Luxation of Adjacent Teeth
Inappropriate use of the extraction instruments may luxate the adjacent tooth. This is prevented by [udicious use of force with elevators and orceps. If the tooth to been extracted is’ crowded and has overlapping adjacent teeth, such as is commonly seen in the mandibular incisor region, intn, narrow forceps such as the no, 2H6 forceps, may be useful for the extraction (Fig. 11-6). Forceps with broader beaks .should be avoided, because it will cause injury and luxation of the adjacent teeth. If an adjacent tooth is luxated or partially avulsed, the treatment goal is to reposition the tooth “into its appropriate position and stabilize it so that adequate healing occurs. This usually requires that the tooth simply be repositioned in the tooth socket and left alone. The occlusion should be checked to ensure that the tooth has not been displaced into a hypererupted and traumatic occlusion. Occasionally, the luxated tooth is very mobile. If this is the case, the tooth should be stabilized with the least possible rigid fixation to maintain the tooth in its position. A simple silk suture that crosses the occlusal table and is sutured to the adjacent gingiva is usually sufficient. Rigid fixation with circumdental wires and, arch bars results in increased chances for external toot resorption and ankylosis of the teeth: therefore it , should usually be avoided (see Chapter 23):
Prevention of Extraction of Wrong Teeth
1. Focus attention on procedure.
2. Enlist patient and assistant to ensure correct tooth is , being removed.
3. Check, then recheck, to confirm correct tooth.
tists have asked for unusual extractions. Careful preoperative planning and clinical assessment of which’ tooth is to be removed before the forceps is applied is the main method of preventing this complication (Box 11-4). If the wrong tooth is extracted anq the dentist realizes this error immediately, the tooth should be replaced , immediately into the tooth socket. If the extraction is for orthodontic purposes, .the dentist should contact the orthodontist immediately and discuss whether or not the tooth that was removed can substitute for the. tooth that: should have been removed, If the orthodontist believes the original tooth must be removed, the correct extraction should be deferred for 4 or 5 weeks, until the fate of the replanted tooth can be assessed. If the wrongfully extract- ‘ed tooth has regained its attachment to the alveolar process, then’ the originally planned extraction can proceed. The surgeon should not extract the contralateral
tooth until a definite alternative treatment plan is made. If the surgeon does not recognize that the wrong tooth was extracted until the patient returns for a postoperative visit, little can be done to correct the problem. Replantation -of the extracted tooth after it has dried cannot-be .successfully accomplished. When the wrong tooth is extracted, it is important to inform the patient, the patient’s parents (if the patient is a minor), and any other dentist involved with the patient’s care, such as the orthodontist. In some situations the orthodontist may’ be able to adjust the treatment plan so that extraction of the wrong tooth necessitates only a minor adjustment.