of the blood clot in the area,.

Sinus precautions.

medications to reduce the risk of maxillary

sinusitis.

Tx.

Large perforation.

Surgical repair.

Sinus precautions.

Medications to reduce the risk of maxillary

sinusitis.

Air entering the loose connective tissue.

Clinically.

Tx.

• Usually subsides spontaneously after 2–4

days.

• Paracentesis.

• Antibiotics.

Causes.

Trauma of the vessels.

Problems related to blood coagulation.

Prevention.

Medical history.

Coagulation profile.

Less traumatic surgery.

Tx.

• Compression for 10 - 30 minutes.

• Sterile bone wax.

• Suturing over gauze pack.

• Electrocoagulation.

Tx.

• Hemostatic materials.

Vasoconstrictors.

Enhancements of blood clotting.

Gelatin sponges.

Oxidized regenerated cellulose.

Collagen.

Causes.

The tissues of the mouth and jaws are highly

vascular

The extraction of a tooth leaves an open

wound, which allows additional oozing&

bleeding;

Causes.

Impossible to apply dressing material with

enough pressure and sealing to prevent

additional bleeding during surgery.

Patients tend to explore the area of surgery with

their tongues and occasionally dislodge blood

clots and creating small negative pressures

before it has organized.

Prevention.

Pt. history.

Preoperative investigations.

Tx.

Instruct the patient to rinse the mouth gently

with chilled water and then to place

appropriate-sized, damp gauze over the area

and bite firmly on it.

Tx.

The patient should repeat the cold rinse and

bite down on a damp tea bag.

Tx.

Return to clinic.

o All blood, saliva, and fluids should be suctioned

from the mouth.

o Observe the bleeding site carefully under

effective lighting.

o Damp gauze held in place with firm pressure by

the surgeon’s finger for at least 5 minutes.

Tx.

Return to clinic.

o Administer LA.

o Gentle curettage of the extraction socket and

suction all areas of the old blood clot.

o Hemostatic agent is inserted into the socket held

in position with a figure-of-eight stitch reinforced

with firm pressure from damp gauze pack.

Tx.

Return to clinic.

o Monitoring the patient for at least 30 minutes.

o Additional laboratory screening tests.

Due to prolonged capillary hemorrhage.

Tx.

1st few hours postoperatively.

o Cold packs during the first 24 h.

o Heat therapy.

o Antibiotics.

o Analgesics.

It is the result of extravasation of fluid by

the traumatized tissues because of

destruction or obstruction of lymph vessels,

resulting in the cessation of drainage of

lymph, which accumulates in the tissues.

Swelling reaches a maximum within 48–72

h after the surgical procedure.

Clinically.

Tx.

Small-sized edema.

o No therapeutic management.

Severe edema.

o Heat therapy.

o Fibrinolytic medication.

o Antibiotics.

Restriction of the mouth opening due to

spasm of the masticatory muscles.

Causes.

Repeated injections during inferior alveolar

nerve block.

Inflammation of the postextraction wound

Hematoma.

Postoperative edema.

TX.

Hot mouth rinses.

Heat therapy.

Gentle massage of the temporomandibular

joint area.

TX.

Analgesics.

Anti-inflammatory.

Muscle relaxant.

Physiotherapy.

Antibiotics.

Sharp bony spicules injure the soft tissues

of the postextraction socket, resulting in

severe pain and inflammation at the

extraction site.

Tx.

Smoothing of the bone margins of the wound.

Tx.

Analgesics.

Gauze impregnated with eugenol for 36 to 48

h.

Postoperative complication appears 2– 3

days after the extraction.

Pathophysiology.

Clinically.

Tx.

Gentle irrigation.

Gauze impregnated with eugenol replaced

frequently every 24 h.

Collagen paste.

Avoid mastication on the affected side.

Good oral hygiene.

Cause.

Use of infected instruments.

Immunocompromised diseases.

Bad oral hygiene.

Prevention.

Prophylactic antibiotics.

Tx.

Antibiotic therapy.

4–5 days after the extraction of the tooth

and is the result of the presence of a

foreign body in the alveolus.

Tx.

Debridement of the alveolus

Removal of every causative agent.

Causes.

Infection.

Wound dehiscence.

Wound dehiscence.

Unsupported flap edges.

Sutures under tension.

Severe edema.

Prevention.

o Aseptic technique.

o Atraumatic surgery.

o Close the incision over intact bone.

o Suture without tension.