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What are some common mistakes that dentists make when performing surgical extractions?

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Surgical extractions involve the removal of a tooth after elevation of a soft tissue flap, removal of bone with or without sectioning of the tooth. At times, surgical extractions may be less traumatic and more conservative than non-surgical extractions.

However, there also instances when surgical extractions may not proceed as planned. Some common mistakes that are made during these procedures are listed below.

  1. Even after evaluation of the tooth and the determination that a surgical extraction is indicated, dentists may still try to use forceps to remove the tooth. This can result in coronal fractures which may be helpful in establishing a purchase point, unnecessary or excessive trauma to the surrounding tissues, as well as patient fatigue.
  1. Poor flap design will also compromise the ease of extracting the tooth but may lead to complications such as delayed wound healing, damage to the soft tissue (papilla), wound necrosis and dehiscence and periodontal defects.
  1. Flap reflection is necessary for the clinician to visualize and access the surgical site. Inadequate reflection, therefore, can result in soft tissue tears and increased tension on the flap itself.
  1. The sequelae of using uncontrolled forces during an extraction includes tooth fracture which may complicate the extraction further or fracture and damage to the adjacent bone.
  1. Appropriate selection of the forceps such that the beaks are adapted well to the anatomy of the tooth is just as important as seating the forces as apically as possible during an extraction. The beaks should be parallel to the long axis of the tooth to ensure that the forces are delivered in the same direction to expand the bone.
  1. When removing root tips, ensure there is good visibility and access to the surgical site. When required, additional flap reflection and/or bone removal may be helpful.
  1. Irrigation of the surgical site is important to maintain visibility and to remove debris effectively. In the long run, this will help prevent any post-operative infection.
  1. Flap reapproximation aids in the prevention of wound necrosis, periodontal defects as well as delayed healing. Appropriate suture techniques will also ensure the flap is held in place with the correct amount of tension.

Source: Manual of Minor Oral Surgery for the General Dentist, Wiley, 2006

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