Oral and Maxillofacial Surgery Clinics of North America
Complications of Third Molar Surgery
Section snippets
Alveolar osteitis
AO is a clinical diagnosis characterized by the development of severe, throbbing pain several days after the removal of a tooth and often is accompanied by halitosis. The extraction socket is often filled with debris and is conspicuous by the partial or complete loss of the blood clot. The frequency of AO ranges from 0.3% to 26% [1], [2], [3], [6], [8], [9], [11], [12], [14], [16]. AO is known to occur more frequently with mandibular third molar extraction sockets, although the exact reason is
Infections
Postoperative infections after third molar removal have been reported to vary from 0.8% to 4.2% [1], [2], [3], [6], [11], [12], [14], [16]. Infections may develop in the early or late postoperative period, with mandibular third molar sites more commonly affected [1], [3]. It has been suggested that age, degree of impaction, need for bone removal or tooth sectioning, exposure of the inferior alveolar neurovascular bundle, presence of gingivitis or pericoronitis, surgeon experience, use of
Bleeding and hemorrhage
The reported range of clinically significant bleeding as a result of third molar extraction has ranged from 0.2% to 5.8% and can be classified as either intra- or postoperative with causes that can be local or systemic. In the recent American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study, the investigators found an intraoperative frequency of unexpected hemorrhage of 0.7% and a postoperative frequency of unexpected or prolonged hemorrhage of 0.1% [1]. In a study
Damage to adjacent teeth
The incidence of damage to adjacent restorations of the second molar has been reported to be 0.3% to 0.4% [11]. Teeth with large restorations or carious lesions are always at risk of fracture or damage upon elevation. Correct use of surgical elevators and bone removal can help prevent this occurrence. Discussion should take place preoperatively with patients at high risk. Maxillary mesioangular impactions with a Pell and Gregory class B (crown to cervical relationship) and mandibular vertical
Mandibular fracture
Mandibular fracture as a result of third molar removal is a recognized complication and has important medicolegal and patient care implications. It should be included on all third molar extraction consent forms. Mandibular fracture during or after surgical third molar removal is a rare but major complication. The incidence of mandibular fracture during or after third molar removal has been reported to be 0.0049% [39]. Other studies cite even lower incidence. Alling and colleagues [40]
Maxillary tuberosity fracture
Fracture of the maxillary tuberosity on extraction of maxillary third molars is a clinically known occurrence. The anatomic position at the end of the dentoalveolar arch is such that the posterior portion has no support, and the internal composition may be significantly maxillary sinus or soft osteoporotic bone. Preoperative radiographic evaluation of the sinus proximity and bone thickness can help anticipate tuberosity fracture. In a study by Chiapasco and colleagues [11], the extraction of
Maxillary third molars
Iatrogenic displacement of maxillary third molars can occur, although it is a rarely reported complication with an unknown incidence. Maxillary third molars that are superiorly positioned may have only a thin layer of bone posteriorly separating them from the infratemporal space. The tooth can be displaced in a posterosuperior direction into the infratemporal space if distal elevation is not accompanied by a retractor placed behind the tuberosity within the designed mucoperiosteal flap (Fig. 1
Aspiration
All third molar extraction procedures carry the risk of tooth aspiration. The use of properly placed oropharyngeal gauze is essential in preventing this complication. The use of intravenous deep sedation by definition compromises the protective reflexes of the airway. The aspiration or swallowing of a tooth or portion of a tooth is usually the result of a patient coughing or gagging.
Oro-antral communication/fistula
An OAC is any opening between the maxillary sinus and the oral cavity. Without diagnosis and treatment this communication may epithelialize and become an oro-antral fistula (OAF).
OAC occurs most frequently from extraction of first molar teeth, followed by second molar teeth [52]. An incidence of 0.008% to 0.25% OAC has been reported with maxillary third molar removal [11], [53]. It is likely that the incidence of OAC from maxillary third molar removal is underestimated, because it may be
Temporomandibular joint complications
A causal relationship between the extraction of third molars and temporomandibular injury currently has little support in the literature. It has been suggested that because the procedure of extracting mandibular third molars involves the patient opening his or her mouth wide for an extended period of time and exerting a variable amount of force on the mandible, it is possible to overload or injure one or both temporomandibular joints [83]. This result would be the case especially if the surgeon
References (84)
- et al.
