41
Volume3 Issue3
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S
upporting
Y
our
P
ractice
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How tomanage
TUBEROSITYFRACTUREDURING
EXTRACTION
Point ofCare
Tuberosity fractureduringextraction
Sudden, intra-operative fracture ofmaxillary tuberosity during
uppermolar extraction.
Presentation
Commonsiteofoccurrence
Upper thirdmolars
Risk factors
•
Dental anatomycharacteristicsor anomalies: longor bulbous roots,
hypercementosis,multi-rooted teeth, lone standinguppermolars, and
highlypneumatizedalveolus
•
Pathoses: sinusdisease, odontogeniccysts, periapical infection, ankylo-
sis, osteoporosis andalveolar atrophyor, conversely, verydensebone
•
Elevator use, particularly largeelevators andelevatorsusedas levers,
rather than ina rotary fashion
Special considerations
•
Special considerations shouldbegiven to systemicallycompromised
patients: thosewhohavediabetes, are immunosuppressedorwitha
weakened immune system (e.g., due tochemotherapyorHIV), have
beenpreviously radiated, suffer from renal disease, or takebisphospho-
nates for osteoporosisormetastaticmalignant disease.
Signs
•
Crunchor loudcrackof bonebreaking
•
Sudden looseningof the toothandbone together,with segment still
attached to soft tissue
•
Bonecomes awaywith toothduringextraction
•
Observableopening into themaxillary sinus: visibleholeor “hollow”
soundwhen suctioning the socket
Symptoms
•
Patientmaycomplainof sharppainat the timeof fractureormaybe
completelyasymptomatic.
•
If sinusperforationhasoccurredanddiagnosis isdelayed, thepatient
maycomplainof refluxof fluids frommouth tonose, sinus stuffiness, or
presentwithovert sinusitis.
Investigation
Confirmclinical suspicionof fractureandassessdisplacement
•
Gently, withminimal force andmovement, assess thedegreeof
mobility across the suspected fracture site. Determine the sizeof the
DentalEmergency
Scenario
HenryLapointe
DDS,PhD,FRCD(C)
Dr. Lapointe is professor
and chair, division of oral
andmaxillofacial surgery,
andassistant director
of postgraduate studies,
SchulichSchool ofMedicine
andDentistry, London,
Ontario.
Henry.Lapointe@
schulich.uwo.ca
Theauthorhasnodeclaredfinancial
interests.
Thisarticlehasbeenpeerreviewed.
