Diagnosis and Management of Common Postextraction Complications

Extraction of impacted teeth is one of the most common surgical procedures performed by oral and maxillofacial surgeons. Every surgical procedure results in some degree of postoperative bleeding and inflammation, typically manifesting as pain and edema. Although the complex physiology of the human body is beyond the scope of this article, the educated clinician should have an understanding of the time line associated with these processes so as to determine whether a patient’s complaint of postoperative bleeding, pain, or swelling represents a normal response to surgical trauma or an aberrant reaction.

Extraction of impacted teeth is one of the most common surgical procedures performed by oral and maxillofacial surgeons. Extensive training, skill, and experience are necessary to perform this procedure with minimal trauma to the surrounding soft and hard tissue. When the clinician is untrained or inexperienced, the incidence of complications rises exponentially. Treatment planning for the removal of asymptomatic teeth is no less problematic. In many situations the course of treatment depends on the clinician’s experience, professional judgment, and knowledge of current evidence-based literature.

Every surgical procedure results in some degree of postoperative bleeding and inflammation, typically manifesting as pain and edema. Through the inflammatory response and the natural progression of the body to heal itself, wound repair and tissue regeneration are activated, and physiologic mediators are concentrated in the wound area, resulting in the induction of nociceptive pathways and a change in vascular permeability. Although the complex physiology of the human body is beyond the scope of this article, the educated clinician should have an understanding of the time line associated with these processes so as to determine whether a patient’s complaint of postoperative bleeding, pain, or swelling represents a normal response to surgical trauma or an aberrant reaction.

Surgical damage to adjacent structures

Occasionally an impacted tooth is located such that its removal may seriously compromise adjacent vital structures, making it prudent to leave the impacted tooth in situ. The potential risks, benefits, and alternatives must be discussed thoroughly with the patient before consent. At the completion of development, full bony impacted third molars may be positioned in close proximity or through the inferior alveolar nerve canal. It may be prudent to leave the impacted tooth (if asymptomatic) in place and not risk paresthesia or anesthesia of the inferior alveolar nerve. Surgical extraction of impacted third molars can result in significant bony defects that may not heal adequately in elderly or medically compromised patients and may result in the loss of adjacent teeth rather than the improvement or preservation of periodontal health.

Only gold members can continue reading. Log In or Register to continue

Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Diagnosis and Management of Common Postextraction Complications
Premium Wordpress Themes by UFO Themes