Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 65

The most common injury to an adjacent tooth is loosening or fracture of a large existing dental prosthetic restoration [3, 4]. Other injuries can include tooth loosening due to inappropriate use of elevators, crown fracture due to caries, and inadvertent extraction of an adjacent tooth [3, 4]. The incidence of injury to an adjacent second molar when performing third molar surgery is between 0.3% and 0.4% [1, 2, 5, 6]. Limited data exist regarding inadvertent extraction of an adjacent tooth specifically during third molar surgery, however; the overall incidence of wrong tooth extraction ranges from 0.026% to 0.047% [3]. The occurrence of wrong tooth extraction is likely increased with premolar extractions for orthodontic purposes, and this highlights the need for excellent communication between the surgeon and the referring dentist/specialist.

Fig. 2.3. Panoramic radiograph with teeth marked for extraction.

Adjacent teeth with large restorations, caries, or recurrent decay pose a significant risk for inadvertent injury. Evaluation of adjacent teeth both clinically and radiographically should be completed prior to beginning an extraction procedure, and patients should be made aware of the possibility of injury. If an adjacent tooth poses a high risk for injury, attempts should be made to avoid luxation with elevators adjacent to the tooth or consideration made for not using an elevator at all. To avoid injury to the opposing dentition during extraction, excessive traction forces should be avoided. If a tooth suddenly releases, this can result in iatrogenic instrument damage to the cusp tips or incisal edges of opposing teeth. Also, placing a finger or suction tip in between the forceps and opposing dentition can prevent contact with the instrument or absorb some of the blunt forces. Wrong tooth removal should never occur if adequate attention is given to planning and an appropriate timeout process. The tooth to be extracted should be marked on the radiograph and confirmed with both the patient and the assistant in terms the patient can also understand (Figure 2.3). The referring dentist/specialist should be contacted if confusion exists as to the correct tooth planned for extraction.

If an injury occurs, it should be treated promptly, and all parties involved should be notified. A fractured tooth or restoration can be temporized and the referring practitioner notified. Loosened or avulsed crowns can be recemented if no recurrent decay exists, or temporarily cemented if caries is noted. If an adjacent tooth is loosened, it should be repositioned and stabilized. Often, this requires only minimal repositioning and the tooth can be left alone. If significant loosening has occurred, stabilization for 10–14 days with the least rigid method of stabilization (nonrigid splinting with stainless steel wire and composite material) should be used to avoid the risk of ankylosis or root resorption. Extraction of the wrong tooth, if immediately noted, may be managed as a tooth avulsion. The tooth should be implanted back into the extraction site and stabilized with nonrigid splinting for 7–10 days. If the tooth is being extracted for orthodontic reasons, the remaining teeth should not be extracted and the referring orthodontist should be notified immediately [3]. Occasionally, modification of the treatment plan can be performed to utilize the tooth that should have been removed and treatment can proceed with the new plan. If the original tooth planned for extraction needs to be removed, health and stability of the accidentally extracted tooth should be confirmed prior to proceeding with further extractions. When the error goes unnoticed at the time of extraction, the tooth can obviously no longer be replanted. It is important to document thoroughly any case of wrong tooth extraction and inform all parties involved. According to Oral and Maxillofacial Surgery National Insurance Company (OMSNIC) data, 46% of all wrong‐site tooth extraction claims are settled with an indemnity payment. Thus, documentation and prompt communication with both the patient and referring dentist are important to avoid litigation.