Re: New qiestion-Extraction of UR5

[Guest guest]

>

> The patient presents requesting removal of a painful # UR5(close to antrum)

>

> How might extraction of this tooth be complicated?

> How should this be managed?

> What symptoms may indicate that this management has failed?

> Lyudmyla

> Huhley

>

Lyuda,please, could you explain what does the abbreviationn " #UR5 " means?I'd

like to understand this exactly.Let me guess--maybe it means " upper radix 5 " ??

[Guest guest]

Hi Viktoria

It is Upper right 5LyudmylaHuhley

From: Viktoriia <dentist_8406@...>Subject: Re: New qiestion-Extraction of UR5 Date: Wednesday, 3 March, 2010, 20:25

>> The patient presents requesting removal of a painful # UR5(close to antrum)> > How might extraction of this tooth be complicated? > How should this be managed? > What symptoms may indicate that this management has failed? > Lyudmyla> Huhley> Lyuda,please, could you explain what does the abbreviationn "#UR5" means?I'd like to understand this exactly.Let me guess--maybe it means "upper radix 5"??

[Guest guest]

> 1)>>>The main complication-- an oroantral fistula can occur.Quote from the book:"To confirm the presence of an OAF(oroantral fistula) the patient can be asked to pinch the nostrilstogether and blow air gently into the nose. The operatorcan then hold cotton wool in tweezers under the socketand look for movement of the fibres. Sometimes, theblood in the socket can be observed to bubble or the noiseof the air moving through the fistula can be detected.Some operators favour inspection of the socket withgood lighting and efficient suction using a blunt probe toexplore the integrity of the socket. The noise of thesuction often becomes more resonate if a communicationexists between socket and sinus.

Management:Once confirmed, an OAF can be treated in two ways:if small, the socket can be sutured and a haemostaticagent such as Surgicel® can be used to encourage clotformation. Strict instructions should be given to avoidnose blowing because this can increase the intrasinuspressure and break-down the early clot that covers thedefect. The patient should be prescribed an antibioticbecause of the risk of infection, which would prevent thesinus healing and lead to a chronic oroantral fistula. Thepatient should be reviewed 1 week later to check progressand then 1 month later to ensure that the socket hashealed.If the OAF is large then it should be closed immediatelyby means of a surgical flap. Most commonlythis is done by means of a buccal advancement flap. Thisis a U-shaped flap with vertical relieving incisions takenfrom the mesial and distal margins of the socket. The flapis mucoperiosteal, which means that the periosteum lieson its inner aspect. Periosteum is a thin sheet of osteogenicsoft tissue that has no elasticity and must thereforebe incised to allow the whole flap to be advanced to thepalatal margin of the socket.The incision ismade horizontally along the whole length of the base ofthe flap; it need not be deep because the periosteum isrelatively thin. Some surgeons reduce the height of thebuccal plate of bone to reduce the length of the advance.Horizontal mattress sutures encourage wound margineversion and aid primary healing. A prophylacticantibiotic would normally be prescribed and the patientasked to avoid nose-blowing.2)>>>Another complication involving the antrum is pushingpart or all of a tooth into the antral cavity.Management: "Normally the operator should arrange for the removal of this root as the patient is again at risk of the development of maxillarysinusitis with or without an oroantral fistula. The patientshould have radiographs taken to confirm the presence of the root in the antrum and the operator should then raisea buccal flap from the mesial and distal margins of thesocket. Access to the antrum should then be increased bybone removal with bone nibblers and drills. The root canthen be removed from the antrum by a variety of techniquesincluding suction, the use of small caries excavatorsor direct removal by tweezers. If these methodsare unsuccessful then the antrum can be flushed-out withsterile saline in an attempt to 'float' the root out, or theantrum can be packed with ribbon gauze, which mightdislodge the root when it is removed. Once the root hasbeen removed from the antrum, the resulting defectshould be closed with a buccal advancement flap, as inthe closure of an oroantral fistula."------------------------------------------------------------------------

Unilateral odontogenic maxillary sinusitis will be the result --if the complicat.management failed