Complications arise from errors in judgment, misuse of instruments, exertion of extreme force, and failure to obtain proper visualization prior to acting. The old adage "to do good, you must see good" is apropos to exodontics, and one might add "Do well what you see."
Because of' the anatomy of the maxillary antrum and its proximity to the maxillary premolar
and molar roots, the antrum should always be considered when extracting teeth in this area.
Extreme force applied to upper molars can result in removal of the molar tooth along with the entire maxillary alveolar process and the floor of the antrum. The first, second, and third molars, along with the tuberosity, have been removed in one segment because of improper use of force in the maxilla. If during an extraction the surgeon feels large segments of bone moving with the tooth when pressure is applied, the forceps should be set aside and a flap raised. If judicious removal of part of the alveolar bone allows the tooth to be removed, then the remaining bone, which is attached to periosteum, may be retained, and it will heal. This will minimize the bony defect. If the bone cannot be removed from the tooth, the mucosa should be incised and reflected so that the mucosa will not tear as the tooth and bone are removed. A laceration is much more difficult to repair than a well-planned incision.
Large antral perforations resulting from exodontics should be closed at the time of the extraction. The bone in the area should be smoothed with a rongeur or bone file. The mucoperiosteal flap is returned to position, and a watertight closure should be accomplished without putting undue pressure on the flap. If this cannot be done, the flap should be freed by means of an incision extending vertically into the mucobuccal fold and the mucosa of the flap undermined to allow it to advance over the defect.
When the antrum is entered during exodontics, the patient should be made aware of the situation and asked to not blow the nose postoperatively and also to refrain if possible from coughing or sneezing. Antibiotics and vasoconstrictive nose drops are prescribed to guard against infection of the sinus and to allow for emptying of the fluid that will collect within the sinus.
Occasionally, buccal roots of premolars and molars are pushed laterally through the wall of the maxilla and lie above the attachment of the buccinator muscle. When the operator uses root exolevers in this area, a finger of the left hand should be held against the buccal plate so that he or she can be aware of any movement of the root in this direction. If the root is dislodged into these tissues, a small incision is made in the mucosa inferior to the root tip and the root tip is removed with a small hemostat or similar instrument.
The infratemporal space lies directly posterior and superior to the tuberosity of the maxilla. Within this space lie many important neurovascular structures. In the elevation of third molars or third molar root tips and in the removal of supernumerary molars, care must be taken not to dislodge them posteriorly. If an object is to be removed from the infratemporal space, adequate visualization and careful dissection are necessary. The incision should include the entire tuberosity and extend posteriorly to the ante本论文由英语论文网提供整理，提供论文/，英语论文/，英语毕业论文，/论文，/英语论文，英语论文题目，/留学生论文，/英文论文，留学生论文/相关核心关键词搜索。 |
