Fracture of Adjacent Restoration
The most common injury to adjacent teeth is the inadvertent fracture of either a restoration or a severely carious tooth while the surgeon’ is attempting to luxate the tooth to be removed with an elevator (Fig. 11-5). If a large restoration exists, the surgeon should warn the patient preoperatively about the possibility of fracturing it during the extraction. Prevention of such a fracture is primarily achieved by avoiding application of instrumentation and force on the restoration (Box 11-3). This means that the straight elevator should be used with great caution or not used at all to luxate the tooth before. extraction. If a
Prevention of Injury to Adjacent Teeth
1. Recognize potential to fracture large restoration.
2. Warn patient preoperatively.
3. Employ judicious use’ of elevators.
4. Ask assistant to warn surgeon of pressure on adjacent teeth. .
restorat ion is dislodged or ,fractured, the surgeon should make SlITt’ that the ‘displaced restoration is removed from, the mouth and does not fall into the empty tooth socket. Once the surgical p.!..ocedure has been completed, ‘the injured tooth should be treated by placement of a temporary restoranon. The patient should be informed that , the fracture has occurred and that a replacement restoration must be placed (see Chapter 12). . • Teeth in the opposite arch may also be injured as a ‘ result of uncontrolled tractional forces. This usually occurs when buccolingual forces inadequately mobilize a tooth and excessive tractional forces are used. The tooth suddenly releases from the socket, and the forceps strikes
against the teeth of the opposite arch and chips or fractures a cusp. This is ‘more likely to occur with extraction of lower teeth, because these teeth may require more vertical tractional forces for their delivery, especially when using the no. 23 (cowhorn) forceps. Prevention of this type of injury can be accomplished by several methods. First and primary, the, surgeon should avoid the use of excessive tractional forces. The tooth should be, adequately luxated with apical, buccolingual, and rotational forces to minimize the need for tractional forces. Even when this is done, however, occasionally a tooth releases unexpectedly. The surgeon or assistant should
protect the teeth of the opposite arch by simply holding a finger or suction tip against them to absorb the blow should the forceps be released in that direction. If such an injury occurs, the tooth should be smoothed or restored as necessary to keep the patient comfortable until a permanent
restoration can be constructed.