Oral surgery contemporary oral and maxilofacial surgery , 6th edition

1. Done by :
Weam Faroun
Rasha Hamdallah
Submit to :
DR. Kareem Abu Libdeh

2. CONTENTS :
 SOFT TISSUE INJURIES
 PROBLEMS WITH A TOOTH BEING EXTRACTED
 INJURIES TO ADJACENT TEETH
 INJURIES TO OSSEOUS STRUCTURES
 INJURIES TO ADJACENT STRUCTURES
 OROANTRAL COMMUNICATIONS
 POSTOPERATIVE BLEEDING
 DELAYED HEALING AND INFECTION
 FRACTURES OF THE MANDIBLE

3. SOFT TISSUE INJURIES
• Tear of a Mucosal Flap
• Puncture Wound
• Stretch or Abrasion

4. TEAR OF A MUCOSAL FLAP
 The most common soft tissue injury , as the
surgeon tries to gain needed surgical access .

5. PUNCTURE WOUND
 This injury is the result of using uncontrolled force .
 Instruments such as a straight elevator or a periosteal
elevator may slip from the surgical field and puncture or tear
into adjacent soft tissue.

6. STRETCH OR ABRASION
 Abrasions or burns to lips, corners of the mouth, or flaps
usually result from the rotating shank of the bur rubbing on
soft tissue or from a metal retractor coming in contact with soft
tissue .

7. PROBLEMS WITH A TOOTH BEING
EXTRACTED
Root Fracture Root
Displacement
Tooth Lost into
the Pharynx

8. ROOT FRACTURE
 Long, curved, divergent roots that lie in dense bone are the
most likely to be fractured .

9. ROOT DISPLACEMENT

10. TOOTH LOST INTO THE PHARYNX

11. INJURIES TO ADJACENT TEETH
•Fracture or Dislodgment of an
Adjacent Restoration
•Luxation of an Adjacent Tooth
•Extraction of the Wrong Tooth

12. FRACTURE OR DISLODGMENT OF AN
ADJACENT RESTORATION

13. LUXATION OF AN ADJACENT TOOTH

14. EXTRACTION OF THE WRONG TOOTH
 A common reason for removing the wrong tooth is that a
dentist removes a tooth for another dentist.
 If the wrong tooth is extracted and the surgeon realizes this
error immediately, the tooth should be replaced quickly into
the tooth socket .
 When the wrong tooth is extracted, it is important to inform the
patient, the patient’s parents or caregivers (if the patient is a
minor), and any other dentist involved with the patient’s care .

15. INJURIES TO OSSEOUS
STRUCTURES
Fracture of the
Alveolar Process
Fracture of the
Maxillary
Tuberosity

16. FRACTURE OF THE ALVEOLAR
PROCESS
 The most likely cause of fracture of the alveolar
process is the use of excessive force with the
forceps, which fractures the cortical plate .

17. FRACTURE OF THE MAXILLARY
TUBEROSITY
 The maxillary tuberosity is important for the
construction of a stable retentive maxillary denture.

18. INJURIES TO ADJACENT
STRUCTURES
1)Injury to Regional
Nerves.
2)Injury to the
Temporomandibular
Joint

19. 1)INJURY TO REGIONAL NERVES.
 The nasopalatine and buccal nerves are frequently
sectioned during the creation of flaps for removal of
impacted teeth.
 Surgical removal of mandibular premolar roots or
impacted mandibular premolars or periapical surgery
in the area of the mental nerve and mental foramen
must be performed with great care.

21.  flap three-corner flap is to be used in the area of the
mental nerve, the vertical-releasing incision must
be placed far enough anteriorly to avoid severing
any portion of the mental nerve.

22.  Incisions made in the retromolar pad region of the
mandible should be placed so as to avoid coming
close to lingual nerve complication

23.  inferior alveolar nerve may be traumatized along
the course of its intrabony canal. The most common
place of injury is the area of the mandibular third
molar

24. 2)INJURY TO THE TEMPOROMANDIBULAR JOINT

25. OROANTRAL COMMUNICATIONS

28. POSTOPERATIVE BLEEDING

29.  Prevention of Postoperative Bleeding
1. Obtain a history of bleeding.
2. Use the atraumatic surgical technique.
3. Obtain good hemostasis at surgery.
4. Provide excellent patient instructions

32. DELAYED HEALING AND INFECTION
1. infection
2. Wound dehiscence
3.dry socket

33. INFECTION
 The most common cause of delayed wound healing
is infection. Infections are a rare complication after
routine dental extraction and are primarily seen
after oral surgery that involves the reflection of soft
tissue flaps and bone removal.

34. 2)WOUND DEHISCENCE
 If a soft tissue flap is replaced and sutured without
an adequate bony foundation, the unsupported soft
tissue flap often sags and separates along the line
of incision. A second cause of dehiscence is
suturing the wound under tension.

35. DRY SOCKET
 Dry socket or alveolar osteitis is delayed healing
but is not associated with an infection. This
postoperative complication causes moderate to
severe pain but is without the usual signs and
symptoms of infection such as fever, swelling, and
erythema.

36. DENTAL TEACHING CLINICS OF
AL QUDS UNIVERSITY STUDY
 During this study, 1305 permanent tooth extractions
were performed in 805 patients.
 58% male patients and 42% female patients.
 Data were collected over a period of 16 months, from
October 1st 2006 to January 28th 2008.

37.  dry socket incidence: non-surgical extraction of teeth was 1.7 %
surgical extraction was 12%

38. Dry socket: in non smoker 2.1%
in smoker 5.1%

39. DRY SOCKET: IN SINGLE-EXTRACTION7.3%
MULTIPLE EXTRACTION 3.4%

40. DRY SOCKET: IN SINGLE-EXTRACTION7.3%
MULTIPLE EXTRACTION 3.4%

41. Dry socket: in (18-33) year is 4.8 %
in (34-49) year is 2.9%
In more than 50 year is 1.6%

42. Study of the Prevalence, clinical picture, and risk
factors of dry socket in a Jordanian dental
teaching center.
 CONCLUSION of the study:
Smoking and surgical trauma are associated with an
increased incidence of dry socket. Moreover,
patients who had single extractions were more
likely to develop dry socket than those who had
multiple extractions in the same visit.

43.  Fracture of the mandible during extraction is a rare
complication; it is associated almost exclusively
with the surgical removal of impacted third molars.
FRACTURES OF THE MANDIBLE

44. REFERENCES
 James R Hupp ,Edward ellis lll , Myron R. Tucker , six
edition , Contemporary oral and maxillofacial surgery.
 Palestinian study :
Abu Younis MH1, Abu Hantash RO., Published online
2011 Feb 7 , Dry Socket: Frequency, Clinical Picture,
and Risk Factors in a Palestinian Dental Teaching
Center, Pubmed (electronic site )
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089956/
 Jordanian study :
 Nusair YM1, Younis MH. , 2007 Mar 1 Prevalence,
clinical picture, and risk factors of dry socket in a
Jordanian dental teaching center, Pubmed (electronic
site )
 https://www.ncbi.nlm.nih.gov/pubmed/17351682