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Acute Alveolar Osteitis

Acute Alveolar Osteitis. Dr Ashraf Abu Karaky Assistant Professor Faculty of Dentistry The University of Jordan. Synonyms. Dry socket Fibrinolytic alveolitis Dry alveolagia Necrotic socket Postoperative Osteitis. Definition. Earliest sign of infection of the alveolar bone.

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Acute Alveolar Osteitis

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  1. Acute Alveolar Osteitis Dr Ashraf Abu Karaky Assistant Professor Faculty of Dentistry The University of Jordan

  2. Synonyms • Dry socket • Fibrinolytic alveolitis • Dry alveolagia • Necrotic socket • Postoperative Osteitis

  3. Definition • Earliest sign of infection of the alveolar bone. - if not treated properly, might spread: • soft tissue; Cellulites • bone; Osteomyelitis

  4. Pathogeneses • Blood clot lost secondary to transformation of plasminogen to plasmin with subsequent lyses of fibrin and formation of kinins • Local trauma, estrogens and bacterial pyrogens are known to stimulate fibrinolysins.

  5. Incidence • 3-5% of extraction cases, more after impacted third molars (up to 30% in some studies) • Age: 20-40 yrs when most teeth are extracted although > 40-45 age group • F>M • Mandible>Maxilla • Posterior > Anterior

  6. Signs & Symptoms • Severe Neuralgic Pain starts in the 1st 24-48hrs. • Bad taste and smell • Socket wall is extremely tender • Empty socket and exposed bone or grayish/yellowish tissue. • Less frequently; swelling and lymphadenopathy after 3-4 days of extraction • S & S may last from 10-40 days.

  7. Radiology

  8. Etiology Unknown Multifactorial; decrease vascularity trauma infection fibrinolysis

  9. Predisposing Factors • Decrease vascularity • Trauma • Infection • Smoking • Contraceptive pills • Higher risk in patients with history of alveolar osteitis

  10. Decrease vascularity - massive use of LA - anatomical considerations - general conditions; systemic conditions that increase bone density - chronic infection

  11. Trauma: - Traumatic extraction - thermal trauma - excessive curettage

  12. Infection - sterility - Recurrent pericorinitis - foreign body - systemic

  13. Management • RG • Irrigation with warm saline • Inspection of the socket • Curettage is not advised • Socket is packed with obtundent and antiseptic dressing. • Pain killers • Antibiotics if needed

  14. Preventive measures • Control local and systemic factors of infection • L A • Proper postoperative instructions • Females on contraceptive pills • Intraoperative irrigation • Antimicrobial rinses before and after extraction • Systemic antibiotics or topical antibiotics for high risk patients.

  15. Periapical Surgery Chapter 17 Peterson

  16. The American Association of Endodontists defines Apicectomy as: The excision of the apical portion of the tooth root and attached soft tissue during periradicular surgery.

  17. History The first cases of endodontic surgery were those performed by abulcasis in the 11th century. Root end resection with retrograde (root end) cavity preparation and filling with amalgam was documented in 1871. Some researchers claim Claude Martin as the inventor of root end resection in 1881.

  18. Indications for Apicectomy • Anatomic problems preventing complete debridement/obturation • Restorative considerations that compromise treatment • Horizontal root fracture with apical necrosis • irretrievable material preventing canal treatment or re-treatment • Procedural errors during treatment • Large periapical lesions that do not resolve with root canal treatment • Need for biopsy

  19. Contra-indications • Unidentified cause of root canal ttt failure • When conventional RCT is possible • Anatomic structures • compromise of crown/root ratio • Medical systemic complications

  20. Technique • Access flap • Apical curettage • Apicectomy • Retrograde root filling

  21. Access flap Mucoperiosteal flap • Full mucoperiosteal flap • Semi lunar flap • Submarginal flap

  22. Apical curettage • Infected tissue • Granulation tissue • Cystic tissue Histopathology

  23. Apicectomy Section of the root apex • With anterior bevel or without? • How much apex to remove? - As much root as possible should remain to deal with occlusal loads - Apical root should be removed (potential for lateral canals) - Extent of apical pathology - Not to expose any post within the canal

  24. Retrograde Filling Provides Apical Seal Cavity preparation Types of fillings: • Amalgam • Super EBA (ortho ethoxy benzoic acid) • IRM • MTA (mineral trioxide aggregate)

  25. “Super EBA and IRM have higher success rate than amalgam.”J Endodontics 1990;16:391-393 • “root end filled with MTA has a complete layer of cementum over the root end following healing and no evidence of inflammation”J Endodontic 1995; 21: 603-608

  26. Success rate • Success rate range from 34%-99% • Mean 82.5% • Best success rate when apicectomy is performed at the same visit with the root filling. • Repeat surgery has a lower success rate (about 35%).

  27. Complications • Failure • Trauma to adjacent roots • Trauma to vital structures • Inflammatory reaction to amalgam retrograde filling • Apex dislodgment

  28. Thank you

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