The American Association of Oral and Maxillofacial Surgeons age-related third molar study
J Oral Maxillofac Surg
(2005) - et al.
Types, frequencies, and risk factors for complications after third molar extraction
J Oral Maxillofac Surg
(2003) - et al.
Complications following removal of impacted third molars: the role of the experience of the surgeon
J Oral Maxillofac Surg
(1986) - et al.
Nerve injuries after third molar removal
Oral Maxillofac Surg Clin North Am
(2007) Risk of periodontal defects after third molar surgery: an exercise in evidence-based clinical decision-making
Oral Maxillofac Surg Clin North Am
(2007)- et al.
Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2004) - et al.
Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: a randomised controlled trial
Br J Oral Maxillofac Surg
(2004) Alveolar osteitis prevention by immediate placement of medicated packing
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2000)- et al.
Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2005) - et al.
Side effects and complications associated with third molar surgery
Oral Surg Oral Med Oral Pathol
(1993)
Incidence and clinical features of delayed-onset infections after extraction of lower third molars
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice
J Am Dent Assoc
Alveolar osteitis after surgical removal of impacted mandibular third molars: identification of the patient at risk
Oral Surg Oral Med Oral Pathol
A prospective study of complications related to mandibular third molar surgery
J Oral Maxillofac Surg
Therapeutic agents in perioperative third molar surgical procedures
Oral Maxillofac Surg Clin North Am
Third molar surgery and associated complications
Oral Maxillofac Surg Clin North Am
Etiology and pathogenesis of fibrinolytic alveolitis
Int J Oral Surg
On the genesis of “dry socket.”
J Oral Maxillofac Surg
Dental extraction wound management: a case against medicating postextraction sockets
J Oral Maxillofac Surg
Role of antimicrobials in third molar surgery: prospective, double blind, randomized, placebo-controlled clinical study
Br J Oral Maxillofac Surg
The impact of intravenous antibiotics on health-related quality of life outcomes and clinical recovery after third molar surgery
J Oral Maxillofac Surg
Postoperative prophylactic antibiotic treatment in third molar surgery: a necessity?
J Oral Maxillofac Surg
Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review
Int J Oral Maxillofac Surg
Investigation of infectious organisms causing pericoronitis of the mandibular third molar
J Oral Maxillofac Surg
Organisms isolated from severe odontogenic soft tissue infections: their sensitivities to cefotetan and seven other antibiotics, and implications for therapy and prophylaxis
Br J Oral Maxillofac Surg
Report of an audit into third molar exodontia
Br J Oral Maxillofac Surg
The microbiology and management of acute dentoalveolar abscess: views of British oral and maxillofacial surgeons
Br J Oral Maxillofac Surg
Life-threatening bleeding after dental extraction in a hemophilia A patient with inhibitors to factor VIII: a case report received from University Hospital Hamburg-Eppendorf, Hamburg, Germany
J Oral Maxillofac Surg
A systematic approach to management of high-flow vascular malformations of the mandible
J Oral Maxillofac Surg
Mandibular arteriovenous malformation treated by transvenous coil embolization: a long-term follow-up with special reference to bone regeneration
J Oral Maxillofac Surg
Immediate and late mandibular fractures after third molar removal
J Oral Maxillofac Surg
Mandibular fractures following third molar extraction: a retrospective clinical and radiological study
Int J Oral Maxillofac Surg
Mandibular fracture after third molar removal
J Oral Maxillofac Surg
Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach
J Oral Maxillofac Surg
A simple retrieval technique for accidentally displaced mandibular third molars
J Oral Maxillofac Surg
Accidental third molar displacement into the lateral pharyngeal space
J Oral Maxillofac Surg
Accidental displacement of an impacted mandibular third molar into the lateral pharyngeal space
J Oral Maxillofac Surg
Accidental displacement of a lower third molar: report of a case in the lateral cervical position
Oral Surg Oral Med Oral Pathol
Oroantral communication: epicritical study of 175 patients, with special concern to secondary operative closure
Int J Oral Surg
Clinically significant oroantral communications: a study of incidence and site
Int J Oral Maxillofac Surg
Closure of oroantral communications using a pedicled buccal fat pad graft
J Oral Maxillofac Surg
Treatment of a persistent oro-antral fistula with a posteriorly based lateral tongue flap
Int J Oral Surg
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